scholarly journals How to Establish an Effective Midline Program: A Case Study of 2 Hospitals

2015 ◽  
Vol 20 (3) ◽  
pp. 179-188 ◽  
Author(s):  
Nancy Moureau ◽  
Gordon Sigl ◽  
Margaret Hill
Keyword(s):  
Vascular Access ◽  
Venous Access ◽  
Central Line ◽  
Central Venous ◽  
Convenience Sample ◽  
Central Lines ◽  
Team Members ◽  
Hospital Patients ◽  
Difficult Venous Access ◽  
Successful Integration

Abstract Introduction: Establishing an effective midline program involves more than simply learning an insertion technique for a new product. Midline catheters provide a reliable vascular access option for those patients with difficult venous access who would otherwise require multiple venipunctures or the use of higher-risk central lines to maintain access. An effective midline program establishes a protocol for device selection and includes standing orders to facilitate speed to placement. Methods: Our retrospective descriptive review evaluated the successful integration of midline programs into existing vascular access bedside insertion programs in 2 acute care hospitals. The investigator reviewed a convenience sample of hospital patients. Participants in the study included vascular access team managers and team members from the sample sites. Results: The results of this 2-hospital study demonstrate successful integration of a midline program into a bedside insertion program with 0 midline-related infections since initiation. Documentation of overall central line-associated bloodstream infection rates for hospital 1 changed from 1.7/1000 catheter-days to 0.2/1000 catheter-days, reflecting a 78% reduction in infections and a projected cost avoidance of $531,570 annually. Both hospitals demonstrated reduced rates of infection following implementation of a midline program. Conclusions: Midlines have a history of lower risk for both infection and thrombosis compared with central venous devices. Although more research is needed on the more recently developed midline catheters, available evidence suggests that midlines provide a safe and reliable form of vascular access, reducing costs and the risk of infection associated with central venous catheters, especially those placed solely for patients with difficult venous access.

Advanced vascular access

2019 ◽  
pp. 177-190
Author(s):  
Richard Craig
Keyword(s):  
Vascular Access ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Short Term ◽  
Central Lines ◽  
Venous Access Devices

In this chapter, the use of ultrasound to facilitate cannulation of a vessel is described in detail, including commentaries on equipment, preparation, scanning, and needling technique. Equipment and techniques for the insertion of short-term non-tunnelled central lines, long-term central venous access devices, arterial lines, and intraosseous needles are presented.

Puncture Injuries Due to Needles Removed From Intravenous Lines: Should the Source Patient Routinely be Tested for Bloodborne Infections?

1993 ◽  
Vol 14 (6) ◽  
pp. 325-330 ◽  
Author(s):  
Farrin A. Manian ◽  
Lynn Meyer ◽  
Joan Jenne
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Occult Blood ◽  
Central Line ◽  
High Rate ◽  
Central Venous ◽  
Convenience Sample ◽  
Central Lines ◽  
Care Community ◽  
Bloodborne Infections

AbstractObjective:To better assess the risk of exposure to bloodborne pathogens following puncture injuries due to needles removed from intravenous(IV) lines.Setting:Tertiary care community medical center.Patients:A convenience sample of hospitalized patients requiring IV piggy-back medications.Methods:Examination of 501 IV ports of peripheral lines, heparin-locks, and central venous lines for visible blood and testing the residual fluid in the needles removed from these ports for the presence of occult blood by using guaiac-impregnated paper.Results:The proximal ports of central venous lines and heparin-locks were statistically more likely to contain visible blood than proximal and distal ports of peripheral lines (17% and 20% versus 1% and 3% respectively, P<0.05). Similarly, needles removed from proximal ports of central venous lines and heparin-locks were statistically more likely to contain occult blood than those from peripheral lines ( 11% and 14% versus 2%, respectively, P<0.05). Only two needles removed from IV lines without visible blood contained occult blood: one from the proximal port of a central line and another from a heparin-lock. None of the needles from peripheral lines without visible blood contained occult blood.Estimation of the risk of transmission of hepatitis B and C and human immunodeficiency virus (HIV) following injury by needles from various IV lines revealed that injury due to needles removed from peripheral IV lines and distal ports of central lines without visible blood was associated with “near zero” risk of transmission of these bloodborne infections at our medical center.Conclusions:Routine serological testing of source patients involving injury due to needles removed from peripheral IV lines and distal ports of central lines without visible blood is not necessary at our medical center. Conversely, due to the relatively high rate of occult blood in the needles removed from proximal ports of central venous lines and heparin-locks, puncture injuries due to these needles are considered significant and managed accordingly.

scholarly journals PERIPHERAL INOTROPES IN CRITICALLY ILL CHILDREN - IS IT SAFE?

