Proactive Planning for Vascular Access Therapy: One Hospital's Plan for Success

2014 ◽  
Vol 19 (4) ◽  
pp. 238-243 ◽  
Author(s):  
Maria Victoria A. deCastro ◽  
Laura J. Eades ◽  
Sylvia A. Rineair ◽  
Pamela J. Schoettker
Keyword(s):  
Vascular Access ◽  
Neonatal Intensive Care ◽  
Wait Time ◽  
Neonatal Intensive Care Units ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Patient Acuity ◽  
Average Wait Time ◽  
Charge Nurses ◽  
Care Processes

Abstract Background: Vascular access is a critical component of care for patients in neonatal intensive care units (NICUs). Our NICU had only a small number of nurses cross-trained to perform peripherally inserted central catheter (PICC) insertions and was not able to provide coverage 24 hours a day, 7 days a week. We combined the vascular access team (VAT) and NICU PICC team to improve the timeliness of NICU PICC insertions, standardize care, and use ultrasound for all PICC placements. Methods: A paper guide tool was developed to prioritize PICC placements as emergent, same-day, or nonemergent. NICU nurses were trained to insert PICCs using ultrasound. Catheter insertion and care processes were standardized for the new centralized PICC team. NICU and VAT staff worked together to improve daily communication, hand-offs, and referrals. Criteria were developed to determine the appropriate hospital location for PICC insertions. Charge nurses began capturing information about patients with PICCs on daily planning sheets. Results: Following implementation of the new combined VAT, the average wait time for emergent and same-day insertions decreased 10%. No adverse events were reported due to a delay in PICC placement or the PICC referral process. Conclusions: Combining the NICU PICC insertion nurses and the VAT into a new centralized PICC team provided an opportunity for growth in both areas. NICU PICCs are now placed efficiently based on patient acuity and referral prioritization throughout the hospital. NICU and VAT physicians and nurses have developed a strong partnership for the provision of PICC services for NICU patients.

scholarly journals Cateter central de inserção periférica: práticas de enfermeiros na atenção intensiva neonatal

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Higor Pacheco Pereira ◽  
Débora Maria Vargas Makuch ◽  
Junia Selma Freitas ◽  
Izabela Linha Secco ◽  
Mitzy Tannia Reichembach Danski
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Insertion Site ◽  
Neonatal Intensive Care Units ◽  
Positive Pressure ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Venous Catheterization ◽  
Reference Hospital ◽  
Terapia Intensiva

Objetivo: Identificar o conhecimento dos enfermeiros quanto à inserção e manutenção do cateter central de inserção periférica em uma Unidade de Terapia Intensiva Neonatal. Método: Estudo exploratório descritivo quantitativo realizado em um hospital pediátrico de referência em maio e junho de 2019. Análise dos dados por meio do programa SPSS (21.0). Resultados: Setenta e oito por cento dos enfermeiros receberam capacitação na instituição, 100,0% realizam lavagem do acesso com solução salina, pressão positiva e técnica pulsátil e todos consideram como pontos críticos o eritema, algia, secreção no local de inserção e obstrução do dispositivo. Conclusão: O papel do enfermeiro é fundamental na diligência com o cateter central de inserção periférica, atuando como educador da equipe de enfermagem para promover a qualificação e adesão aos protocolos institucionais continuamente.Descritores: Recém-nascido; Cateterismo venoso central; Unidades de terapia intensiva neonatal; Enfermagem neonatal.Peripherally inserted central catheter: nursing practices in neonatal intensive careObjective: To identify nursing knowledge regarding the insertion and maintenance of the peripherally inserted central catheter in a Neonatal Intensive Care Unit. Method: Exploratory descriptive quantitative study carried out in a pediatric reference hospital in May and June 2019. Data analysis using the SPSS program (21.0). Results: Seventy-eight percent of nurses received training at the institution, 100.0% performed access flushing with saline, positive pressure and pulsating technique and all considered as critical points erythema, pain, secretion at the insertion site and obstruction of the device. Conclusion: The role of the nurse is fundamental in the diligence with the peripherally inserted central catheter, acting as an educator of the nursing team to promote qualification and adherence to institutional protocols continuously.Descriptors: Newborn; Central venous catheterization; Neonatal intensive care units; Neonatal nursing.Catéter central insertado periféricamente: prácticas de enfermería en cuidados intensivos neonatalesObjetivo: identificar el conocimiento de las enfermeras sobre la inserción y el mantenimiento del catéter central insertado periféricamente en una unidad de cuidados intensivos neonatales. Metodo: estudio cuantitativo descriptivo exploratorio realizado en un hospital pediátrico de referencia en mayo y junio de 2019. Análisis de datos con el programa SPSS (21.0). Resultados: el setenta y ocho por ciento de las enfermeras recibieron capacitación en la institución, el 100.0% realizó enrojecimiento de acceso con solución salina, presión positiva y técnica pulsante y todos se consideraron puntos críticos como eritema, dolor, secreción en el sitio de inserción y obstrucción del dispositivo Conclusión: El papel de la enfermera es fundamental en la diligencia con el catéter central insertado periféricamente, actuando como un educador del equipo de enfermería para promover la calificación y el cumplimiento de los protocolos institucionales continuamente.Descriptores: Recién nacido; Cateterismo venoso central; Unidades de cuidados intensivos neonatales; Enfermería neonatal.

