Nancy Moureau | Griffith University (original) (raw)
Papers by Nancy Moureau
American Journal of Health-System Pharmacy, 2022
Purpose The study’s purpose was to measure the impact of anti-reflux needleless connector usage i... more Purpose The study’s purpose was to measure the impact of anti-reflux needleless connector usage in prevention of intraluminal thrombotic occlusions among central venous catheters, as represented by alteplase usage, in a home infusion patient population. Methods An18-month before-and-after cohort study of a single home infusion intervention was conducted to compare occlusion outcomes with use of two types of needleless connectors—neutral and anti-reflux—in preventing catheter occlusions, which have been reported to occur in 28% of home infusion patients, resulting in treatment delays, increased nursing encounters and emergency room visits, and higher overall pharmacy costs for supplies and alteplase. Results A total of 552,707 patient therapy days were studied: 42.5% in the neutral needleless connector group (n = 235,004 therapy days) and 57.5% in the anti-reflux needleless connector group (n = 317,703 therapy days). The rate of alteplase usage with neutral versus anti-reflux needlel...
adaptation, distribution and reproduction in any medium or format, as long as you give appropriat... more adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
The journal of vascular access, 2021
Maintaining peripheral vascular access represents a major challenge for medical providers and pat... more Maintaining peripheral vascular access represents a major challenge for medical providers and patients leading to the emergence of ultrasound guided vascular access teams. Upper extremity peripheral vascular access options are often limited in the chronically ill patient population with end stage cancer, patients with severe contractures, tracheostomies, and feeding tubes and patients referred for palliative care are just some examples of patients who live with difficult access. The following is a case description of a mid-thigh superficial femoral vein midline catheter for comfort care medications in a patient with exhausted peripheral vasculature on hospice.
Intravascular catheters are indispensable tools in acute care, but with the benefits come the ris... more Intravascular catheters are indispensable tools in acute care, but with the benefits come the risk of local or systemic Healthcare Acquired Infections (HAIs). In fact, more than 250,000-500,000 intravascular-related bloodstream infections occur in the United States each year with resulting mortality rates of 12%-25%. (Maki, Kluger & Crnich, 2006; CDC, 2002). While bloodstream infections related to the use of peripheral lines may not occur as often as they do with central lines, they do occur. Although most studies focus on central catheter-related bloodstream infections due to their greater documented preva- lence and severity, some studies have evaluated the prevalence of peripheral intravenous catheter-associated bloodstream infections. In 2006 Maki reviewed 200 studies that prospectively examined the risk of Bloodstream Infections (BSIs) associ- ated with intravascular devices over a forty year period. The infection rate with peripheral intravenous catheters was 0.5 per 1000 cath...
Intravascular catheters are indispensable tools in acute care, but with the benefits come the ris... more Intravascular catheters are indispensable tools in acute care, but with the benefits come the risk of local or systemic Healthcare Acquired Infections (HAIs). In fact, more than 250,000-500,000 intravascular-related bloodstream infections occur in the United States each year with resulting mortality rates of 12%-25%. (Maki, Kluger & Crnich, 2006; CDC, 2002). While bloodstream infections related to the use of peripheral lines may not occur as often as they do with central lines, they do occur. Although most studies focus on central catheter-related bloodstream infections due to their greater documented preva- lence and severity, some studies have evaluated the prevalence of peripheral intravenous catheter-associated bloodstream infections. In 2006 Maki reviewed 200 studies that prospectively examined the risk of Bloodstream Infections (BSIs) associ- ated with intravascular devices over a forty year period. The infection rate with peripheral intravenous catheters was 0.5 per 1000 cath...
Intravascular catheters are indispensable tools in acute care, but with the benefits come the ris... more Intravascular catheters are indispensable tools in acute care, but with the benefits come the risk of local or systemic Healthcare Acquired Infections (HAIs). In fact, more than 250,000-500,000 intravascular-related bloodstream infections occur in the United States each year with resulting mortality rates of 12%-25%. (Maki, Kluger & Crnich, 2006; CDC, 2002). While bloodstream infections related to the use of peripheral lines may not occur as often as they do with central lines, they do occur. Although most studies focus on central catheter-related bloodstream infections due to their greater documented preva- lence and severity, some studies have evaluated the prevalence of peripheral intravenous catheter-associated bloodstream infections. In 2006 Maki reviewed 200 studies that prospectively examined the risk of Bloodstream Infections (BSIs) associ- ated with intravascular devices over a forty year period. The infection rate with peripheral intravenous catheters was 0.5 per 1000 cath...
