JVAD spring 2008

May 10, 2008

Email this news item to a friend/colleague

The spring edition of the The Journal of the Association of Vascular Access has been published. The content of this edition includes:

Dawson R.B. (2008) Nursing Beyond the “Process”: Collegiality and Consultation Improves Outcomes by Protecting the ftissue Integrity of PICC Insertions Sites. The Journal of the Association of Vascular Access. 13(1), p.8.

Abstract

“On a daily basis vascular access nurses are presented with complex patient care issues involving intravenous therapy. The nursing process as an instrument to organize nursing care is valuable; however, is it enough to positively affect patient outcomes? Nursing beyond the fundamental process requires the intent to advocate and protect the patient from unnecessary risk or harm. A patient with impaired tissue integrity from epidermolysis bullosa required a nurse specialist whose practice included advocacy, collegiality and consultation in order to protect a PICC insertion site and prevent complications. The intervention included the use of a soft silicone contact layer (Mepitel) and a transparent semi-permiable membrane dressing (Tegaderm). A new clinical process was born from the collaboration of two nursing professionals and it positively impacted patient outcomes. This is a professional approach to nursing care that is under utilized” (Dawson 2008).

Olson C. and Heilman J.M. (2008) Clincal Performance of a New Transparent Chlorhexidine Gluconate Central Venous Catheter Dressing. The Journal of the Association of Vascular Access. 13(1), p.13.

Absract

“As the sciences of vascular access and infection prevention rapidly advance healthcare professionals are often faced with new technologies designed to help, but which are often so complicated to use that they cause unforeseen problems. As a vascular access team at a major mid-western hospital, we evaluated the ease-of-use and the performance characteristics of a new transparent catheter dressing, 3M Tegaderm CHG IV Securement Dressing (3M Health Care, St. Paul, MN) containing the antimicrobial chlorhexidine gluconate (CHG), with a variety of central venous catheters insertion sites in comparison to a standard non-antimicrobial dressing Tegaderm (3M Health Care, St. Paul, MN). Following IRB approval, sixty-three consenting patients were enrolled and randomized; 33 in the CHG antimicrobial dressing group and 30 in the standard dressing group. Thirty six patients had peripherally inserted central catheters (PICCs), 20 had intrajugular insertions (IJ), and 7 had subclavian insertions. The new 3M Tegaderm CHG IV Securement Dressing (3M Health Care, St. Paul, MN) was evaluated for its ability to permit visualization of the insertion site, ease of use, ease of using correctly, ability to secure the catheter and absorb exudates and remain transparent.

The new 3M Tegaderm CHG IV Securement Dressing (3M Health Care, St. Paul, MN) was found to be as easy to use in central venous catheter care clinical practice as the standard of care non-antimicrobial transparent adhesive dressing. No additional training or education was needed to properly use it. This dressing was applied and removed like standard transparent adhesive dressings, but offered many advantages over standard dressings. Advantages include that it is antimicrobial, handles moderate bleeding, remains transparent and appears to offer greater catheter securement than the Tegaderm (3M Health Care, St. Paul, MN) standard dressing. The CHG gel pad also conformed well to the catheter” (Olsen and Heilman 2008).

Daniels L.S. and Gouvas M.O. (2008) Effects of INR Levels on Bleeding Occurrances During the First 24-hours of Ultrasound Guided PICC Line Insertions. The Journal of the Association of Vascular Access. 13(1), p.22.

Abstract

“A sample of 127 patients with an International Normalized Ratio (INR) of 1.5 or greater, undergoing a Peripherally Inserted Central Catheter (PICC) insertion, were observed for bleeding at the time of insertion and for 24 hours post insertion. Over 60% of patients experienced no or mild bleeding at insertion. For an INR less than 3.0, fewer than 10% of the sample experienced moderate bleeding within the first 24 hours. No PICCs were discontinued due to bleeding. Results suggest that INR levels below 3.0 did not appear to have an impact on amount of bleeding during PICC insertion. After 24 hours, INR levels of 3.0 and above did appear to have an impact on the amount of bleeding” (Daniels and Gouvas 2008).

A. Scocca A., Gioia A. and Poli P. (2008) Initial Experience of a Nurse-Implemented Peripherally Inserted Central Catheter Program in Italy. Journal of the Association of Vascular Access. 13(1), p.27.

Abstract

“In Italy prior to 2006 central venous catheters were inserted only by anaesthesiologists. Nurses were excluded based on professional profile. In 2005 the nursing staff of the Pain Therapy and Palliative Care Unit (PTPCU) at Santa Chiara Hospital in Pisa, proposed that nurses be permitted to insert Peripherally Inserted Central Catheters (PICCs). The recommendation was submitted to the Italian National Board of Nurses with a request to implement a training program. The Board approved the proposal in January 2006. Initially the PTPCU nursing staff had PICC training programs through the St. Chiara Hospital Vocational Training Office. The program was initially implemented by a nurse volunteer who had critical care training, intravenous therapy experience and who demonstrated competence with PICC placement based on training by PTPCU interventional anaesthesiologists. To date, nearly 250 successful PICC placements have been performed using the Modified Seldinger TEchnique (MST) in conjunction with ultrasound guidance. Physicians and nurses identified potential candidates and the patients were assessed by the PICC nurse. The combination of PICC/MST was found to facilitate placement in patients with impalpable vessels and above the antecubital fossa as well as improve freedom of movement and reduce the likelihood of patients accidently dislodging the device. The primary reasons for PICC placement included antibiotic or antiviral therapy (26%), total parenteral nutrition administration (35%) and chemotherapy (39%). There were 211 catheters exclusively for inpatients and 39 catheters exclusively for outpatients. The PICC program resulted in an excellent safety profile, a high success rate, and few post-procedural complications. It was a less costly option compared to centrally inserted, tunnelled, or implanted central vascular access devices; it improved the quality of the nursing care and decreased patients’ waiting time for vascular access placement” (Scocca et al 2008).

Verhey P.T., Gosselin M.V., Primack S.L., Blackburn P.L. and Kraemer A.C. (2008) The Right Mediastinal Border and Central Venous Anatomy of Frontal Chest Radiograph - Direct CT Correlation. Journal of the Association of Vascular Access. 13(1), p.32.

Abstract

“We describe a direct and accurate method for defining chest radiographic anatomy and use this method to delineate the anatomic composition of the right mediastinal border in an adult population. Intravenous contrast-enhanced computed tomographic scans of the chest and accompanying scout tomograms from 99 adults without previously known or detected cardiopulmonary disease that could potentially distort mediastinal, cardiac, or pulmonary anatomy were retrospectively evaluated. Transverse CT images through the mediastinum were directly referenced to the respective acquisition location on the scout tomogram via the acquisition reference line. The anatomic composition of the right mediastinal border on the scout tomogram was determined by drawing a vertical line tangential to the most lateral right mediastinal structure in each transverse CT image. The lengths and relationships of these structures were tabulated. These results will help to create a consensus among radiologists and other clinicians regarding radiographic anatomy, allowing improved localization of mediastinal pathology and enabling more optimal positioning of vascular and cardiac support services” (Verhey et al 2008).