Journal of Infusion Nursing最新文献

This randomized controlled crossover study, conducted in a university hospital, aimed to compare the success of the first attempt at peripheral intravenous catheter (PIVC) insertion using 2 technologies of the visualization of veins in children at risk of difficult intravenous access (DIVA) guided by light-emitting diodes (LEDs) or infrared radiation (IR). The allocation of the type of technology initially used was determined by randomization. The primary outcome was successful insertion of the PIVC on first attempt. Data were analyzed using the McNemar test, paired t-test, and multiple logistic regression models. This crossover study included 143 children: 69 in Group A and 74 in Group B. The first-attempt PIVC insertion success rate with IR and LED was 65.2% and 44.9% in Group A and 55.4% and 50.0% in Group B, respectively, without statistical significance (P = .720). The results also showed that 51.5% of patients with difficult-to-see vessels (P = .022) and 49.8% with previous complications related to intravenous therapy (P = .008) had first-attempt PIVC insertion success using either transillumination device. The first-attempt PIVC insertion success was statistically similar between the groups. The device also assists in visualizing the veins in children at risk of DIVA.

The purpose of this research is to describe the factors affecting hazardous chemotherapy exposure and strategies to foster chemotherapy safety among oncology nurses. Fifteen oncology nurses and 5 oncology nurse managers were recruited from 2 medical centers in the Midwest United States through convenience purposive sampling. A qualitative descriptive approach was employed. Semi-structured interviews were conducted with the participants and analyzed using the content analysis method. Five main themes emerged: (1) description of chemotherapy exposure incidents, (2) nurse's personal health beliefs, (3) cues to adhere to chemotherapy handling guidelines, (4) invisible exposure to chemotherapy, and (5) strategies to promote chemotherapy safety at the workplace. Important strategies that promote chemotherapy safety for nurses are providing continuous education on chemotherapy safety, offering chemotherapy-specific equipment and personal protective equipment in several sizes, promoting nurses' health beliefs toward chemotherapy safety (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and perceived self-efficacy), supporting a culture of safety at the workplace, having policies on handling guidelines and exposure incident reporting, monitoring nurses' adherence to chemotherapy handling guidelines, using hazard labels and alerts, and monitoring chemotherapy contamination on common surfaces in oncology settings. Oncology nurses and nurse managers should be involved in designing strategies that promote nurses' occupational safety.

The aims of this study were to develop a questionnaire on peripheral intravenous catheter (PIVC) maintenance, evaluate its content validity, and assess factors influencing the level of knowledge of nursing professionals regarding best practices.The study was conducted in 3 stages: (1) development of a questionnaire on PIVC maintenance; (2) content validity assessment by experts with assessment of comprehensiveness, relevance, and clarity; and (3) application of the questionnaire to 1493 nursing professionals. Relationships between personal characteristics and knowledge levels were evaluated. The questionnaire score ranged from 0 to 26. The participants obtained a mean score of 13.7 (SD, 2.4). Factors associated with a higher knowledge level included higher educational level, training on PIVC maintenance upon admission, and employment in an institution with recurrent PIVC maintenance training. Gaps in knowledge included the recommended technique for active disinfection, how catheter stabilization should be performed, recommended technique for flushing and minimizing blood reflux into the catheter, appropriate frequency for assessing the insertion site of the catheter, and signs of catheter complications. A questionnaire for assessing knowledge of best practices in PIVC maintenance was developed and had adequate evidence of content validity. Aspects related to greater education were associated with a higher knowledge level. Knowledge gaps were identified.

This study aimed to develop, assess, and test an Objective Structured Clinical Examination (OSCE) to evaluate nurses' competency in planning and managing infusion therapy. The study adopted a methodological approach with a quantitative design and was conducted from December 2020 to August 2021 at a university hospital in São Paulo, Brazil. Data collection occurred in 3 stages: development of scenarios and assessment checklists, evaluation of expert consensus, and testing scenarios with the target audience. Data analysis involved calculating the Modified Kappa coefficient. The OSCE comprised 8 clinical stations, designed based on the theoretical framework of the Vessel Health and Preservation model and the Infusion Therapy Standards of Practice, which delineate evidence-based procedures for vascular access and infusion therapy. During expert assessment and examination testing, all evaluated items demonstrated coefficient values ≥0.74. Thus, the study successfully developed evidence-based OSCE for infusion therapy, showing strong expert consensus. Testing with nurses yielded positive outcomes, affirming the effectiveness of the educational practice's design and structure.