Professioni infermieristiche, 2020
INTRODUCTION Although there are many methods to confirm vascular device tip, chest x-ray represen... more INTRODUCTION Although there are many methods to confirm vascular device tip, chest x-ray represents the recommended procedure to verify the correct positioning of a central device, but it exposes patients to x-rays, delays treatment, and permits device length to be checked post-procedure. AIM To evaluate the efficacy of Peripherally Inserted Central Catheter positioning through an Integrated System (ultrasound-guided and electrocardiogram confirmation). METHODS A case-control study was conducted on a randomized sample of 165 patients, requiring Peripherally Inserted Central Catheter placement for chemotherapy treatment. The case group was composed of patients with vascular device placed through the Integrated System and the control group devices' length was anthropometrically estimated. Chest radiography was performed on both groups to verify tip location. RESULTS No cases of primary malposition related to the Integrated System were registered. The vascular devices positioned wi...
Background: The current standard of care for Peripherally Inserted Central Catheters (PICCs) is r... more Background: The current standard of care for Peripherally Inserted Central Catheters (PICCs) is radiological con- firmation of terminal tip location. Tip location practices in Europe have used electrocardiographic (EKG) guided posi- tioning for central venous catheters for more than twenty years with tip positioning safely confirmed over thousands of insertions (Madias, 2003). The goal of this group was to confirm the findings of a study performed by Pittiruti and his team; and to establish safe function in the use of EKG guidance for verification of terminal tip position with PICCs placed at McKenzie Willamette Medical Center. Methods: In 2008/2009 McKenzie Willamette Medical Center conducted a study to determine whether or not EKG guidance can be used as a reliable means to accurately place and confirm terminal tip location of PICCs. A group of trained nurses performed PICC placement using EKG guidance followed by radiological confirmation of SVC position. All PICCs placed from Oc...
Journal of the Association for Vascular Access, 2020
HighlightsBackground: The purpose of this study was to investigate ultrasound-guided peripheral i... more HighlightsBackground: The purpose of this study was to investigate ultrasound-guided peripheral intravenous (UGPIV) supply usage practices by clinicians working in vascular access, in emergency departments (EDs), or in other roles.Methodology: In 2019, a voluntary cross-sectional descriptive survey was conducted via SurveyMonkey. Data collected included demographics, practice-oriented information, procedural activities, and supplies used for UGPIV insertions. Frequency distributions and results of Fisher’s exact test and one-way analysis of variance were reported using R v.3.5.2.Results: A total of 26,649 surveys were distributed with a response rate of 5.5% (n = 1475). Forty-eight percent of respondents (n = 709) indicated that they worked in a vascular access role, 310 (21%) worked in an ED, and 455 (31%) categorized their role as other. Clinically meaningful differences existed in all variables for UGPIV procedures and supplies between departments (P < 0.0001) and in all care ...
Journal of the Association for Vascular Access, 2019
HighlightsLean leadership for process improvement. Prospective comparator multimodal design study... more HighlightsLean leadership for process improvement. Prospective comparator multimodal design study. Vascular access specialty team (VAST group 2) versus generalist nursing model (group 1). First stick success of 96%. Statistically significant improvement in dwell time with VAST versus generalist nursing model (89% versus 15% lasting until end of therapy). Projected 2.9 million in savings annually. Peripheral intravenous catheter team centralized proposal to Chief Nursing Officer (CNO) with acceptance based on outcomes. Reduction in cost per bed per year using a vascular access specialty team of $3376.Background: Peripheral intravenous catheter (PIVC) sales per year exceed that of the number of people in the United States (US), 350 million. With only 37 million US hospital patient admissions per year, these data indicate an average usage of 10 PIVCs per patient admission, suggesting a very high failure, very low success rate, and excess cost associated with PIVC insertions. Patients o...