scholarly journals The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns

2015 ◽  
Vol 23 (3) ◽  
pp. 475-482 ◽  
Author(s):  
Priscila Costa ◽  
Amélia Fumiko Kimura ◽  
Debra Huffman Brandon ◽  
Eny Dorea Paiva ◽  
Patricia Ponce de Camargo
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Neonatal Intensive Care ◽  
Operating Characteristic ◽  
Bivariate Analysis ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Single Lumen ◽  
Double Lumen Catheter ◽  
Lumen Catheter

OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns.METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve.RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points), moderate (4 to 8 points), and high (≥ 9 points). Accuracy was 0.76.CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.

scholarly journals P012: Why did you leave? Contacting left without being seen patients to understand their emergency department experience

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S61-S61
Author(s):  
B. Brar ◽  
J. Stempien ◽  
D. Goodridge
Keyword(s):  
Health Care ◽  
Wait Time ◽  
Wait Times ◽  
Average Wait Time ◽  
Left Without Being Seen ◽  
Care Processes ◽  
Time Period ◽  
Initial Interaction ◽  
Improving Health Care

Introduction: As experienced in Emergency Departments (EDs) across Canada, Saskatoon EDs have a percentage of patients that leave before being assessed by a physician. This Left Without Being Seen (LWBS) group is well documented and we follow the numbers closely as a marker of quality, what happens after they leave is not well documented. In Saskatoon EDs, if a CTAS 3 patient that has not been assessed by a physician decides to leave the physician working in the ED is notified. The ED physician will: try to talk to the patient and convince them to stay, can assess the patient immediately if required, or discuss other appropriate care options for the patient. In spite of this plan patients with a CTAS score of 3 or higher (more acute) still leave Saskatoon EDs without ever being seen by a physician. Our desire was to follow up with the LWBS patients and try to understand why they left the ED. Methods: Daily records from one of the three EDs in Saskatoon documenting patients with a CTAS of 3 or more acute who left before being seen by a physician were reviewed over an eight-month period. A nurse used a standardized questionnaire to call patients within a few days of their ED visit to ask why they left. If the patients declined to take part in the quality initiative the interaction ended, but if they agreed a series of questions was asked. These included: how long they waited, reasons why they left, if they went somewhere else for care and suggestions for improvement. Descriptive statistics were obtained and analyzed to answer the above questions. Results: We identified 322 LWBS patients in an eight-month time period as CTAS 3 or more acute. We were able to contact 41.6% of patients. The average wait time was 2 hours and 18 minutes. The shortest wait time was 11 minutes, whereas the longest wait time was 8 hours and 39 minutes. It was found that 49.1% of patients went to another health care option (Medi-Clinic or another ED in Saskatoon) within 24hrs of leaving the ED. Long wait times were cited as the number one reason for leaving. Lack of better communication from triage staff regarding wait time expectations was cited as the top response for perceived roadblocks to care. Reducing wait times was cited as the number one improvement needed to increase the likelihood of staying. Conclusion: The Saskatoon ED LWBS patient population reports long wait times as the main reason for leaving. In order to improve the LWBS rates, improving communication and expectations regarding perceived wait times is necessary. The patient perception of the ED experience is largely intertwined with wait times, their initial interaction with triage staff, and how easily they navigate our very busy departments. Therefore, it is vital that we integrate the patient voice in future initiatives geared towards improving health care processes.

