The journal of vascular access
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Observational Study
Association between multiple IV attempts and perceived pain levels in the emergency department.
Intravenous (IV) access is the most commonly performed procedure in the emergency department (ED). Patients with difficult venous access require multiple needlesticks (MNS) for successful IV cannulation and may experience increased pain with many attempts. ⋯ Patients experience increased pain in association with multiple IV attempts.
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Central venous catheterization is a commonly used procedure to gain access to the central circulation. Although ultrasound guidance decreases the complication rates, arterial puncture may still occur. Failure to recognize this early may lead to devastating complications such as thrombosis and embolic stroke. We discuss the factors associated with increased risk of arterial puncture, techniques to detect them early and the management of established carotid artery cannulation. ⋯ Even with ultrasound-guided central venous catheterization, it is essential to remain vigilant for the early detection of vascular complications. Clinical suspicion combined with diagnostic modalities such as chest radiograph, transduction and manometry can increase the detection rates.
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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.