Journal of the Association for Vascular Access, 2003
Journal of the Association for Vascular Access, 2018
Background: Dislodgement rates with intravenous catheters are reported at 1.8%–24% events per yea... more Background: Dislodgement rates with intravenous catheters are reported at 1.8%–24% events per year resulting in failed access, interrupted treatment, and greater resource consumption with catheter replacement. The purpose of this study was to quantitatively evaluate the perceptions of frequency, impact, contributing factors, and safety issues from accidental dislodgement affecting intravenous (IV) devices as reported by healthcare clinicians. Methodology: A cross-sectional descriptive survey was conducted via a voluntary online web-based survey of clinicians. Subjects were divided as those actively working in a clinical healthcare setting and those no longer active. Analysis of data was performed quantifying responses of clinicians on question of dislodgement. Results: Survey results indicate clinicians routinely observe a significant percentage of accidental dislodgement, with 68% of the 1561 respondents reporting often, daily, or multiple times daily occurrence and 96.5% identifyi...
Journal of the Association for Vascular Access, 2006
British journal of nursing (Mark Allen Publishing), Jan 26, 2018
Use of intravenous devices for the delivery of medical treatment spans all healthcare facilities ... more Use of intravenous devices for the delivery of medical treatment spans all healthcare facilities ranging from hospitals to clinics and home care. Clinical pathways are processes used by healthcare providers to integrate and illustrate the best evidence and approach to care for a specific area of practice. The Vessel Health and Preservation (VHP) model is a framework and pathway process, consisting of four quadrants, to guide initiation and management of treatment requiring intravenous access. The pathway is designed to promote preservation of the vasculature of patients from admission through discharge with a focus on acute care. This article describes the model and pathway process. Moving through the quadrants of assessment/selection, insertion, management and evaluation of outcomes the clinician receives vascular access education to establish an understanding of the key principles and is then better able to provide care to the patient. Research on the VHP model has found that pati...
Journal of Infusion Nursing, 2017
The majority of peripherally inserted central catheters (PICCs) are currently inserted with the a... more The majority of peripherally inserted central catheters (PICCs) are currently inserted with the aid of ultrasound guidance in the middle third of the upper arm. A growing patient population is presenting with challenging vessel access requiring placement of the PICC in the high upper third of the arm. To avoid this suboptimal exit site, a subcutaneous tunneling of the PICC is established away from the axilla to a more appropriate skin exit site. A prospective evaluation was performed in a single facility for all PICC placements from September 2014 to June 2015. Of the results of 685 PICC requests received during the study, 50 (7.2%) were placed with the modified Seldinger tunneling technique with 96% success. There were no reports of increased pain, insertion complications, or therapy failures. Subcutaneous tunneling, when applied to bedside PICC insertions, provides a safe, effective, and cost-efficient option for a select, more challenging patient population.
Journal of Wound, Ostomy & Continence Nursing, 2017
Patients relying on central venous access devices (CVADs) for treatment are frequently complex. M... more Patients relying on central venous access devices (CVADs) for treatment are frequently complex. Many have multiple comorbid conditions, including renal impairment, nutritional defi ciencies, hematologic disorders, or cancer. These conditions can impair the skin surrounding the CVAD insertion site, resulting in an increased likelihood of skin damage when standard CVAD management practices are employed. Supported by the World Congress of Vascular Access (WoCoVA), developed an evidence-and consensusbased algorithm to improve CVAD-associated skin impairment (CASI) identifi cation and diagnosis, guide clinical decision-making, and improve clinician confi dence in managing CASI. A scoping review of relevant literature surrounding CASI management was undertaken March 2014, and results were distributed to an international advisory panel. A CASI algorithm was developed by an international advisory panel of clinicians with expertise in wounds, vascular access, pediatrics, geriatric care, home care, intensive care, infection control and acute care, using a 2-phase, modifi ed Delphi technique. The algorithm focuses on identifi cation and treatment of skin injury, exit site infection, noninfectious exudate, and skin irritation/contact dermatitis. It comprised 3 domains: assessment, skin protection, and patient comfort. External validation of the algorithm was achieved by prospective pre-and posttest design, using clinical scenarios and self-reported clinician confi dence (Likert scale), and incorporating algorithm feasibility and face validity endpoints. The CASI algorithm was found to signifi cantly increase participants' confi dence in the assessment and management of skin injury (P = .002), skin irritation/contact dermatitis (P = .001), and noninfectious exudate (P < .01). A majority of participants reported the algorithm as easy to understand (24/25; 96%), containing all necessary information (24/25; 96%). Twenty-four of 25 (96%) stated that they would recommend the tool to guide management of CASI.
