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ObjectiveThis study aimed to evaluate the utility of optical sensor-based technology in mitigating the frequency and severity of peripheral intravenous infiltration and/or extravasation (PIVIE) in neonates.DesignSingle-centre, retrospective, observational cohort study.SettingTertiary-level neonatal intensive care unit (NICU) (112 cots) at the Women’s Wellness and Research Centre (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar, January 2019–December 2022.ParticipantsAll neonates admitted to the NICU requiring intravenous therapy via a neonatal short peripheral intravenous catheter (n-SPC) were included. Participants were excluded if the insertion was unsuccessful, if they had incomplete data, or if they received intravenous therapy exclusively through alternative vascular access devices.InterventionsThe study analysed two cohorts representing different clinical practices over two distinct periods. In the conventional cohort (Phase 1, 2019–2020), PIVIE detection relied solely on periodic ‘Touch Look Compare (TLC)’ assessments. In the ivWatch cohort (Phase 2, 2021–2022), continuous optical sensor-based monitoring using the ivWatch system was implemented alongside TLC assessments. This sequential design allowed for a comparison of outcomes between the two phases.Outcome measurementsThe primary outcomes were the occurrence and severity of PIVIE. Secondary outcomes included the influence of patient demographics, vascular access characteristics, and management details on PIVIE incidence and severity.ResultsOver the 4-year data collection period, 32 713 peripheral intravenous catheters were analysed across two cohorts. PIVIE was the most common reason for unplanned device removal. In the conventional cohort (Phase 1, 2019–2020), 4941 infiltration events were reported (29.9%), compared with 4872 events (30.1%) in the ivWatch cohort (Phase 2, 2021–2022). However, severity measures using the Intravenous Extravasation Grading Scale (IEGS) revealed a marked reduction in severe PIVIE cases, with severe events decreasing from 243 (4.9%) in the conventional cohort to 54 (1.1%) in the ivWatch cohort (p<0.001).ConclusionsPIVIE remains a frequent complication in neonatal vascular access. Continuous site monitoring with optical sensor technology was associated with earlier detection of PIVIE events and reduced IEGS severity scores. These findings highlight the potential of integrating sensor-based monitoring with traditional observational methods to improve patient outcomes in neonatal care.

Intravenous cannulation is usually the first procedure performed in modern healthcare, although establishing peripheral intravenous access is challenging in some patients. The impact of the ratio between venous diameter and the size of the inserted catheter (catheter to vein ratio, CVR) on the first attempt success rate can be of added value in clinical. This study tries to give insight into the consideration that must be made when selecting the target vein and the type of catheter, and proved the null hypothesis that an optimal CVR would not be associated with increased first attempt cannulation success. This was a post-hoc analyses on adult patients admitted for peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines, by applying the traditional landmark approach. The CVR was calculated afterwards for each individual patient by dividing the external diameter of the inserted catheter by the diameter of the target vein, which was multiplied by 100%. In total, 610 patients were included. The median CVR was 0.39 (0.15) in patients with a successful first attempt, whereas patients with an unsuccessful first attempt had a median CVR of 0.55 (0.20) (P<0.001). The optimal cut-off point of the CVR was 0.41. First attempt cannulation was successful in 92% of patients with a CVR0.41 had a first attempt success rate of 65% (P<0.001). This first introduction of the CVR in relation to cannulation success should be further investigated. Although, measuring the venous diameter or detection of a vein with a specific diameter prior to cannulation may increase first attempt cannulation success.

Neonatal-short peripheral intravenous catheters (n-SPCs) and neonatal-long peripheral intravenous catheters (n-LPCs) are widely used for short-term vascular access in neonates. A retrospective single-centred cohort study was conducted in the neonatal intensive care unit between 2019 and 2022 to compare the 2 types of catheters. A total of 34,464 catheter insertions were analysed (32,885 n-SPCs, 1,579 n-LPCs). n-LPCs had longer dwell time (48:27 ± 39:08 h versus 34:01 ± 33:31 h, p  < 0.001). Accidental removals were lower in n-LPCs (0.3% versus 2.6%, p  < 0.001). n-LPCs had higher rates of phlebitis (16.1% versus 6.6%, p  < 0.001) and peripheral intravenous infiltration or extravasation (PIVIE) rate (40.0% versus 29.9%). Severe PIVIE (≥ 30% severity) was higher in n-LPCs (8.5% versus 2.8%, p  < 0.001). n-LPCs offer a more stable and effective option for peripheral vascular access in neonates. Their use should be balanced with strategies to reduce the risk of phlebitis and severe PIVIE.

