Displaying all 12 publications

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  1. Tan PC, Mackeen A, Khong SY, Omar SZ, Noor Azmi MA
    Sci Rep, 2016 Mar 18;6:23223.
    PMID: 26987593 DOI: 10.1038/srep23223
    A peripheral intravenous catheter is often inserted as part of care during labour. The catheter is inserted into the back of the hand or lower forearm vein in usual practice. There is no trial data to guide the care provider on which is the better insertion site in any clinical setting. 307 women admitted to the labour ward who required insertion of intravenous catheter were randomised to back of hand or lower forearm vein catheter insertion. Catheter insertion is by junior to mid-grade providers. We evaluated insertion success at the first attempt, pain during insertion and catheter replacement due to malfunction as main outcomes. After catheter removal, we recorded patient satisfaction with site, future site preference and insertion site swelling, bruising, tenderness, vein thrombosis and pain. Insertion of a catheter into back of hand vein is more likely to be successful at the first attempt. Insertion pain score, catheter replacement rate, patient satisfaction, patient fidelity to site in a future insertion and insertion site complications rate are not different between trial arms. In conclusion, both insertion sites are suitable; the back of the hand vein maybe easier to cannulate and seems to be preferred by our frontline providers.
    Matched MeSH terms: Catheterization, Peripheral/adverse effects; Catheterization, Peripheral/instrumentation; Catheterization, Peripheral/methods*
  2. Sze Yong T, Vijayanathan AA, Chung E, Ng WL, Yaakup NA, Sulaiman N
    J Vasc Access, 2021 Jan 13.
    PMID: 33438482 DOI: 10.1177/1129729820987373
    OBJECTIVE: To compare catheter related blood stream infection (CRBSI) rate between cuffed tunnelled and non-cuffed tunnelled PICC.

    METHODS: We prospectively followed 100 patients (50:50 cuffed and non-cuffed PICC) and compared CRBSI rate between these groups. Daily review and similar catheter care were performed until a PICC-related complication, completion of therapy, death or defined end-of-study date necessitate removal. CRBSI was confirmed in each case by demonstrating concordance between isolates colonizing the PICC at the time of infection and from peripheral blood cultures.

    RESULTS: A total of 50 cuffed PICC were placed for 1864 catheter-days. Of these, 12 patients (24%) developed infection, for which 5 patients (10%) had a CRBSI for a rate of 2.7 per 1000 catheter-days. Another 50 tunnelled non-cuffed PICCs were placed for 2057 catheter-days. Of these, 7 patients (14%) developed infection, for which 3 patients (6%) had a CRBSI. for a rate of 1.5 per 1000 catheter-days. The mean time to development of infection is 24 days in cuffed and 19 days in non-cuffed groups. The mean duration of utilization was significantly longer in non-cuffed than in cuffed group (43 days in non-cuffed vs 37 days in cuffed group, p = 0.008).

    CONCLUSIONS: Cuffed PICC does not further reduce the rate of local or bloodstream infection. Tunnelled non-cuffed PICC is shown to be as effective if not better at reducing risk of CRBSI and providing longer catheter dwell time compared to cuffed PICC.