Journal of vascular and interventional radiology : JVIR, Jan 11, 2017
To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occl... more To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occlusion. Data from a multihospital study were used to examine factors associated with PICC occlusion. Occlusion was defined if documented in the medical record or when tissue plasminogen activator was administered for occlusion-related concerns. Mixed-effects logistic regression was used to predict occlusion, controlling for patient-, provider-, device-, and hospital-level characteristics. A total of 14,278 PICCs placed in 13,408 patients were included. Of these, occlusion developed in 1,716 PICCs (12%) in 1,684 patients. The most common indications for PICC insertion were intravenous antibiotic therapy (32.7%), difficult intravenous access (21.5%), and central access (13.7%). PICCs placed in the right arm had decreased odds of occlusion compared with those in the left arm (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.72-0.94). Verification of catheter tip position following in...
Journal of vascular and interventional radiology : JVIR, Jan 11, 2017
To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occl... more To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occlusion. Data from a multihospital study were used to examine factors associated with PICC occlusion. Occlusion was defined if documented in the medical record or when tissue plasminogen activator was administered for occlusion-related concerns. Mixed-effects logistic regression was used to predict occlusion, controlling for patient-, provider-, device-, and hospital-level characteristics. A total of 14,278 PICCs placed in 13,408 patients were included. Of these, occlusion developed in 1,716 PICCs (12%) in 1,684 patients. The most common indications for PICC insertion were intravenous antibiotic therapy (32.7%), difficult intravenous access (21.5%), and central access (13.7%). PICCs placed in the right arm had decreased odds of occlusion compared with those in the left arm (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.72-0.94). Verification of catheter tip position following in...
Journal of the Association for Vascular Access, 2016
The research presented in this article examines the effects of implementing a prevention program ... more The research presented in this article examines the effects of implementing a prevention program for bullying and aggressive behaviors to sixth graders in 14 Florida middle schools. The evaluation was conducted as a control/experimental design. The primary goals of this manuscript are to determine: (a) the change from baseline student habits of thought related to violence prevention, (b) student habits of thought related to attitudes and physical behaviors related to violence, and (c) teacher perceptions of student attitudes and behaviors related to violence. Equally important, this study adds to our understanding of bullying prevention programs by examining the impact of an Aggressors,' Victims' and Bystanders' program in terms of three dimensions: (1) teacher perceptions of student thoughts and behaviors related to their ability to solve conflict, (2) middle school student habits of thought about violence prevention, and (3) middle school student attitudes about behaviors associated with the prevention of violence, including aggressor behaviors and actions and bystander behaviors and actions.
American Journal of Health-System Pharmacy, 2022
Purpose The study’s purpose was to measure the impact of anti-reflux needleless connector usage i... more Purpose The study’s purpose was to measure the impact of anti-reflux needleless connector usage in prevention of intraluminal thrombotic occlusions among central venous catheters, as represented by alteplase usage, in a home infusion patient population. Methods An18-month before-and-after cohort study of a single home infusion intervention was conducted to compare occlusion outcomes with use of two types of needleless connectors—neutral and anti-reflux—in preventing catheter occlusions, which have been reported to occur in 28% of home infusion patients, resulting in treatment delays, increased nursing encounters and emergency room visits, and higher overall pharmacy costs for supplies and alteplase. Results A total of 552,707 patient therapy days were studied: 42.5% in the neutral needleless connector group (n = 235,004 therapy days) and 57.5% in the anti-reflux needleless connector group (n = 317,703 therapy days). The rate of alteplase usage with neutral versus anti-reflux needlel...