Correspondence to Matheus van Rens, Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar; matheusvanrens@gmail.com Intravenous vascular access (VA) is essential in neonatal intensive care units (NICUs). Short peripheral intravenous catheters (PIVCs) are the most frequently used short-term device.1 Many unmodifiable and potentially modifiable factors affect the incidence of complications, contributing to the success or failure of therapy.2 Numerous interventions such as evidence-based care bundles, innovations in device design and manufacturer are targeted at reducing the incidence and severity of complications.3 Internationally, specialist multiprofessional teams for central venous access are widely established4 but evidence about the impacts of teams for managing peripheral intravenous access is less evident. [...]we aimed to examine the impacts of a dedicated neonatal peripheral vascular access team (NeoVAT) on key clinical and organisational quality measures of infusion therapy. [...]economic analysis to determine a fuller picture is required.Table 1 NeoVAT results Factor 2018 2019 2020 RR P value Insertion success  Overall insertion success 81% 82% 96% 0.84 (0.83–0.85) <0.001  1st attempt success – 60% 68% 0.88 (0.85–0.91) <0.001  Average attempts 1.7 1.5 1.4 <0.001 Dwell time  Average dwell time* 32 hours 34 hours 36 hours <0.001 PLABSI  PLABSI events (n=events) 52 25 19  PLABSI rate per 1000 /days 1.68 0.78 0.55 0.47 (0.29–0.77) <0.001 Complications  Failure of therapy 58.5% 55.0% 49.6% 0.85 (0.83–0.87) <0.001  Occurrence phlebitis 47.0% 41.0% 32.0% 0.68 (0.65–0.71) <0.001  PIVIE Severity Score 21 15 13 <0.001 *Dwell time calculated from date and time of insertion to date and time of removal.

Peripheral intravenous cannulation is the most common invasive hospital procedure but is associated with a high failure rate. This study aimed to improve the A-DIVA scale (Adult Difficult Intra Venous Access Scale) by external validation, to predict the likelihood of difficult intravenous access in adults. This multicenter study was carried out throughout five hospitals in the Netherlands. Adult participants were included, regardless of their indication for intravenous access, demographics, and medical history. The main outcome variable was defined as failed peripheral intravenous cannulation on the first attempt. A total of 3587 participants was included in this study. The first attempt success rate was 81%. Finally, five variables were included in the prediction model: a history of difficult intravenous cannulation, a difficult intravenous access as expected by the practitioner, the inability to detect a dilated vein by palpating and/or visualizing the extremity, and a diameter of the selected vein less than 3 millimeters. Based on a participant’s individual score on the A-DIVA scale, they were classified into either a low, moderate, or high-risk group. A higher score on the A-DIVA scale indicates a higher risk of difficult intravenous access. The five-variable additive A-DIVA scale is a reliable and generalizable predictive scale to identify patients at risk of difficult intravenous access.

(1) Background: In Portugal, no accurate and reliable predictive instruments are known that could assist healthcare professionals in recognizing patients with difficult venous access. Thus, this study aimed to translate and validate the Modified A-DIVA scale to European Portuguese. (2) Methods: A methodological and cross-sectional study was conducted in two phases: translation of the Modified A-DIVA scale to European Portuguese following six stages proposed by Beaton and collaborators, and assessment of its psychometric properties in a non-probability sample of 100 patients who required peripheral intravenous catheterization in a Portuguese hospital. (3) Results: The European version of the Modified A-DIVA scale (A-DM scale) showed excellent inter-rater accordance scores, k = 0.593 (95% CI, 0.847 to 0.970), p < 0.0005. The A-DM scale’s criterion and construct validity was assessed through predictive, convergent, and correlational analysis with variables identified in the literature as associated with difficult peripheral intravenous access, with moderate to large magnitudes and statistical significance. (4) Conclusions: The A-DM scale is a reliable and valid instrument that can support healthcare professionals and researchers in the early identification of patients at risk of difficult peripheral intravenous access. Future validation studies are needed to test the A-DM scale’s applicability across clinical settings and in different patient cohorts.

