Journal of intravenous nursing : the official publication of the Intravenous Nurses Society
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A retrospective study of 431 patients who had peripherally inserted midclavicular or central catheters placed during a consecutive 13-month period using the conventional landmark method for placement was compared with a second group of 326 patients, who during a 12-month period had such catheters placed using ultrasonography. The data demonstrate a 42% decrease in the number of needle penetrations needed to successfully cannulate veins when ultrasound was used during placement. There is a 26% greater chance of successful cannulation of the vein on the first attempt with ultrasound-guided placements than with those using the traditional landmark method.
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Based on patient condition, intravenous therapies, caregiver support, and organizational policy, correct device selection plays an integral part in the overall care and management of the alternate care setting i.v. therapy patient. This paper will identify the various aspects of appropriate device selection for i.v. therapy prescriptions.
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Experience and comfort with central venous access devices (CVADs) has increased dramatically during the past 2 decades. However, coordination of care remains a challenge as patients with long-term catheters move between levels of care with multiple healthcare providers. ⋯ Effective communication among all care providers enhances teamwork and improves efficiency. The consistent collection and evaluation of data regarding CVAD complications and outcomes is important for assessing quality and determining best practices.
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The role of the interventional radiologist in the care of patients requiring placement of central venous access devices is rapidly evolving. With experience gained from diagnosing and treating central venous catheter-related complications, interventional radiologists are assuming an increasing role in the placement of these devices. With imaging guidance, catheter and guidewire skills, and a commitment to providing a clinical service that includes management of catheter malfunctions and complications, central venous access by the interventional radiologist has proven a safe and effective alternative to standard surgical techniques.
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Pain management is rapidly changing as the mysteries of how healthy and damaged nervous systems work to communicate pain to the brain become better understood. The role of subcutaneous or intravenous lidocaine in the management of neuropathic pain has been increasingly studied. Patients with a variety of pain have been shown to benefit from this therapy, including patients with cancer, postherpetic neuralgia, second degree burns, strokes, and diabetes. As research and experience grow, so too will the practitioner's ability to successfully use intravenous and subcutaneous lidocaine therapy for their patients with pain.