adaptation, distribution and reproduction in any medium or format, as long as you give appropriat... more adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
The journal of vascular access, 2021
Maintaining peripheral vascular access represents a major challenge for medical providers and pat... more Maintaining peripheral vascular access represents a major challenge for medical providers and patients leading to the emergence of ultrasound guided vascular access teams. Upper extremity peripheral vascular access options are often limited in the chronically ill patient population with end stage cancer, patients with severe contractures, tracheostomies, and feeding tubes and patients referred for palliative care are just some examples of patients who live with difficult access. The following is a case description of a mid-thigh superficial femoral vein midline catheter for comfort care medications in a patient with exhausted peripheral vasculature on hospice.
Intravascular catheters are indispensable tools in acute care, but with the benefits come the ris... more Intravascular catheters are indispensable tools in acute care, but with the benefits come the risk of local or systemic Healthcare Acquired Infections (HAIs). In fact, more than 250,000-500,000 intravascular-related bloodstream infections occur in the United States each year with resulting mortality rates of 12%-25%. (Maki, Kluger & Crnich, 2006; CDC, 2002). While bloodstream infections related to the use of peripheral lines may not occur as often as they do with central lines, they do occur. Although most studies focus on central catheter-related bloodstream infections due to their greater documented preva- lence and severity, some studies have evaluated the prevalence of peripheral intravenous catheter-associated bloodstream infections. In 2006 Maki reviewed 200 studies that prospectively examined the risk of Bloodstream Infections (BSIs) associ- ated with intravascular devices over a forty year period. The infection rate with peripheral intravenous catheters was 0.5 per 1000 cath...
Intravascular catheters are indispensable tools in acute care, but with the benefits come the ris... more Intravascular catheters are indispensable tools in acute care, but with the benefits come the risk of local or systemic Healthcare Acquired Infections (HAIs). In fact, more than 250,000-500,000 intravascular-related bloodstream infections occur in the United States each year with resulting mortality rates of 12%-25%. (Maki, Kluger & Crnich, 2006; CDC, 2002). While bloodstream infections related to the use of peripheral lines may not occur as often as they do with central lines, they do occur. Although most studies focus on central catheter-related bloodstream infections due to their greater documented preva- lence and severity, some studies have evaluated the prevalence of peripheral intravenous catheter-associated bloodstream infections. In 2006 Maki reviewed 200 studies that prospectively examined the risk of Bloodstream Infections (BSIs) associ- ated with intravascular devices over a forty year period. The infection rate with peripheral intravenous catheters was 0.5 per 1000 cath...
Intravascular catheters are indispensable tools in acute care, but with the benefits come the ris... more Intravascular catheters are indispensable tools in acute care, but with the benefits come the risk of local or systemic Healthcare Acquired Infections (HAIs). In fact, more than 250,000-500,000 intravascular-related bloodstream infections occur in the United States each year with resulting mortality rates of 12%-25%. (Maki, Kluger & Crnich, 2006; CDC, 2002). While bloodstream infections related to the use of peripheral lines may not occur as often as they do with central lines, they do occur. Although most studies focus on central catheter-related bloodstream infections due to their greater documented preva- lence and severity, some studies have evaluated the prevalence of peripheral intravenous catheter-associated bloodstream infections. In 2006 Maki reviewed 200 studies that prospectively examined the risk of Bloodstream Infections (BSIs) associ- ated with intravascular devices over a forty year period. The infection rate with peripheral intravenous catheters was 0.5 per 1000 cath...
Professioni infermieristiche, 2020
INTRODUCTION Although there are many methods to confirm vascular device tip, chest x-ray represen... more INTRODUCTION Although there are many methods to confirm vascular device tip, chest x-ray represents the recommended procedure to verify the correct positioning of a central device, but it exposes patients to x-rays, delays treatment, and permits device length to be checked post-procedure. AIM To evaluate the efficacy of Peripherally Inserted Central Catheter positioning through an Integrated System (ultrasound-guided and electrocardiogram confirmation). METHODS A case-control study was conducted on a randomized sample of 165 patients, requiring Peripherally Inserted Central Catheter placement for chemotherapy treatment. The case group was composed of patients with vascular device placed through the Integrated System and the control group devices' length was anthropometrically estimated. Chest radiography was performed on both groups to verify tip location. RESULTS No cases of primary malposition related to the Integrated System were registered. The vascular devices positioned wi...