Peripherally inserted central catheter placement in a multidisciplinary intensive care unit: A preliminary study demonstrating safety and procedural time in critically ill subjects

2020 ◽  
pp. 112972982092861
Author(s):  
Ryan J Smith ◽  
Rodrigo Cartin-Ceba ◽  
Julie A Colquist ◽  
Amy M Muir ◽  
Jeanine M Moorhead ◽  
...  
Keyword(s):  
Critically Ill ◽  
Vascular Access ◽  
Critically Ill Patients ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Time Required ◽  
Central Catheters

Objective: Peripherally inserted central catheters are a popular means of obtaining central venous access in critically ill patients. However, there is limited data regarding the rapidity of the peripherally inserted central catheter procedure in the presence of acute illness or obesity, both of which may impede central venous catheter placement. We aimed to determine the feasibility, safety, and duration of peripherally inserted central catheter placement in critically ill patients, including obese patients and patients in shock. Methods: This retrospective cohort study was performed using data on 55 peripherally inserted central catheters placed in a 30-bed multidisciplinary intensive care unit in Mayo Clinic Hospital, Phoenix, Arizona. Information on the time required to complete each step of the peripherally inserted central catheter procedure, associated complications, and patient characteristics was obtained from a prospectively assembled internal quality assurance database created through random convenience sampling. Results: The Median Procedure Time, beginning with the first needle puncture and ending when the procedure is complete, was 14 (interquartile range: 9–20) min. Neither critical illness nor obesity resulted in a statistically significant increase in the time required to complete the peripherally inserted central catheter procedure. Three (5.5%) minor complications were observed. Conclusion: Critical illness and obesity do not delay the acquisition of vascular access when placing a peripherally inserted central catheter. Concerns of delayed vascular access in critically ill patients should not deter a physician from selecting a peripherally inserted central catheter to provide vascular access when it would otherwise be appropriate.

scholarly journals Direct cost of peripheral catheterization by nurses

2019 ◽  
Vol 72 (1) ◽  
pp. 88-94
Author(s):  
Ana Beatriz Mateus Pires ◽  
Antônio Fernandes Costa Lima
Keyword(s):  
Direct Cost ◽  
Neonatal Intensive Care ◽  
Participant Observation ◽  
Single Case ◽  
Unit Cost ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Cost Of Materials ◽  
The Cost ◽  
Nursing Professionals

ABSTRACT Objective: To measure the average direct cost of peripherally inserted central catheterization performed by nurses in a pediatric and neonatal intensive care unit. Method: A quantitative, exploratory-descriptive, single-case study, whose sample consisted of the non-participant observation of 101 peripherally inserted central catheter procedures. The cost was calculated by multiplying the execution time (timed using a chronometer) spent by nursing professionals, participants in the procedure, by the unit cost of direct labor, added to the cost of materials, drugs, and solutions. Results: The average direct cost of the procedure was US$ 326.95 (standard deviation = US$ 84.47), ranging from US$ 99.03 to US$ 530.71, with a median of US$ 326.17. It was impacted by material costs and the direct labor of the nurses. Conclusion: The measurement of the average direct cost of the peripherally inserted central catheter procedure shed light on the financials of consumed resources, indicating possibilities of intervention aiming to increase efficiency in allocating these resources.

