Benefits of the Implementation of the Peripherally Inserted Central Venous Catheter in the Nursing Practices of a Medical Service in Portugal
Benefits of the Implementation of the Peripherally Inserted Central Venous Catheter in the Nursing Practices of a Medical Service in Portugal

Author:

Publisher:

Published: 2017

Total Pages:

ISBN-13:

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Introduction: The incorporation of a new technology for healthcare in nursing practices, such as the peripherally inserted central venous catheter (PICC), requires the acquisition of new knowledge in order to be translated to benefits. These benefits may be for the sake of the patient and the nursing team itself (1-2). In view of implementing PICC in the nursing practices of a medical service in Portugal, research was conducted with the objective of understanding the benefits of implementing PICC in the nursing practice. Method: A qualitative approach using the focal group technique. Five nurses who cared for PICC patients in a medical service in Portugal participated. The interviews of the focus groups were recorded, and transcription and thematic analysis followed. Results: Benefits for the patients: reduction in the number of venous punctures to collect blood for analysis and for the insertion of the peripheral venous catheter (PVC), avoiding pain by replacing the routinely used venous puncture by PICC, less anxiety related to venous puncture and reduction of local complications such as phlebitis and infiltration. Benefits for the nursing team: a decrease in the number of venous puncture attempts to insert the PVC, eliminating patients without venous access on which to administer intravenous treatments thereby reducing stress, reducing time of nursing care in looking for a peripheral venous access and medication administration was performed safely and quickly. Discussion & Conclusion: The selection of the venous catheter in line with scientific evidence and patient characteristics(3) and the acquisition of specific skills through continuing education are factors that favor the implementation of the PICC in nursing practices(4), translating into qualitative benefits for the patients and the nursing team alike.

Peripherally Inserted Central Venous Catheter: an Alternative for Improving the Quality of Nursing Care
Peripherally Inserted Central Venous Catheter: an Alternative for Improving the Quality of Nursing Care

Author:

Publisher:

Published: 2017

Total Pages:

ISBN-13:

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Introduction: Evidence suggests high rates of complications related to the peripheral venous catheter (PVC). Among causes is the administration of irritant/vesicant medicine, with pH u2264 5 or u2265 9 and osmolarity u2265 900 mOsm/L(1-2) . These risk factors are indications for using peripherally inserted central venous catheters (PICC)(3-4). Therefore, their use may be an alternative for improving the outcome of nursing care. However, safely using PICC requires the acquisition of knowledge based on scientific evidence, because care differs from that usually provided to patients with PVC(4). Objective: Analyze the cumulative incidence of complications in Portuguese patients with PICC or PVC after implementing an educational intervention on care with PICC. Method: A theoretical and practical educational intervention with nurses of a service of medicine of Portugal, on care for patients in the insertion, maintenance and monitoring of the PICC. A cohort pilot study was held during 40 consecutive days, in 2016. Patients included were adults: nine patients with PICC and 36 with PVC. Descriptive statistical analysis was performed. Results: Complication in patients with PICC: obstruction (22.2%); PVC: Phlebitis (22.2%), infiltration (38.8%), obstruction (27.7%), accidental removal of the PVC (47.2%), fluid leakage on insertion (36.1%) and pain at the site of insertion (5.5%). Discussion & Conclusion: Permanent education is essential to improve nurses' knowledge of PICC care, and is a strategy to achieve higher levels of qualification and the transformation of practices (5). PICC showed a lower incidence of complications when compared to the PVC, becoming a favorable alternative to improve the quality of nursing care to patients who have a medical indication for PICC. Ensuring the criteria of selection of a venous catheter is essential in order to reduce complications, improve the results of nursing care and promote the patients' well-being (3-4).