Background: The current standard of care for Peripherally Inserted Central Catheters (PICCs) is r... more Background: The current standard of care for Peripherally Inserted Central Catheters (PICCs) is radiological con- firmation of terminal tip location. Tip location practices in Europe have used electrocardiographic (EKG) guided posi- tioning for central venous catheters for more than twenty years with tip positioning safely confirmed over thousands of insertions (Madias, 2003). The goal of this group was to confirm the findings of a study performed by Pittiruti and his team; and to establish safe function in the use of EKG guidance for verification of terminal tip position with PICCs placed at McKenzie Willamette Medical Center. Methods: In 2008/2009 McKenzie Willamette Medical Center conducted a study to determine whether or not EKG guidance can be used as a reliable means to accurately place and confirm terminal tip location of PICCs. A group of trained nurses performed PICC placement using EKG guidance followed by radiological confirmation of SVC position. All PICCs placed from Oc...
Journal of the Association for Vascular Access, 2020
HighlightsBackground: The purpose of this study was to investigate ultrasound-guided peripheral i... more HighlightsBackground: The purpose of this study was to investigate ultrasound-guided peripheral intravenous (UGPIV) supply usage practices by clinicians working in vascular access, in emergency departments (EDs), or in other roles.Methodology: In 2019, a voluntary cross-sectional descriptive survey was conducted via SurveyMonkey. Data collected included demographics, practice-oriented information, procedural activities, and supplies used for UGPIV insertions. Frequency distributions and results of Fisher’s exact test and one-way analysis of variance were reported using R v.3.5.2.Results: A total of 26,649 surveys were distributed with a response rate of 5.5% (n = 1475). Forty-eight percent of respondents (n = 709) indicated that they worked in a vascular access role, 310 (21%) worked in an ED, and 455 (31%) categorized their role as other. Clinically meaningful differences existed in all variables for UGPIV procedures and supplies between departments (P < 0.0001) and in all care ...
Journal of the Association for Vascular Access, 2019
HighlightsLean leadership for process improvement. Prospective comparator multimodal design study... more HighlightsLean leadership for process improvement. Prospective comparator multimodal design study. Vascular access specialty team (VAST group 2) versus generalist nursing model (group 1). First stick success of 96%. Statistically significant improvement in dwell time with VAST versus generalist nursing model (89% versus 15% lasting until end of therapy). Projected 2.9 million in savings annually. Peripheral intravenous catheter team centralized proposal to Chief Nursing Officer (CNO) with acceptance based on outcomes. Reduction in cost per bed per year using a vascular access specialty team of $3376.Background: Peripheral intravenous catheter (PIVC) sales per year exceed that of the number of people in the United States (US), 350 million. With only 37 million US hospital patient admissions per year, these data indicate an average usage of 10 PIVCs per patient admission, suggesting a very high failure, very low success rate, and excess cost associated with PIVC insertions. Patients o...
Journal of the Association for Vascular Access, 2003
Journal of the Association for Vascular Access, 2018
Background: Dislodgement rates with intravenous catheters are reported at 1.8%–24% events per yea... more Background: Dislodgement rates with intravenous catheters are reported at 1.8%–24% events per year resulting in failed access, interrupted treatment, and greater resource consumption with catheter replacement. The purpose of this study was to quantitatively evaluate the perceptions of frequency, impact, contributing factors, and safety issues from accidental dislodgement affecting intravenous (IV) devices as reported by healthcare clinicians. Methodology: A cross-sectional descriptive survey was conducted via a voluntary online web-based survey of clinicians. Subjects were divided as those actively working in a clinical healthcare setting and those no longer active. Analysis of data was performed quantifying responses of clinicians on question of dislodgement. Results: Survey results indicate clinicians routinely observe a significant percentage of accidental dislodgement, with 68% of the 1561 respondents reporting often, daily, or multiple times daily occurrence and 96.5% identifyi...