    Matched MeSH terms: Catheterization, Peripheral
  3. Vijaynanthan, A., Nawawi, O., Abdullah, B.J.J.
    JUMMEC, 2017;20(2):8-12.
    MyJurnal
    In the current study, we report a new technique to place a tunnelled peripherally inserted central catheter
    (PICC) at the upper arm of patient under real-time ultrasound-guided venipuncture using disposal equipment
    provided within a standard PICC set. The tunnelling of the PICC required an extra time of 5 minutes but was
    well tolerated by all patients involved in the study. The tunnelled PICC was applied on 50 patients and the
    infection rate as well its catheter dwell time were compared to another 50 patients with conventional PICC.
    The rate of patients who developed infection decreased from 34% for conventional PICC to 16% in tunnelled
    PICC patients. The central line-associated blood stream infections rate was also decreased from 4.4 per 1000
    catheter-days for conventional PICC to 1.3 per 1000 catheter-days for tunnelled PICC. The mean time to infection
    development for tunnelled PICC (24 days) was longer than those observed with conventional PICC (19 days).
    Tunnelled PICC has also increased the mean catheter dwell time from 27 days (for conventional PICC) to 47
    days. Tunnelling a PICC has the potential to reduce the infection rate while increase the catheter dwell time.
    Matched MeSH terms: Catheterization, Peripheral
  4. Fraga MV, Stoller JZ, Glau CL, De Luca D, Rempell RG, Wenger JL, et al.
    Pediatrics, 2019 11;144(5).
    PMID: 31615954 DOI: 10.1542/peds.2019-1401
    Point-of-care ultrasound is currently widely used across the landscape of pediatric care. Ultrasound machines are now smaller, are easier to use, and have much improved image quality. They have become common in emergency departments, ICUs, inpatient wards, and outpatient clinics. Recent growth of supportive evidence makes a strong case for using point-of-care ultrasound for pediatric interventions such as vascular access (in particular, central-line placement), lumbar puncture, fluid drainage (paracentesis, thoracentesis, pericardiocentesis), suprapubic aspiration, and soft tissue incision and drainage. Our review of this evidence reveals that point-of-care ultrasound has become a powerful tool for improving procedural success and patient safety. Pediatric patients and clinicians performing procedures stand to benefit greatly from point-of-care ultrasound, because seeing is believing.
    Matched MeSH terms: Catheterization, Peripheral/methods*
  5. Khoo PJ, Tay KL, Jamaluddin AA, Gunasaker D
    Ann Med Surg (Lond), 2018 Sep;33:44-46.
    PMID: 30167303 DOI: 10.1016/j.amsu.2018.08.004
    Introduction: We present a case of broken peripheral intravenous catheter/cannula (PIVC), a well-known, underreported complication of PIVC placement. The fractured cannula could have resulted in intravascular foreign body retention, which is usually iatrogenic.

    Presentation of case: In this case, we conceded that both iatrogenic and self-infliction were culpable. The intoxicated, aggressive patient forcefully removed the inserted cannula after repeated attempts by medical personnel to place it. The same cannula was used for multiple attempts. After the location of the fractured catheter was reconfirmed with radiological imaging, venotomy and removal of the foreign body were performed.

    Conclusion: Due to potentially devastating consequences, early detection, adherence to standard operating procedures for peripheral venous access, management of aggressive patients, and meticulous teamwork must be upheld.