This nurse-led research study investigates the comparative effectiveness of heparin versus 0.9% sodium chloride locking in blood cancer patients with peripherally inserted central catheters (PICCs). Subjects were randomly assigned to receive either heparin or 0.9% sodium chloride locking for up to 7 days. Results show no significant difference in maintaining the PICCs' patency between the 2 locking methods. Additionally, heparin was associated with more side effects, higher costs, and increased nursing time compared to 0.9% sodium chloride. These findings support adopting 0.9% sodium chloride for PICC maintenance in blood cancer patients, aiming to enhance patient safety and reduce costs.

Age-related physiological changes affect various aspects of peripheral intravenous catheter (PIVC) cannulation. However, the characteristics of PIVCs, especially in older patients, have been poorly investigated. In the current cross-sectional observational study, PIVC sizes, PIVC sites, the number of attempts until successful insertion, and the degree of venodilation upon insertion among hospital inpatients aged ≥65 years were investigated, along with measurements of the vessel diameter and depth using ultrasound. In total, 91 PIVC insertions were analyzed. The vessel diameter was estimated to be smaller than that in domestic adult inpatients. Most of the catheters were placed at the ideal site on the first attempt. However, considering the optimal vein-to-catheter ratio, most of the cannulations were oversized and would be oversized even when using a 24-gauge catheter. In addition, obvious differences were found in the vessel diameter, catheter size, and catheter site compared with previous studies conducted outside of Asia. The current study indicates the need for further research on the identification of appropriate veins, and the definition of "appropriate" approaches might vary among countries.

Intravenous pumps (IVPs) deliver IV medications to millions of acute care patients each year and result in many adverse events reported to the US Food and Drug Administration (FDA). Although the use of IVPs has improved overall safety, there are still high rates of error that risk the safety of all patients, especially those of advanced age and those suffering from critical illness. Most of the documented errors are based on clinician reports, although there is reason to believe that errors due to flow rate inaccuracy go undetected and unreported. The purpose of this systematic literature review was to explore literature regarding flow rate accuracy for IVPs used in US acute care medicine. The systematic review was conducted by searching PubMed, CINHAL, and Web of Science. Articles chosen were from any year, written in the English language, and had content pertaining to the use of IVPs and key concepts of interest. Concepts discussed throughout the literature are relevant to the IVPs used for patient care, including outlet pressure, intake pressure, dead volume, and pump setup. This review provides a conceptual overview of what is known about this technology but reveals a gap in knowledge related to actual IVP clinical accuracy.

Health care providers use several types of syringes in their daily routine to provide or safely deliver therapeutic agents to patients. Pump infusion with a syringe (PIS) are used for the rapid delivery of large amounts of fluid or blood to patients in critical conditions, such as hypovolemic shock. Patients often experience bacterial infections, such as catheter-related bloodstream infections, specifically when they are in critical condition in the intensive care unit (ICU) after surgery or undergoing resuscitation in an emergency department. A previous study has shown that PIS may cause intraluminal contamination. This study compared PIS-induced contamination among different types of available syringes, including disposable plastic syringes produced by several companies, glass syringes, and syringes with plastic covers. The authors found that plastic syringes caused approximately equivalent PIS-induced contamination and that glass syringes caused substantially more contamination than plastic syringes. However, syringes equipped with a plastic cover exhibited no contamination. Furthermore, disinfection with ethanol completely prevented PIS-induced contamination. This study supports the evidence that PIS may cause bacterial contamination and that a thorough aseptic technique is needed, especially when using glass syringes. These findings highlight the need to develop alternative devices for rapid infusion.