Journal of the Association for Vascular Access, 2006
British journal of nursing (Mark Allen Publishing), Jan 26, 2018
Use of intravenous devices for the delivery of medical treatment spans all healthcare facilities ... more Use of intravenous devices for the delivery of medical treatment spans all healthcare facilities ranging from hospitals to clinics and home care. Clinical pathways are processes used by healthcare providers to integrate and illustrate the best evidence and approach to care for a specific area of practice. The Vessel Health and Preservation (VHP) model is a framework and pathway process, consisting of four quadrants, to guide initiation and management of treatment requiring intravenous access. The pathway is designed to promote preservation of the vasculature of patients from admission through discharge with a focus on acute care. This article describes the model and pathway process. Moving through the quadrants of assessment/selection, insertion, management and evaluation of outcomes the clinician receives vascular access education to establish an understanding of the key principles and is then better able to provide care to the patient. Research on the VHP model has found that pati...
Journal of Infusion Nursing, 2017
The majority of peripherally inserted central catheters (PICCs) are currently inserted with the a... more The majority of peripherally inserted central catheters (PICCs) are currently inserted with the aid of ultrasound guidance in the middle third of the upper arm. A growing patient population is presenting with challenging vessel access requiring placement of the PICC in the high upper third of the arm. To avoid this suboptimal exit site, a subcutaneous tunneling of the PICC is established away from the axilla to a more appropriate skin exit site. A prospective evaluation was performed in a single facility for all PICC placements from September 2014 to June 2015. Of the results of 685 PICC requests received during the study, 50 (7.2%) were placed with the modified Seldinger tunneling technique with 96% success. There were no reports of increased pain, insertion complications, or therapy failures. Subcutaneous tunneling, when applied to bedside PICC insertions, provides a safe, effective, and cost-efficient option for a select, more challenging patient population.
Journal of Wound, Ostomy & Continence Nursing, 2017
Patients relying on central venous access devices (CVADs) for treatment are frequently complex. M... more Patients relying on central venous access devices (CVADs) for treatment are frequently complex. Many have multiple comorbid conditions, including renal impairment, nutritional defi ciencies, hematologic disorders, or cancer. These conditions can impair the skin surrounding the CVAD insertion site, resulting in an increased likelihood of skin damage when standard CVAD management practices are employed. Supported by the World Congress of Vascular Access (WoCoVA), developed an evidence-and consensusbased algorithm to improve CVAD-associated skin impairment (CASI) identifi cation and diagnosis, guide clinical decision-making, and improve clinician confi dence in managing CASI. A scoping review of relevant literature surrounding CASI management was undertaken March 2014, and results were distributed to an international advisory panel. A CASI algorithm was developed by an international advisory panel of clinicians with expertise in wounds, vascular access, pediatrics, geriatric care, home care, intensive care, infection control and acute care, using a 2-phase, modifi ed Delphi technique. The algorithm focuses on identifi cation and treatment of skin injury, exit site infection, noninfectious exudate, and skin irritation/contact dermatitis. It comprised 3 domains: assessment, skin protection, and patient comfort. External validation of the algorithm was achieved by prospective pre-and posttest design, using clinical scenarios and self-reported clinician confi dence (Likert scale), and incorporating algorithm feasibility and face validity endpoints. The CASI algorithm was found to signifi cantly increase participants' confi dence in the assessment and management of skin injury (P = .002), skin irritation/contact dermatitis (P = .001), and noninfectious exudate (P < .01). A majority of participants reported the algorithm as easy to understand (24/25; 96%), containing all necessary information (24/25; 96%). Twenty-four of 25 (96%) stated that they would recommend the tool to guide management of CASI.
