| 1. |
- Adrian, Maria, et al.
(författare)
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Minimal guidewire length for central venous catheterization of the right subclavian vein : A CT-based consecutive case series
- 2022
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Ingår i: Journal of Vascular Access. - : SAGE Publications. - 1129-7298 .- 1724-6032. ; 23:3, s. 375-382
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Central venous catheter (CVC) misplacement occurs frequently after right subclavian vein catheterization. It can be avoided by using ultrasound to confirm correct guidewire tip position in the lower superior vena cava prior to CVC insertion. However, retraction of the guidewire during the CVC insertion may dislocate the guidewire tip from its desired and confirmed position, thereby resulting in CVC misplacement. The aim of this study was to determine the minimal guidewire length required to maintain correct guidewire tip position in the lower superior vena cava throughout an ultrasound-guided CVC placement in the right subclavian vein.METHODS: One hundred adult patients with a computed tomography scan of the chest were included. By using multiplanar reconstructions from thin-sliced images, the distance from the most plausible distal puncture site of the right subclavian vein to the optimal guidewire tip position in the lower superior vena cava was measured (vessel length). In addition, measurements of equipment in common commercial over-the-wire percutaneous 15-16 cm CVC kits were performed. The 95th percentile of the vessel length was used to calculate the required minimal guidewire length for each CVC kit.RESULTS: The 95th percentile of the vessel length was 153 mm. When compared to the calculated minimal guidewire length, the guidewires were up to 108 mm too short in eight of eleven CVC kits.CONCLUSION: After confirmation of a correct guidewire position, retraction of the guidewire tip above the junction of the brachiocephalic veins should be avoided prior to CVC insertion in order to preclude dislocation of the catheter tip towards the right internal jugular vein or the left subclavian vein. This study shows that many commercial over-the-wire percutaneous 15-16 cm CVC kits contain guidewires that are too short for right subclavian vein catheterization, i.e., guidewire retraction is needed prior to CVC insertion.
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| 2. |
- Ahlin, Catharina, et al.
(författare)
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Development of instruments for assessment of knowledge and skills in performing venepuncture and inserting peripheral venous catheters
- 2013
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Ingår i: Journal of Vascular Access. - : SAGE Publications. - 1129-7298 .- 1724-6032. ; 14:4, s. 364-372
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Performing venepuncture is one of the most routinely performed invasive procedures in nursing care. The aim of this study was to develop instruments for the assessment of nursing students’ knowledge and skills when performing venepuncture and inserting a peripheral venous catheter.
Methods: Two instruments were developed using the following steps. 1) Assessment items of importance for the procedures (venepuncture 48 items and peripheral venous catheter 51 items) were collected from focus groups including nurses, lecturers and patients. 2) The number of items was reduced using a method based on the Delphi method. Experts (n=51) reviewed the instruments in two rounds. The revised versions included 31 items for venepuncture and 33 items for peripheral venous catheter insertion. 3) Usability tests were conducted by nurses who tested the instruments to confirm that items were possible to assess. 4) Inter-rater reliability was assessed by twelve lecturers who in pairs, but independently of each other, used the instruments to assess 50 nursing students.
Results: Proportion of agreement and Cohen’s kappa coefficient were calculated for each item to determine inter-rater reliability. Among the tested items for both instruments, the median proportion of agreement was 1 (range 0.66-1) and the median kappa was 0.52 (range 0.22-1).
Conclusions: The instruments developed for assessing nursing students’ knowledge and skills of venepuncture and peripheral venous catheter insertion showed satisfactory inter-rater reliability.
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| 3. |
- Ahlqvist, Margary, et al.
(författare)
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Satisfactory reliability among nursing students using the instrument PVC ASSESS to evaluate management of peripheral venous catheters
- 2014
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Ingår i: Journal of Vascular Access. - : SAGE Publications. - 1129-7298 .- 1724-6032. ; 15:2, s. 128-134
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Nursing students should be given opportunities to participate in clinical audits during their education. However, audit tools are seldom tested for reliability among nursing students. The aim of this study was to present reliability among nursing students using the instrument PVC assess to assess management of peripheral venous catheters (PVCs) and PVC-related signs of thrombophlebitis. Methods: PVC assess was used to assess 67 inserted PVCs in 60 patients at ten wards at a university hospital. One group of nursing students (n= 4) assessed PVCs at the bedside (inter-rater reliability) and photographs of these PVCs were taken. Another group of students (n= 3) assessed the PVCs in the photographs after 4 weeks (test-retest reliability). To determine reliability, proportion of agreement [P(A)] and Cohen's kappa coefficient (k) were calculated. Results: For bedside assessment of PVCs, P(A) ranged from good to excellent (0.80-1.0) in 55% of the 26 PVC assess items that were tested. P(A) was poor (< 0.70) for two items: "adherence of inner dressing to the skin" and " PVC location." In 81% of the items, k was between moderate and almost perfect: moderate (n= 5), substantial (n= 3), almost perfect (n= 5). For edema at insertion site and two items on PVC dressing, k was fair (0.21-0.40). Regarding test-retest reliability, P(A) varied between good and excellent (0.81-1) in 85%-95% of the items, and the k ranged between moderate and almost perfect (0.41-1) in 90%-95%. Conclusions: PVC assess demonstrated satisfactory reliability among nursing students. However, students need training in how to use the instrument before assessing PVCs.
