The journal of vascular access
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In an emergency, the administration of fluids and medications remains a vital component of patient care. Although this is usually achieved via an intravenous line, intraosseous (IO) cannulation is accepted as a useful alternative for the administration of fluids and medications in situations where intravenous cannulation is difficult or impossible. Despite this, IO cannulation appeared to be infrequently performed by paramedics in Johannesburg (JHB). This study investigated factors that may be affecting the frequency with which IO cannulation is performed by paramedics in JHB. ⋯ Procedures are more inclined to move from the in-hospital to the prehospital environment if they are seen to be commonly performed, safe and effective. It would appear that paramedics infrequently witness IO cannulation being performed in emergency departments. This together with a lack of appropriate equipment, training and retraining including the perceived invasiveness and pain associated with the procedure appears to be dissuading paramedics from regularly performing IO cannulation.
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Almost all central venous catheters are placed using the Seldinger technique. Despite the introduction of ISO 11070 in 1998, we continue to see mechanical wire failures and their associated complications. ⋯ The mechanical properties of different types of guidewires show considerable differences, not detected with current ISO 11070 based testing. Uncovering those may allow set up of clinical trials to examine whether regular use of wires with high-end mechanical properties could reduce CVC insertion-related complication rates.
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Peripherally inserted central venous catheters (PICCs) are being increasingly placed at the bedside by trained vascular access professional such as nurses. This is to increase the availability of the service, for cost containment, and to reduce the workload on the interventional radiologist. We describe a single institution experience with over 700 PICC lines placed by trained nurses at the bedside and determine the success rate, malposition rate of the PICC line , degree of support needed from the Interventional radiologist, and factors affecting a successful placement of a PICC line by the nurses. ⋯ Bedside placement of PICC line by trained vascular nurses is an effective method with a high success rate, low malposition rate and requires minimal support from interventional radiology.