Journal of vascular and interventional radiology : JVIR, Jan 11, 2017
To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occl... more To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occlusion. Data from a multihospital study were used to examine factors associated with PICC occlusion. Occlusion was defined if documented in the medical record or when tissue plasminogen activator was administered for occlusion-related concerns. Mixed-effects logistic regression was used to predict occlusion, controlling for patient-, provider-, device-, and hospital-level characteristics. A total of 14,278 PICCs placed in 13,408 patients were included. Of these, occlusion developed in 1,716 PICCs (12%) in 1,684 patients. The most common indications for PICC insertion were intravenous antibiotic therapy (32.7%), difficult intravenous access (21.5%), and central access (13.7%). PICCs placed in the right arm had decreased odds of occlusion compared with those in the left arm (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.72-0.94). Verification of catheter tip position following in...
Journal of vascular and interventional radiology : JVIR, Jan 11, 2017
To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occl... more To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occlusion. Data from a multihospital study were used to examine factors associated with PICC occlusion. Occlusion was defined if documented in the medical record or when tissue plasminogen activator was administered for occlusion-related concerns. Mixed-effects logistic regression was used to predict occlusion, controlling for patient-, provider-, device-, and hospital-level characteristics. A total of 14,278 PICCs placed in 13,408 patients were included. Of these, occlusion developed in 1,716 PICCs (12%) in 1,684 patients. The most common indications for PICC insertion were intravenous antibiotic therapy (32.7%), difficult intravenous access (21.5%), and central access (13.7%). PICCs placed in the right arm had decreased odds of occlusion compared with those in the left arm (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.72-0.94). Verification of catheter tip position following in...
Journal of the Association for Vascular Access, 2016
The research presented in this article examines the effects of implementing a prevention program ... more The research presented in this article examines the effects of implementing a prevention program for bullying and aggressive behaviors to sixth graders in 14 Florida middle schools. The evaluation was conducted as a control/experimental design. The primary goals of this manuscript are to determine: (a) the change from baseline student habits of thought related to violence prevention, (b) student habits of thought related to attitudes and physical behaviors related to violence, and (c) teacher perceptions of student attitudes and behaviors related to violence. Equally important, this study adds to our understanding of bullying prevention programs by examining the impact of an Aggressors,' Victims' and Bystanders' program in terms of three dimensions: (1) teacher perceptions of student thoughts and behaviors related to their ability to solve conflict, (2) middle school student habits of thought about violence prevention, and (3) middle school student attitudes about behaviors associated with the prevention of violence, including aggressor behaviors and actions and bystander behaviors and actions.
Vascular access is a high volume, high impact clinical process. Insertion of an intravenous devic... more Vascular access is a high volume, high impact clinical
process. Insertion of an intravenous device is the
most common invasive procedure performed with
hospitalized patients. Unfortunately, little has been
done to quantify or qualify an intentional process for
vascular access selection and management for this
common invasive procedure. Traditional intravenous
access is reactive, painful and ineffective, often
resulting in exhaustion of all peripheral veins prior
to consideration of other access options. Evidence
suggests clinical pathway models improve outcomes
by reducing variations and establishing processes
to evaluate and coordinate care thus minimizing
fragmentation and cost. In 2008, a multidisciplinary
summit convened to assess current clinical practice
problems and create a proactive model for acute
care management of vascular access. From that
summit a new vascular access pathway approach
was created based on published evidence, standards
and best practice guidelines. The protocol, called
the Vessel Health and Preservation Protocol (VHP),
is a systematic clinical pathway with measurable
objectives incorporating patient-focused safety for The
Right Line for The Right Patient at The Right Time™
approach. Timely, intentional proactive intervention
for device selection implemented within 24 hours
of admission to acute care, with device placement
within 48 hours reaps reliable access, reduced delays
in treatment administration and improved patient
satisfaction. Vessel Health and Preservation is an
approach to patient care utilizing Clinical Pathway
Protocols to improve vascular access selection
flow and reduce patient risk. Implementation of an
organized approach to vascular access provides
the educational, regulatory and clinical outcomes
necessary for reliable vascular access and improved
patient safety.
Intravenous access is a requirement for patients in today's acute care medical treatment plan. Pl... more Intravenous access is a requirement for patients in today's acute care medical treatment plan. Placement of vascular access devices, especially central venous access devices when not necessary places the patient at undue risk of a healthcare acquired infection or complications. Understanding the evidence, guidelines and indications for the most appropriate device is necessary to effectively deliver safe treatment.