Entrapped peripherally inserted central catheter due to fibrin sheath in a neonate with noninvasive extraction and review of literature

2021 ◽  
pp. 1-4
Author(s):  
J.L. Ruikka ◽  
C. Acun ◽  
S. Karnati
Keyword(s):  
Neonatal Intensive Care ◽  
Surgical Intervention ◽  
Rare Complication ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Review Of Literature ◽  
Line Placement ◽  
Fibrin Sheath ◽  
Sheath Formation

Peripherally inserted central catheter line entrapment is a rare complication in the neonatal intensive care unit and only a small number of cases have been reported. While studies have suggested recommendations for removal, there is still a need for surgical intervention in some cases. This is a case of a premature infant with long term peripherally inserted central catheter line placement with fibrin sheath formation that required multiple attempts before successful noninvasive removal and a review of the cases with difficult peripherally inserted central catheter removal in newborns.

Letters

2008 ◽  
Vol 27 (6) ◽  
pp. 427-427
Author(s):  
Lee Shirland
Keyword(s):  
Vascular Access ◽  
Great Risk ◽  
Skin Closure ◽  
System State ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Vascular Access Devices ◽  
Dressing Change ◽  
Central Catheters

I am writing concerning an article titled “Neonatal Peripherally Inserted Central Catheters: Recommendations for Prevention of Insertion and Postinsertion Complications,” published in Vol. 27, No. 4 (July/August 2008), pages 245– 257. Of concern are Figures 3 and 4 on page 253 titled securing the catheter with adhesive skin closure strips and looping the catheter. The instructions and pictures demonstrate how to secure the catheter using skin closure strips and show the strips placed over the catheter. This is of great concern. The manufacturer’s recommendations on BD L-Cath System state the following on page 8 line 26, “Secure the catheter and dress the site with a sterile dressing. Tapes and securing devices should never be applied directly to the non-protected catheter.” This caution is echoed in the article titled “Tiny Patients, Tiny Dressings: A Guide to Neonatal PICC Dressing Change,” published in Advances in Neonatal Care, Vol. 8, No. 3, pages 141–162. The author states the following, “Some hospitals use skin closure strips. If these are utilized, manufacturer’s recommendations should be followed, and they should never be placed directly overlying the catheter to avoid catheter breakage and embolism.” The author supports this statement with the following reference, Frey AM. PICC complications in neonates and children. Journal of Vascular Access Devices. 1999: 17–26. It is clear that skin closure strips used to secure the peripherally inserted central catheter pose great risk and must never be applied directly over the catheter. Thank you for sharing this important information with your readers.

scholarly journals Association of Patient Acuity and Missed Nursing Care in U.S. Neonatal Intensive Care Units

2018 ◽  
Vol 77 (5) ◽  
pp. 451-460 ◽  
Author(s):  
Eileen T. Lake ◽  
Douglas O. Staiger ◽  
Emily Cramer ◽  
Linda A. Hatfield ◽  
Jessica G. Smith ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Parent Education ◽  
Nursing Care ◽  
Neonatal Intensive Care ◽  
Work Environments ◽  
National Database ◽  
Neonatal Intensive Care Units ◽  
Patient Acuity ◽  
Missed Care

The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study of missed care in a U.S. NICU sample adds national scope and an important explanatory variable, patient acuity. Using 2016 NICU registered nurse survey responses ( N = 5,861) from the National Database of Nursing Quality Indicators, we found that 36% of nurses missed one or more care activities on the past shift. Missed care prevalence varied widely across units. Nurses with higher workloads, higher acuity assignments, or in poor work environments were more likely to miss care. The most common activities missed involved patient comfort and counseling and parent education. Workloads have increased and work environments have deteriorated compared with 8 years ago. Nurses’ assignments should account for patient acuity. NICU nurse staffing and work environments warrant attention to reduce missed care and promote optimal infant and family outcomes.

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