2021 ◽  
Author(s):  
Ravi K Mooli ◽  
K Sadasivam
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Critically Ill Children ◽  
Central Venous ◽  
Middle Income ◽  
Central Lines ◽  
Middle Income Countries ◽  
Peripheral Venous Access ◽  
Vasoactive Medications ◽  
Paediatric Intensive Care Units

ABSTRACTMany children needing paediatric intensive care units care require inotropes, which are started peripherally prior to securing a central venous access. However, many hospitals in low- and middle-income countries may not have access to central lines and the vasoactive medications are frequently given through a peripheral venous access.AimThe aim of our study was to estimate the safety of peripheral vasoactive inotropes in children.MethodsChildren requiring peripheral vasoactive medications were included in this study. We retrospectively collected data at two time points on use and complications of peripheral vasoactive medications.ResultsEighty-four children (51 pre-COVID era and 33 COVID pandemic) received peripheral vasoactive medications. Only 3% of children (3/84) developed extravasation injury, all of whom recovered completely.ConclusionsResults from our study suggest that extravasation injury due to peripheral inotrope infusion is very low (3%) and it can be safely administered in children at a diluted concentration.

Who Should be Involved in the Selection Of Venous Access Devices?

2004 ◽  
Vol 9 (1) ◽  
pp. 41-43
Author(s):  
Cynthia Chernecky ◽  
Katherine Nugent ◽  
Jennifer L. Waller ◽  
Denise Macklin
Keyword(s):  
Decision Making ◽  
Decision Maker ◽  
Vascular Access ◽  
Venous Access ◽  
Decision Making Process ◽  
Convenience Sample ◽  
Vascular Access Devices ◽  
Race And Gender ◽  
And Gender ◽  
Selection Of

Abstract The purposes of this study were to describe who should be involved in the vascular access device (VAD) decision-making process, according to patients and caregivers, and to describe if there were differences associated with persons involved in the selection of VADs according to race and gender. Convenience sample included 32 oncology out-patients and 10 caregivers from the southern United States. There were differences by race and sex in decision-making priorities of patients with vascular access devices indwelling; however, these were not statistically significant. Patients, physicians, and oncology nurses were viewed by both patients and caregivers as significant to the decision-making process. In contrast, caregivers were ranked as the least significant by both patients and caregivers. Females chose the physician as the primary decision-maker while males chose the patient as the primary decision-maker.

Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero

2020 ◽  
Vol 37 (S 02) ◽  
pp. S14-S17
Author(s):  
Stephen A. Pearlman
Keyword(s):  
Quality Improvement ◽  
Central Venous Access ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Central Line ◽  
Central Lines ◽  
The Past ◽  
Healthcare Improvement ◽  
Key Points ◽  
Innovative Techniques

Neonatal infections, including those associated with central lines, continue to be a major cause of morbidity and mortality despite many other improvements in neonatal outcomes. Over the past decades, significant advances have been made to reduce central line-associated bloodstream infections (CLABSIs) using quality improvement methodology. This article will review pertinent studies that used both the Institute for Healthcare Improvement Model for Improvement and other innovative techniques such as orchestrated testing and health care failure mode and effects analysis. These studies, by applying best practices, have demonstrated substantial and sustainable reductions in CLABSI. Some initiatives have been able to achieve rates of zero CLABSI for prolonged periods of time. While neonates often require prolonged central venous access and suffer from impaired immunity which increases the risk of CLABSI, this review demonstrates the journey to zero is feasible. Key Points

scholarly journals Transillumination of palm for peripheral intravenous cannulation in an infant with difficult venous access

