Journal of intravenous nursing : the official publication of the Intravenous Nurses Society
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Review Practice Guideline Guideline
Guidelines for the management of intravascular catheter-related infections.
These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications. ⋯ Therefore, the recommendations in these guidelines are intended to support, and not replace, good clinical judgment. Also, a section on selected, unresolved clinical issues that require further study and research has been included. There is an urgent need for large, well-designed clinical studies to delineate management strategies more effectively, which will improve clinical outcomes and save precious health care resources.
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Patients who do not report pain and healthcare providers who fail to assess for pain are major barriers to the relief of pain. Using pain as the fifth vital sign and being knowledgeable about pain assessment and management can help nurses and other healthcare providers overcome many of the barriers to successful pain control. A successful pain control plan includes establishing the pain diagnosis, treating the cause of the pain when possible, optimizing analgesic use, implementing nonpharmacological interventions to maximize physical and psychological comfort and function, and referring the patient for invasive pain management options when indicated.
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The frequency of vascular access device (VAD) complications increases with the complexity of therapy or poor catheter maintenance. Catheter occlusions are most frequently caused by inadequate catheter flushing or technique. ⋯ The incidence of catheter patency loss was reduced by 50%. The nurses also reported considerable timesaving in catheter maintenance and patient education and an overwhelmingly positive response from staff and patients.
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Protracted venous infusion of 5-fluorouracil (5-FU) is a common treatment for patients with gastrointestinal malignancy. A central venous access device is required for safe and effective drug delivery. This study uses a survival analysis to compare the useful life and treatment completion success of tunelled centrally placed catheters (TCPCs) and peripherally inserted central catheters (PICCs). ⋯ Survival of indwelling catheters was similar for both devices for the first 120 days, but after that TCPC survival was statistically better than that of PICCs (P = 0.051). Complications occurred in 61% of patients with TCPCs and 67% of patients with PICCs. The authors conclude that PICCs provide less invasive, more cost-effective, and easier to schedule central venous access for 5-FU infusion; however, their advantage over TCPCs decreases significantly in treatments lasting more than 120 days.
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To determine the incidence of peripheral intravenous therapy-related phlebitis in an adult population, 305 peripheral i.v. catheter sites were observed from the time of admission of the patient (or initiation of the first peripheral i.v. catheter) to the time of the participant's discharge from the facility (or 48 hours after the removal of the final catheter). Parameters monitored included patient demographics, diagnosis, i.v. fluids and medications, type of peripheral catheter, dwell time, and dressing integrity. ⋯ In three cases, although the catheter site was clear at the time of catheter removal, postinfusion phlebitis developed within 24 hours. Catheter site locations, diagnoses, medications, and i.v. fluids in these cases were varied.