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| 4. |
- Balaz, Peter, et al.
(författare)
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True aneurysm in autologous hemodialysis fistulae : definitions, classification and indications for treatment
- 2015
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Ingår i: Journal of Vascular Access. - : SAGE Publications. - 1129-7298 .- 1724-6032. ; 16:6, s. 446-453
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Forskningsöversikt (refereegranskat)abstract
- INTRODUCTION: Definition, etiology, classification and indication for treatment of the arteriovenous access (AVA) aneurysm are poorly described in medical literature. The objectives of the paper are to complete this information gap according to the extensive review of the literature.METHODS: A literature search was performed of the articles published between April 1, 1967, and March 1, 2014. The databases searched included Medline and the Cochrane Database of Systematic Reviews. The eligibility criteria in this review studies the need to assess the association of aneurysms and pseudoaneurysms with autologous AVA. Aneurysms and pseudoaneurysms involving prosthetic AVA were not included in this literature review. From a total of 327 papers, 54 non-English papers, 40 case reports and 167 papers which did not meet the eligibility criteria were removed. The remaining 66 papers were reviewed.RESULTS: Based on the literature the indication for the treatment of an AVA aneurysm is its clinical presentation related to the patient's discomfort, bleeding prevention and inadequate access flow. A new classification system of AVA aneurysm, which divides it into the four types, was also suggested.CONCLUSIONS: AVA aneurysm is characterized by an enlargement of all three vessel layers with a diameter of more than 18 mm and can be presented in four types according to the presence of stenosis and/or thrombosis. The management of an AVA aneurysm depends on several factors including skin condition, clinical symptoms, ease of cannulation and access flow. The diameter of the AVA aneurysm as a solo parameter is not an indication for the treatment.
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| 5. |
- Bertoglio, Sergio, et al.
(författare)
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Improving outcomes of short peripheral vascular access in oncology and chemotherapy administration
- 2017
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Ingår i: Journal of Vascular Access. - : SAGE Publications. - 1129-7298 .- 1724-6032. ; 18:2, s. 89-96
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Tidskriftsartikel (refereegranskat)abstract
- A short peripheral intravenous catheter or cannula (PIVC) is frequently used to deliver chemotherapy in oncology practice. Although safe and easy to insert, PIVCs do fail, leading to personal discomfort for patients and adding substantially to treatment costs. As the procedure of peripheral catheterization is invasive, there is a need for greater consistency in the choice, insertion and management of short PIVCs, particularly in the oncology setting where there is a growing trend for patients to receive many different courses of IV treatment over a number of years, sometimes with only short remissions. This article reviews best practice with respect to PIVCs in cancer patients and considers the necessity for bundling these actions. Two care bundles, addressing both insertion and ongoing care and maintenance, are proposed. These have the potential to improve outcomes with the use of short PIVCs for vascular access in oncology practice.
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| 6. |
- Bertoglio, Sergio, et al.
(författare)
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Improving outcomes of short peripheral vascular access in oncology and chemotherapy administration
- 2017
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Ingår i: Journal of Vascular Access. - : Wichtig Publishing. - 1129-7298 .- 1724-6032. ; 18:2, s. 89-96
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Tidskriftsartikel (refereegranskat)abstract
- A short peripheral intravenous catheter or cannula (PIVC) is frequently used to deliver chemotherapy in oncology practice. Although safe and easy to insert, PIVCs do fail, leading to personal discomfort for patients and adding substantially to treatment costs. As the procedure of peripheral catheterization is invasive, there is a need for greater consistency in the choice, insertion and management of short PIVCs, particularly in the oncology setting where there is a growing trend for patients to receive many different courses of IV treatment over a number of years, sometimes with only short remissions. This article reviews best practice with respect to PIVCs in cancer patients and considers the necessity for bundling these actions. Two care bundles, addressing both insertion and ongoing care and maintenance, are proposed. These have the potential to improve outcomes with the use of short PIVCs for vascular access in oncology practice.
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| 7. |
- Göransson, Katarina, 1974-, et al.