Is it Worth Having a Dedicated Infusion Therapy Nurse? Impact on Peripherally Inserted Central Venous Catheter-associated Bloodstream Infections Rates and Costs
Is it Worth Having a Dedicated Infusion Therapy Nurse? Impact on Peripherally Inserted Central Venous Catheter-associated Bloodstream Infections Rates and Costs

Author: Daiane Cais

Publisher:

Published: 2017

Total Pages:

ISBN-13:

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Background: Peripherally inserted central venous catheters (PICC) are increasingly used in healthcare services and bloodstream infections associated to them (PICC-BSI) leads to increased mortality and costs. We aimed to compare direct costs of PICC-BSI in a 300-bed Brazilian Hospital, before and after employing a dedicated infusion therapy nurse (ITN). Methods: After May/2016, a dedicated ITN for adult patients was admitted to perform the following functions: to apply evidence-based indications for vascular access and avoid its potential overuse, ultrasound-guided PICC insertion, nursing staff capacitation in PICC maintenance, patient education and empowerment for catheter care, management of peripheral line indicators. PICC-BSI episodes occurred before (Jan/15 to May/16) and after (Jun/16 to Nov/17) ITN were detected by active surveillance by Infection Control Team, according to National Healthcare Safety Network criteria. PICC-BSI costs were measured considering an extra length of stay and antimicrobial therapy of 7 days, cost of PICC and laboratorial inputs for BSI detection. Values were converted from Brazilian Real to US dollar (quotation updated 02/15/2018). Results: There were 07 PICC-BSI before and 05 after ITN, which correspond to 0.7 and 0.4/1000 PICC-day infection rate respectively (reduction of 43%). After May/2016, there was an increase of 50% in PICC use per patient-day (8% and 12%). The average PICC-BSI direct cost was $9,900 - extra length of stay: $7,492; antimicrobial therapy: $1,095; cost of PICC: $765; laboratorial samples: $548. Discussion & Conclusions: In this study, we evaluated only the direct and estimated costs of PICC-BSI, but the value should be much higher if we consider indirect costs such as healthcare workers hours, complications and the need for transfers to intensive care units. In our hospital, a dedicated ITN nurse contributed to reduce the rate of infection, generating savings for the service and contributing to the quality of care and patient experience.

Vessel Health and Preservation: The Right Approach for Vascular Access
Vessel Health and Preservation: The Right Approach for Vascular Access

Author: Nancy L. Moureau

Publisher: Springer

Published: 2019-06-10

Total Pages: 303

ISBN-13: 3030031497

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This Open access book offers updated and revised information on vessel health and preservation (VHP), a model concept first published in poster form in 2008 and in JVA in 2012, which has received a great deal of attention, especially in the US, UK and Australia. The book presents a model and a new way of thinking applied to vascular access and administration of intravenous treatment, and shows how establishing and maintaining a route of access to the bloodstream is essential for patients in acute care today. Until now, little thought has been given to an intentional process to guide selection, insertion and management of vascular access devices (VADs) and by default actions are based on crisis management when a quickly selected VAD fails. The book details how VHP establishes a framework or pathway model for each step of the patient experience, intentionally guiding, improving and eliminating risk when possible. The evidence points to the fact that reducing fragmentation, establishing a pathway, and teaching the process to all stakeholders reduces complications with intravenous therapy, improves efficiency and diminishes cost. As such this book appeals to bedside nurses, physicians and other health professionals.

Vascular access in cancer patients – clinical implications
Vascular access in cancer patients – clinical implications

