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).

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.

Peripherally Inserted Central Venous Catheters
Peripherally Inserted Central Venous Catheters

Author: Sergio Sandrucci

Publisher: Springer

Published: 2014-07-25

Total Pages: 0

ISBN-13: 9788847056640

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Indications for central venous cannulation in critically ill patients have increased dramatically, but central venous access has the drawbacks of morbidity and a scarcity of experienced operators. Ultrasound-guided peripheral venous access offers a solution, in that it reduces morbidity and can be performed by a dedicated nursing team. The aim of this book is to teach the fundamentals of this emerging technique. Advice is provided on choice of materials; maneuvers for positioning of peripherally inserted central venous catheters (PICCs), techniques for evaluation of PICC tip placement; prevention, diagnosis, and management of complications; and organization of a dedicated team within a hospital or a supportive care program. Legal and economic issues are also considered. The book will be of interest to a wide range of professionals, including nutritionists, oncologists, anesthesiologists, surgeons, registered nurses, nurse practitioners, physicians, physician assistants, and radiologists.

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.

The Rand/UCLA Appropriateness Method User's Manual
The Rand/UCLA Appropriateness Method User's Manual

Author: Kathryn Fitch

Publisher: Rand Corporation

Published: 2001

Total Pages: 109

ISBN-13: 9780833029188

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Health systems should function in such a way that the amount of inappropriate care is minimized, while at the same time stinting as little as possible on appropriate and necessary care. The ability to determine and identify which care is overused and which is underused is essential to this functioning. To this end, the "RAND/UCLA Appropriateness Method" was developed in the 1980s. It has been further developed and refined in North America and, increasingly, in Europe. The rationale behind the method is that randomized clinical trials--the "gold standard" for evidence-based medicine--are generally either not available or cannot provide evidence at a level of detail sufficient to apply to the wide range of patients seen in everyday clinical practice. Although robust scientific evidence about the benefits of many procedures is lacking, physicians must nonetheless make decisions every day about when to use them. Consequently, a method was developed that combined the best available scientific evidence with the collective judgment of experts to yield a statement regarding the appropriateness of performing a procedure at the level of patient-specific symptoms, medical history, and test results. This manual presents step-by-step guidelines for conceptualising, designing, and carrying out a study of the appropriateness of medical or surgical procedures (for either diagnosis or treatment) using the RAND/UCLA Appropriateness Method. The manual distills the experience of many researchers in North America and Europe and presents current (as of the year 2000) thinking on the subject. Although the manual is self-contained and complete, the authors do not recommend that those unfamiliar with the RAND/UCLA Appropriateness Method independently conduct an appropriateness study; instead, they suggest "seeing one" before "doing one." To this end, contact information is provided to assist potential users of the method.

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.

Infections in Hematology
Infections in Hematology

Author: Georg Maschmeyer

Publisher: Springer

Published: 2014-12-13

Total Pages: 328

ISBN-13: 3662440008

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Infections are among the most frequent complications in patients with hematological malignancies and in those undergoing high-dose chemotherapy and autologous hematopoietic stem cell transplantation. A profound knowledge on the epidemiology, diagnostic approaches, treatment modalities and prophylactic strategies is essential for the clinical management of these complications in patients who are often severely immunocompromised owing to their underlying diseases and in particular, the intensive myelosuppressive chemo and immunotherapy. This textbook provides a clinically oriented, compact and up-to-date overview on infections in hematology patients and their management. The typical pathogens to be considered in different subgroups of patients are identified and further aspects of the microbiological background are explored. Clinical, imaging, and laboratory-based diagnostic techniques are discussed and therapeutic strategies appropriate to different situations are then presented, with due attention to the pitfalls, toxicities and interactions that can arise during antimicrobial treatment. Strategies to prevent infection are also outlined, encompassing antimicrobial prophylaxis, isolation procedures, hospital hygiene, protective immunization and the use of hematopoietic growth factors.

Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies
Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies

Author: OECD

Publisher: OECD Publishing

Published: 2019-10-17

Total Pages: 447

ISBN-13: 9264805907

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This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.