    Matched MeSH terms: Catheterization, Peripheral
  6. Zubair Faramir Zainul Fadziruddin, Adi Azriff Basri, Ernnie Illyani Basri
    MyJurnal
    Intravenous (IV) infusion of medical fluid is a very common procedure used as part of medical procedure treatment. It is also the best alternative medical administration route when medical administration through orally is impossible. The most common use of VAD is the short Peripheral IV Catheter (PIVC) or recognized as IV Cannula. In spite of that, even with experience used of PIVC in medical practice nowadays the rate of IV access failure is very high which is up to 69%. Intensive research studies shows the dislodgement case is one of the major contributions of PIVC failure. For some reason only a fewer cases are reported to the administration. This article seeks the awareness and risk factor regarding to the prevailing IV access failure using the PIVC. This manuscript reviewed the statistical data of PIVC dislodgement, significant of dislodgement, dislodgment cases among pediatric, medical staff factor related to PIVC dislodgement and alternative of securement device. This manuscript also discussed the needs of new securement device in order to reduce the percentage of PIVC dislodgement from occurs.
    Matched MeSH terms: Catheterization, Peripheral
  7. Yoong, Wilkinson Jian Tan, Jo Wearn Yeap, Sharifah Sulaiha Syed Aznal
    MyJurnal
    Background: Peripheral venous catheterisation is indispensable in modern practise of medicine. The indications of venous access should be weighed against the risk of complications, the commonest being thrombophlebitis. Thrombophlebitis causes patient discomfort and the need for new catheter insertion and risk of developing further widespread infections. Methodology: This observational study was conducted on adult patients admitted to the surgical and medical ward of a tertiary hospital in Negeri Sembilan Malaysia in 2011. Four researchers visited patients daily and examined for signs of thrombophlebitis; warmth, erythema, swelling, tenderness or a palpable venous cord. Risks factors that were studied in this research were patient/s age and gender, duration of catheterization, use of catheter for infusion, size of catheter, site of catheter insertion and types of infusate. Thrombophlebitis was graded using a scale adapted from Bhandari et al. (1979). Results: In total, 428 patients were recruited with an incidence rate of thrombophlebitis of 35.2%. Among those who developed thrombophlebitis, 65% had mild thrombophlebitis, 19% moderate and 8% severe thrombophlebitis. Results showed that female patients had a significant increased risk of developing thrombophlebitis. Also risk increased significantly with increased duration of catheterization and usage of the catheter for infusion. The age of a patient, types of infusate use, size of catheter and site of catheter insertion did not significantly influence the development of thrombophlebitis. Conclusion: The study showed that risk of developing thrombophlebitis is significantly increased among female patients, and also with increased duration of catheterization and use of the peripheral venous catheter for infusion. We recommended elective replacement of catheter every 72 hours and daily examination of catheters for signs of thrombophlebitis by a healthcare personnel.
    Matched MeSH terms: Catheterization, Peripheral
  8. Azlina Daud, Fatimah Mohamad, Siti Noorkhairina Sowtali
    MyJurnal
    Objective: This study aims to determine the incidence rate of phlebitis among patients with peripheral intravenous catheter. Methods: An observational study was conducted in one of the hospitals in East Coast Malaysia. There were 321 data collected among patients who had peripheral intravenous catheter in medical, gynecology and orthopedic wards. The incidence of phlebitis was evaluated using modified Visual Infusion Phlebitis score checklist. Results: The incidence of phlebitis, was found out to be 36.1% (n=116/321). Most patients who developed phlebitis had visual infusion phlebitis, with a score of two (34.9%) and the rest developed phlebitis with a score of three (1.2%). Conclusion: This high incidence of phlebitis indicated a worrying outcome. Therefore, the study findings suggested that a specific guideline on post insertion management of peripheral intravenous catheter should be revised which may help in reducing more incidence of phlebitis, subsequently reduce infection in ward, and provide more safety environment in hospital and reducing cost in managing infection control.
    Matched MeSH terms: Catheterization, Peripheral
  9. Rickard CM, Marsh NM, Larsen EN, McGrail MR, Graves N, Runnegar N, et al.
    Lancet, 2021 04 17;397(10283):1447-1458.
    PMID: 33865494 DOI: 10.1016/S0140-6736(21)00351-2
    BACKGROUND: The optimal duration of infusion set use to prevent life-threatening catheter-related bloodstream infection (CRBSI) is unclear. We aimed to compare the effectiveness and costs of 7-day (intervention) versus 4-day (control) infusion set replacement to prevent CRBSI in patients with central venous access devices (tunnelled cuffed, non-tunnelled, peripherally inserted, and totally implanted) and peripheral arterial catheters.

    METHODS: We did a randomised, controlled, assessor-masked trial at ten Australian hospitals. Our hypothesis was CRBSI equivalence for central venous access devices and non-inferiority for peripheral arterial catheters (both 2% margin). Adults and children with expected greater than 24 h central venous access device-peripheral arterial catheter use were randomly assigned (1:1; stratified by hospital, catheter type, and intensive care unit or ward) by a centralised, web-based service (concealed before allocation) to infusion set replacement every 7 days, or 4 days. This included crystalloids, non-lipid parenteral nutrition, and medication infusions. Patients and clinicians were not masked, but the primary outcome (CRBSI) was adjudicated by masked infectious diseases physicians. The analysis was modified intention to treat (mITT). This study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12610000505000 and is complete.

    FINDINGS: Between May 30, 2011, and Dec, 9, 2016, from 6007 patients assessed, we assigned 2944 patients to 7-day (n=1463) or 4-day (n=1481) infusion set replacement, with 2941 in the mITT analysis. For central venous access devices, 20 (1·78%) of 1124 patients (7-day group) and 16 (1·46%) of 1097 patients (4-day group) had CRBSI (absolute risk difference [ARD] 0·32%, 95% CI -0·73 to 1·37). For peripheral arterial catheters, one (0·28%) of 357 patients in the 7-day group and none of 363 patients in the 4-day group had CRBSI (ARD 0·28%, -0·27% to 0·83%). There were no treatment-related adverse events.

    INTERPRETATION: Infusion set use can be safely extended to 7 days with resultant cost and workload reductions.

    FUNDING: Australian National Health and Medical Research Council.