Author: Knut Taxbro

Publisher: Linköping University Electronic Press

Published: 2019-07-23

Total Pages: 106

ISBN-13: 9176850226

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Central venous catheters (CVC) are vital for patients receiving chemotherapy not compatible with peripheral infusion. Thousands of centrally and peripherally inserted central venous catheters are inserted into patients with cancer each year. All types of intravascular catheters are associated with complications. These complications may be divided into infectious, thrombotic, mechanical and occlusive events. All of these events have the potential to harm patients and cause additional expense for the health-care system. Furthermore, the above-mentioned complications are largely avoidable through proper patient selection, insertion technique, hygiene precautions and catheter maintenance. Catheter-related infections and deep venous thrombosis are the two most common and feared CVC related complications. Infection in a catheter can cause lifethreatening bacteraemia, and thrombosis can lead to pulmonary embolisation, post-thrombotic syndrome and stenosis of the vessel affected. Many studies describing methods to minimise infectious complications associated with central venous catheters have been carried out. These methods appear to have been implemented in most modern advanced healthcare facilities resulting in a continual decrease in catheter-related infections over the last two decades. New implantation techniques, fewer infections and better catheter materials are likely to have contributed to the reduction in the incidence of catheter-related deep venous thrombosis (CR-DVT). Peripherally inserted central venous catheters (PICC) and subcutaneously implanted vascular access ports (PORT) are two very commonly used catheter devices for delivery of chemotherapy. International guidelines are unclear as to which device to choose due to the paucity of controlled trials. The aim of this thesis was to study complications related to central venous access devices used over long periods of time, usually for the delivery of chemotherapy. Vascular access in cancer patients – clinical implications We prospectively studied PORT complications (Study 1) over a six-month follow- up period. In Study 2, we assessed the number of common CVC-related micro- organisms that are transferred across PORT membrane contaminated by a controlled suspension of micro-organisms when a non-coring access needle is inserted using two different techniques. In the largest randomised controlled trial published on this topic (Study 3), we compared PICC with PORT regarding CRDVT and other catheter-related complications. The economic implications of using PICC or PORT were assessed from health-care system´s perspective (Study 4), using data on adverse events and clinical factors (implantation, treatments and dwell-time) from Study 3. Chemotherapy against various forms of cancer is very common. Implantation of PORT is one of the ten most common surgical procedures in Sweden according to the Swedish Perioperative Register. Hence, the topic in this thesis may be clinically relevant to many patients and their health care providers. We found that the incidence of catheter-related blood stream infection was very low in the cohorts studied. In general, PICCs are associated with significantly more CR-DVTs and adverse events than PORTs. The cost to the health-care system when using PICC is higher than for PORT when complications are included. Given the choice, patients about to commence chemotherapy appear to prefer PORT to PICC. PORT implantation is more painful than PICC insertion, but PICC appears to influence activities of daily life more than PORT.

Implementation of a Central Venous Line Care Kit Bundle
Implementation of a Central Venous Line Care Kit Bundle

Author: Atria Knight

Publisher:

Published: 2014

Total Pages: 0

ISBN-13:

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Health care organizations across the United States share a common goal of keeping patients safe. This goal of maintaining safety includes preventing nosocomial infections known as central line associated blood stream infections (CLABSIs). These infections are typically caused by improper care of or improper insertion of a central venous line. Research has shown that with a simple process known as central venous line care kit bundling infection rates can decline from 17 per 1,000 catheter days to zero CLABSIs annually. Bundling of care required that all supplies for central venous line care be collectively bundled in kits and placed in a designated area on nursing units in an effort to ensure that all required supplies are present during line care. Initiation of a plan that would yield such results simply requires staff to verify that all necessary central line care components are present prior to starting central venous line care. Being that there was new policy was not added there was simply a change in presentation of required supplies; staff would simply be educated on the new appearance of the central venous line care kits. Doing so has the potential to drastically change the face of health care. Medical staff would be able to better protect their patients which in turn offers a greater sense of pride and accomplishment. Not only does prevention of such infections improve staff morale; patient outcomes, morbidity rates, and mortality rates improve along with hospital benefitting both economically and socially. Implementation of central venous line care kit bundles produces significant and sustainable positive changes in health care and patient safety.