(författare)
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Indication and Usage of Peripheral Venous Catheters Inserted in Adult Patients during Emergency Care
- 2011
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Ingår i: Journal of Vascular Access. - : SAGE Publications. - 1129-7298 .- 1724-6032. ; 12:3, s. 193-199
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to identify the underlying decisions taken regarding the insertion of prehospital peripheral venous catheters in adult patients and, additionally, to ascertain peripheral venous catheter insertion rate and explore prehospital and hospital (within 24 hours of insertion) pharmaceutical treatment via peripheral venous catheters. Method This cross-sectional study gathered data through a study-specific questionnaire and patient record auditing. We distributed a study-specific questionnaire to be completed by ambulance crews, and carried out patient record auditing for 345 patients (median age 64 years, range 18–97 years) arriving at the emergency department at a Swedish level-1 trauma center in October 2008. Results Of 135 patients (39%) arriving at the emergency department with a peripheral venous catheter, 94 (70%) had received the device because the ambulance crews intended to use it for intravenous therapeutics (of which analgesics, intravenous fluids, and psycholeptics were most frequently used). In 30 patients (22%), the prehospital inserted device was not used by the ambulance crews or at hospital within 24 hours. The corresponding rate of unused peripheral venous catheters inserted in patients after arrival at the hospital was 35%. Conclusions We found that the main reason for the ambulance staff to insert a peripheral venous catheter in a prehospital setting was that they intended to use the device. Further, the rate of unused peripheral venous catheters was lower among prehospital peripheral venous catheters than hospital.
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| 8. |
- Göransson, Katarina, 1974-, et al.
(författare)
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Prehospital Peripheral Venous Catheters : A Prospective Study of Patient Complications
- 2012
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Ingår i: Journal of Vascular Access. - : SAGE Publications. - 1129-7298 .- 1724-6032. ; 13:1, s. 16-21
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To investigate prehospital peripheral venous catheters (PVCs) in relation to the frequency of thrombophlebitis. Method Data in this prospective study were collected using three types of data source: a study-specific questionnaire, a PVC observation instrument (PVC assess), and electronic patient records. The questionnaire was distributed to ambulance crews who had inserted a PVC before bringing the patient to an emergency department at a level one trauma centre in Sweden during 10 weeks in 2008–2009. Patients admitted to hospital ward were followed-up daily by registered nurses using the PVC assess until the PVC was removed. Patient record data were collected by means of auditing. Results Of the 83 patients available for follow-up, 45 (54%) developed thrombophlebitis. Quick PVC removal was performed in 32 (71%) of these patients while 13 (29%) PVCs were left in situ for 1–8 days. No association was found between the occurrence of thrombophlebitis and potential risk factors. Conclusions Although thrombophlebitis frequently occurred in PVCs inserted in a prehospital setting, early removal of the device with complication was common. Further studies are warranted to identify the optimal in situ time for PVCs inserted by prehospital emergency teams.
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| 9. |
- Hedin, U
(författare)
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Long-term results of PTFE grafts
- 2015
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Ingår i: The journal of vascular access. - : SAGE Publications. - 1724-6032 .- 1129-7298. ; 1616 Suppl 9, s. S87-S92
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Tidskriftsartikel (refereegranskat)abstract
- Vascular surgeons are essential in “lifeline” creation for hemodialysis patients and should be the central player in any multidisciplinary access service together with nephrologists, dialysis staff and interventional radiology. In this position, access surgeons are involved in complicated clinical decision making regarding primary and secondary access selection, which throughout the last decade has been largely aided, and influenced, by national and international guidelines as well as other initiatives. These recommendations, unanimously and appropriately, advocate the placement of native fistulas over synthetic grafts (the majority grafts from expanded polytetrafluoroethylene, ePTFE, herein referred to as PTFE) based on the superiority of fistulas with respect to complications such as infections and thrombosis. Nevertheless, the use of PTFE grafts for hemodialysis access is an accepted and firmly established alternative to native fistulas where data today reveal unwanted consequences to overinterpretation of established guidelines such as increased catheter use. This information highlights a need for an adjustment of access selection strategies based on patient-centered algorithms. Here, available results on PTFE graft performance in hemodialysis access is recapitulated, with respect to both conventional grafts and technical modifications, and conclude with a modified approach to primary access selection.
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| 10. |
- Hedin, U, et al.
(författare)
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Upper-arm hemodialysis access in Sweden
- 2017
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Ingår i: The journal of vascular access. - : SAGE Publications. - 1724-6032 .- 1129-7298. ; 18:Suppl. 1, s. S110-S113
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Tidskriftsartikel (refereegranskat)abstract
- To provide the contemporary use of upper-arm access for hemodialysis in Sweden using data from a unique national registry for hemodialysis access. Methods Data were retrieved from a nation-wide registry for dialysis access in Sweden, Dialysis Access Database (DiAD) on the use and function of specific access types with a focus on upper-arm accesses. Results The data demonstrate an increased use of upper-arm access, likely dependent on a changing patient population, with brachiocephalic arteriovenous fistula (AVF) as the most common access type. Women received more upper-arm accesses than men. Given the recent establishment of the registry, patency and access function can at this point give preliminary data. Indications of a better function for brachiobasilic AVFs in staged procedures were observed as well as for upper-arm arteriovenous grafts (AVGs) in women. Conclusions Registry data support an increased use of upper-arm accesses, especially in women. The study also demonstrates the potential of a dedicated national access registry to improve access care.
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