The three-dimensional shape of the ultrasound beam produces a thicker scan plane than most users assume. Viewed longitudinally, a needle placed lateral to a vessel just outside the central scanning plane can be displayed incorrectly in the ultrasound image as if placed intravascularly. This phenomenon is called the beam width artefact, also known as the elevation or slice thickness artefact. The goal of this study was to demonstrate the potential negative effect of the beam width artefact on the performance of in-plane ultrasound-guided vascular access procedures, and to provide a solution. Randomized, double-blinded study Department of anaesthesiology and intensive care of a teaching hospital 31 experienced (anesthesiologists and intensivists) and 36 inexperienced (anesthetic nurses) ultrasound users We developed an acoustic lens that narrows the scan plane to reduce the beam width artefact. The lens was tested in a simulated vascular access study. The primary endpoint was first pass success. Secondary endpoints were the number of punctures and needle withdrawals, procedure time, needle visibility and operator satisfaction. First pass success was highly enhanced using the acoustic lens, with a success rate of 92.5% versus 68.7% without the lens (difference 23.8, 95% confidence interval 11.0–35.3, p < 0.001). The total number of punctures needed to obtain intravenous access was also reduced using the lens (1.10 versus 1.38, difference 0.27, 95% CI 0.11–0.43, p = 0.002). Procedure time, needle withdrawals, needle visibility and satisfaction were similar. Both inexperienced and experienced users benefited from the acoustic lens. The beam width artefact has a significant effect on the performance of ultrasound-guided needle-based procedures. The efficacy of in-plane superficial vascular access procedures can be enhanced by narrowing the imaging plane using an acoustic lens. •The beam width artefact can negatively impact superficial ultrasound-guided in-plane procedures.•An acoustic focusing lens can attenuate the beam width artefact by reducing beam width and focus depth.•First pass success was significantly enhanced using the focusing lens in a phantom study.•The beam width artefact hinders inexperienced as well as experienced ultrasound users.

First attempt cannulation success was 73% during the first procedure, but increased to 98% on the fortieth attempt (p<0.001). [...]optimal performance of US-guided cannulation has to be completed in the least amount of time with the highest success rate on the first attempt of cannulation. [...]participants closed the theoretical training session by completing a post-test of 40 questions. All patients over 18 years of age were asked for participation regardless of their ASA (American Society of Anesthesiologists) physical status, demographics and medical history. Besides age, there were no exclusion criteria, resulting in the most real reflection of the actual population of patients.

Ultrasound increases a first-attempt success rate for vascular access when considered by knowledgeable and experienced practitioners. Education and training of these practitioners in ultrasound-guided peripheral intravenous cannulation is becoming increasingly common, although no consensus has been reached regarding its curriculum. The current systematic literature review aims to explore different training modules and components in use, and its efficacy and efficiency in ultrasound-guided peripheral intravenous cannulation in hospitalized adults by different healthcare providers. Database search was performed from January 2009 to December 2018 for publications describing the training or education of healthcare professionals in ultrasound-guided peripheral intravenous cannulation in adult patients. Data-analyses was performed on 23 studies, concluding that competency on ultrasound-guided peripheral intravenous cannulation can be achieved after following a brief training in a fixed curriculum, consisting of a didactic training session, a simulated hands-on component, and is completed after a supervised live-case training. Lectures should focus on ultrasound physics, including the vascular anatomy. The hands-on training included identification of veins on a life model without cannulating, followed by cannulation of veins using a nonhuman tissue model. At the end, supervised cannulation of veins on the upper extremity with an ultrasound-guided technique was performed on live patients to show competency.