References
- Assessing and Addressing Difficult Access
- WOCOVA Difficult Intravenous Access Pathway (DIVA)- Slides
- Ehrhardt BS, et al. Making it stick: Developing and testing the difficult intravenous access (DIVA) tool. Am J Nurs 2018
- Literature reports that venipuncture skills are one of the hardest for novice nurses to master. The DIVA tool is created to help identify patients that will result in difficult IV access. 80% of nurses agree DIVA is a good indicator of IV access difficulty.
- Paje D, et al. Patterns and Predictors of Short-Term Peripherally Inserted Catheter Use: A Multicenter Prospective Cohort Study. J Hosp Med 2018
- Short-term use of PICCs is common and associated with patient, provider, and device factors. The placement of a PICC line is associated with potential complications and efforts that target reducing short-term use are necessary.
- Whalen M, et al. Outcomes of an innovative evidence-based practice project: Building a difficult-access team in the Emergency Department. Journal of Emergency Nursing 2018
- A dedicated difficult venous access team in the emergency department reduced the amount of time between physician orders to administration of medication. A dedicated DVA technician is recommended as they are a “concrete solution to threats of patient safety, as well as ED crowding, and [have] the potential to affect both patient- and department-level care.”
- Vein visualization as an important tool for patients with decreased vein visibility:
- Chiao F, et al. Vein visualization: patient characteristic factors and efficacy of a new infrared vein finder technology. British Journal of Anesthesia 2013
- Vein finder technology increased vein visibility particularly in populations with decreased vein visibility utilizing conventional methods.
- Aulagnier J, et al. Efficacy of AccuVein to facilitate peripheral intravenous placement in adults presenting to an emergency department: A randomized clinical trial. Academic Emergency Medicine 2014
- Randomization to the use of AccuVein technology vs conventional methods did not improve IV cannulation in ED patients.
- Chiao F, et al. Vein visualization: patient characteristic factors and efficacy of a new infrared vein finder technology. British Journal of Anesthesia 2013
- Value of ultrasound guidance for peripheral IV placement:
- Stolz A, et al. Ultrasound- guided peripheral venous access: a meta-analysis and systematic review. J Vasc Access 2015
- Systemic review and meta-analysis of available literature concluding that ultrasound guidance improves peripheral IV cannulation success rates.
- Scoppettuolo G, et al. Ultrasound-guided “short” midline catheters for difficult venous access in the emergency department: a retrospective analysis. Int J Emerg Med 2016
- Ultrasound guided midline catheters had a 100% success rate for achieving access in patients with veins that were difficult to visualize and/or palpate in an emergency room setting.
- Sou V, et al. A clinical pathway for the management of difficult venous access. BMC Nursing 2017
- Difficult intravenous pathway increased first attempt success at cannulation by using ultrasound guided peripheral IV insertion by a trained team to access patients with veins that were difficult to visualize and/or palpate.
- Stolz A, et al. Ultrasound- guided peripheral venous access: a meta-analysis and systematic review. J Vasc Access 2015
- Peripheral IV Catheter:
- Helm RE, et al. Accepted but unacceptable: peripheral IV catheter failure. Journal of Infusion Nursing 2015
- Peripherally IV insertion is the most common invasive procedure performed worldwide yet retains a 35% to 50% failure rate. 6 methods are presented to improve dwell time.
- Helm RE, et al. Accepted but unacceptable: peripheral IV catheter failure. Journal of Infusion Nursing 2015
- Impact of Catheter Dislodgement:
- McParlan D, et al. Intravascular catheter migration: A cross-sectional and health-economic comparison of adhesive and subcutaneous engineered stabilization devices for intravascular device securement. J Vasc Access 2020.
- This study suggests that introduction of subcutaneous ESDs has resulted in significant benefits for the patient and practitioner, and has eliminated PICC replacement due to catheter dislodgment or migration.
- Moureau, N. Impact and safety associated with accidental dislodgement of vascular access devices: A survey of professions, settings and devices. JAVA 2018
- Dislodgement rates with intravenous catheters are estimated at 1.8-24% events per year. The consequences accidental dislodgement are treatment interruptions, financial costs due to catheter replacement, and patient dissatisfaction. The most common contributing factor of dislodgement is confused patients and catheter tape or securement is loose.
- Zerla PA, et al. Evaluating safety, efficacy, and cost-effectiveness of PICC securement by subcutaneously anchored stabilization device. J Vasc Access 2017
- SAS is a highly effective and cost-conscious method for securement of medium- to long-term PICCs with expected duration longer than 30 days. Its implementation has positive impact on the organization. (*Study funded by industry)
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