    Matched MeSH terms: Catheterization, Peripheral/adverse effects; Catheterization, Peripheral/economics; Catheterization, Peripheral/instrumentation*
  10. Goh BL, Ganeshadeva Yudisthra M, Lim TO
    Semin Dial, 2009 Mar-Apr;22(2):199-203.
    PMID: 19426429 DOI: 10.1111/j.1525-139X.2008.00536.x
    Peritoneal dialysis (PD) catheter insertion success rate is known to vary among different operators, and peritoneoscope PD catheter insertion demands mastery of a steep learning curve. Defining a learning curve using a continuous monitoring tool such as a Cumulative Summation (CUSUM) chart is useful for planning training programs. We aimed to analyze the learning curve of a trainee nephrologist in performing peritoneoscope PD catheter implantation with CUSUM chart. This was a descriptive single-center study using collected data from all PD patients who underwent peritoneoscope PD catheter insertion in our hospital. CUSUM model was used to evaluate the learning curve for peritoneoscope PD catheter insertion. Unacceptable primary failure rate (i.e., catheter malfunction within 1 month of insertion) was defined at >40% and acceptable performance was defined at <25%. CUSUM chart showed the learning curve of a trainee in acquiring new skill. As the trainee became more skillful with training, the CUSUM curve flattened. Technical proficiency of the trainee nephrologist in performing peritoneoscope Tenckhoff catheter insertion (<25% primary catheter malfunction) was attained after 23 procedures. We also noted earlier in our program that Tenckhoff catheters directed to the right iliac fossae had poorer survival as compared to catheters directed to the left iliac fossae. Survival of catheters directed to the left iliac fossae was 94.6% while the survival for catheters directed to the right iliac fossae was 48.6% (p < 0.01). We advocate that quality control of Tenckhoff catheter insertion is performed using CUSUM charting as described to monitor primary catheter dysfunction (i.e., failure of catheter function within 1 month of insertion), primary leak (i.e., within 1 month of catheter insertion), and primary peritonitis (i.e., within 2 weeks of catheter insertion).
    Matched MeSH terms: Catheterization, Peripheral/instrumentation; Catheterization, Peripheral/utilization*
  11. Cheong SM, Totsu S, Nakanishi H, Uchiyama A, Kusuda S
    J Neonatal Perinatal Med, 2016;9(1):99-105.
    PMID: 27002262 DOI: 10.3233/NPM-16915054
    OBJECTIVE: In order to evaluate safety and usefulness of peripherally inserted double lumen central catheter (PIDLCC) in very low birth weight (VLBW) infants, outcomes of VLBW infants who had PIDLCC was studied.

    SUBJECTIVE: Thirty-nine VLBW infants who were admitted to our NICU in 2013 were retrospectively analyzed.

    RESULTS: Mean birth weight and gestational age was 1042.7 gram and 28.5 weeks, respectively. Total duration of indwelling PIDLCC was 1121 days (mean 28.5+18.2 days) with 85 PIDLCCs used. Dressing at the insertion site was done twice weekly with 10% povidone iodine. Four (10.3% with mean of 48 days) infants had catheter-related blood stream infection (CRBSI), with a 3.57 infection per 1000 catheter-day. The mean for days of PIDLCC in 35 infants without CRBSI was 26.5 days. Organisms isolated were Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus capitis ureolytic. Our study showed significant difference in the duration of indwelling catheter (p = 0.023) and intraventricular hemorrhage (p = 0.043) between the CRBSI group and non-CRBSI group. Five (12.8%) infants had abnormal thyroid function test, in which two infants required thyroxine supplementation upon discharge. However, duration of PIDLCC and abnormal thyroid function test was not statistically significant (p = 0.218). One (2.5%) infant died (death was not related to CRBSI). There was no serious adverse effects secondary to PIDLCC.

    CONCLUSION: It is concluded that the use and maintenance of PIDLCC is safe for VLBW infants, but close monitoring should be observed to detect early signs of infection.

    Matched MeSH terms: Catheterization, Peripheral/adverse effects*; Catheterization, Peripheral/statistics & numerical data
  12. Rosenthal VD, Bat-Erdene I, Gupta D, Rajhans P, Myatra SN, Muralidharan S, et al.
    J Vasc Access, 2021 Jan;22(1):34-41.
    PMID: 32406328 DOI: 10.1177/1129729820917259
    BACKGROUND: Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available.

    METHODS: Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.

    RESULTS: We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%).

    CONCLUSIONS: Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.

    Matched MeSH terms: Catheterization, Peripheral/adverse effects*; Catheterization, Peripheral/mortality
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