The GAVeCeLT manual of Picc and Midline
The GAVeCeLT manual of Picc and Midline

Author: Mauro Pittiruti

Publisher: Edra

Published: 2017-05-30T00:00:00+02:00

Total Pages: 316

ISBN-13: 882144399X

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Venous access devices are necessary for any patient requiring repeated blood sampling, parenteral nutrition, chemotherapy, antibiotic therapy or other IV treatments to be delivered in the hospital setting or at home. In the last decade, ultrasound-guided PICCs and Midline catheters – inserted by adequately trained physicians or nurses - have suddenly and widely spread in the field of venous access devices all over the world. The introduction and diffusion of PICCs in Italy has been historically linked to the GAVeCeLT association (the Italian Group of Long Term Venous Access Devices) and particularly to the authors’ scientific and didactic activity. This volume examines the clinical indications for these devices and illustrates the details of their insertion and management in several clinical settings. Furthermore, all the specifications regarding the materials to use and all the aspects related to device removal and replacement, as well as the different strategies for complications prevention, are thoroughly discussed.

MacDonald's Atlas of Procedures in Neonatology
MacDonald's Atlas of Procedures in Neonatology

Author: Jayashree Ramasethu

Publisher: Lippincott Williams & Wilkins

Published: 2019-10-16

Total Pages: 1228

ISBN-13: 1496394267

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Detailed, step-by-step instructions and abundant full-color illustrations make MacDonald’s Atlas of Procedures in Neonatology, Sixth Edition, an indispensable resource in the neonatal intensive care nursery. This unique reference uses a practical outline format to present clear, easy-to-follow information on indications, preparation, technique, precautions, and how to avoid potential complications. New chapters, new procedural content, and new videos bring you fully up to date with current practice in the NICU.

Design and Implementation of Health Information Systems
Design and Implementation of Health Information Systems

Author: World Health Organization Staff

Publisher:

Published: 2000

Total Pages: 270

ISBN-13: 9789241561990

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This book provides a practical guide to the design and implementation of health information systems in developing countries. Noting that most existing systems fail to deliver timely, reliable, and relevant information, the book responds to the urgent need to restructure systems and make them work as both a resource for routine decisions and a powerful tool for improving health services. With this need in mind, the authors draw on their extensive personal experiences to map out strategies, pinpoint common pitfalls, and guide readers through a host of conceptual and technical options. Information needs at all levels - from patient care to management of the national health system - are considered in this comprehensive guide. Recommended lines of action are specific to conditions seen in government-managed health systems in the developing world. In view of common constraints on time and resources, the book concentrates on strategies that do not require large resources, highly trained staff, or complex equipment. Throughout the book, case studies and numerous practical examples are used to explore problems and illustrate solutions. Details range from a list of weaknesses that plague most existing systems, through advice on when to introduce computers and how to choose appropriate software and hardware, to the hotly debated question of whether patient records should be kept by the patient or filed at the health unit. The book has fourteen chapters presented in four parts. Chapters in the first part, on information for decision-making, explain the potential role of health information as a managerial tool, consider the reasons why this potential is rarely realized, and propose general approaches for reform which have proved successful in several developing countries. Presentation of a six-step procedure for restructuring information systems, closely linked to an organizational model of health services, is followed by a practical discussion of the decision-making process. Reasons for the failure of most health information to influence decisions are also critically assessed. Against this background, the second and most extensive part provides a step-by-step guide to the restructuring of information systems aimed at improving the quality and relevance of data and ensuring their better use in planning and management. Steps covered include the identification of information needs and indicators, assessment of the existing system, and the collection of both routine and non-routine data using recommended procedures and instruments. Chapters also offer advice on procedures for data transmission and processing, and discuss the requirements of systems designed to collect population-based community information. Resource needs and technical tools are addressed in part three. A comprehensive overview of the resource base - from staff and training to the purchase and maintenance of equipment - is followed by chapters offering advice on the introduction of computerized systems in developing countries, and explaining the many applications of geographic information systems. Practical advice on how to restructure a health information system is provided in the final part, which considers how different interest groups can influence the design and implementation of a new system, and proposes various design options for overcoming specific problems. Experiences from several developing countries are used to illustrate strategies and designs in terms of those almost certain to fail and those that have the greatest chances of success

Closing the Gap in a Generation
Closing the Gap in a Generation

Author: WHO Commission on Social Determinants of Health

Publisher: World Health Organization

Published: 2008

Total Pages: 257

ISBN-13: 9241563702

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Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.