2015 ◽  
Vol 2 (1) ◽  
pp. 31-33
Author(s):  
Gentle Sunder Shrestha ◽  
Binita Acharya ◽  
Sushil Tamang
Keyword(s):  
Venous Access ◽  
Venous Cannulation ◽  
Central Venous Cannulation ◽  
Central Venous ◽  
Intravenous Access ◽  
Paediatric Patients ◽  
Difficult Venous Access

Establishing venous access can be technically difficult in paediatric patients. Alternatives to intravenous access like central venous cannulation or venous cutdown carry a higher risk of complications. We report a case of successful intravenous access in an infant with anticipated difficulty, by performing transillumination of palm using a torch light.Journal of Society of Anesthesiologists of Nepal 2015; 2(1): 31-33

Reducing Bloodstream Infection Risk in Central and Peripheral Intravenous Lines: Initial Data on Passive Intravenous Connector Disinfection

2014 ◽  
Vol 19 (2) ◽  
pp. 87-93 ◽  
Author(s):  
Michelle DeVries ◽  
Patricia S. Mancos ◽  
Mary J. Valentine
Keyword(s):  
Bloodstream Infection ◽  
Isopropyl Alcohol ◽  
Central Line ◽  
Infection Risk ◽  
Central Venous ◽  
Central Lines ◽  
Related Risk ◽  
Practice Audit ◽  
Intravenous Catheters ◽  
Central Catheters

Abstract Background: Although few facilities focus on it, bloodstream infection (BSI) risk from peripheral intravenous catheters (PIVs) may exceed central line-related risk. Over a 6-year period, Methodist Hospitals substantially reduced BSIs in patients with central lines but not in patients with PIVs. A practice audit revealed deficiencies in manual disinfection of intravenous connectors, thereby increasing BSI risk. Methodist thus sought an engineered approach to hub disinfection that would compensate for variations in scrubbing technique. Methods: Our institution involved bedside nurses in choosing new hub disinfection technology. They selected 2 devices to trial: a disinfection cap that passively disinfects hubs with isopropyl alcohol and a device that friction-scrubs with isopropyl alcohol. After trying both, nurses selected the cap for use in the facility's 3 intensive care units. After no BSIs occurred during a 3-month span, we implemented the cap throughout the hospital for use on central venous catheters; peripherally inserted central catheters; and peripheral lines, including tubing and Y-sites. Results: Comparing the postintervention period (December 2011-August 2013) to the preintervention span (September 2009–May 2011), the BSI rate dropped 43% for PIVs, 50% for central lines, and 45% overall (PIVs + central lines). The central line and overall results are statistically significant. The PIV BSI rate drop is attributable to cap use alone because the cap was the only new intervention during the postimplementation period. The other infection reductions appear to be at least partly due to cap use. Conclusions: Our institution achieved substantial BSI reductions, some statistically significant, by applying a disinfection cap to both PIVs and central lines.

Vascular Access in Resuscitation

2014 ◽  
Vol 120 (4) ◽  
pp. 1015-1031 ◽  
Author(s):  
Jonathan A. Anson
Keyword(s):  
Vascular Access ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Venous Access ◽  
Central Line ◽  
Attractive Alternative ◽  
Chest Compressions ◽  
Line Placement ◽  
Life Saving

Abstract Intraosseous vascular access is a time-tested procedure which has been incorporated into the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation. Intravenous access is often difficult to achieve in shock patients, and central line placement can be time consuming. Intraosseous vascular access, however, can be achieved quickly with minimal disruption of chest compressions. Newer insertion devices are easy to use, making the intraosseous route an attractive alternative for venous access during a resuscitation event. It is critical that anesthesiologists, who are often at the forefront of patient resuscitation, understand how to properly use this potentially life-saving procedure.

A dedicated consultant-led vascular access team significantly reduces out-of-hours and emergency permanent central venous access insertions

2010 ◽  
Vol 45 (2) ◽  
pp. 419-421 ◽  
Author(s):  
John M. Wells ◽  
Wajid B. Jawaid ◽  
Peter Bromley ◽  
James Bennett ◽  
G. Surren Arul
Keyword(s):  
Vascular Access ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
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