Infusion Nursing

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A Day in the Life of a CVAD Patients are increasingly receiving therapy at home via central vascular access devices (CVADs). Limited data exist regarding patients' experiences with outpatient CVADs. This study characterized outpatient CVAD care via 14-day patient diaries. Information included location, frequency, and purpose of CVAD access episodes and who performed CVAD care. Across all patients, 77% of care was provided in the patient's home compared with other sites. Home care was provided via self-care (48%), by a family member/caregiver (25%), or by a nurse (27%). Flushing the device was the most frequent reason for device access (52%). An occlusion rate of 9.57 per 1000 device days was also noted. Further examination of CVAD maintenance and patient/care provider education is warranted.

Caregiver Training for Pediatric Home Parenteral Nutrition: A 5-Session Discharge Curriculum To maximize safety and the patient experience, caregivers require intensive training to administer home parenteral nutrition (HPN) before initial hospital discharge. This article provides the rationale, best practices, and a template for caregiver predischarge HPN education provided by nurses. The standardized HPN discharge curriculum is outlined over 5 didactic and hands-on sessions.

Trifecta of Collaboration: Working Together to Improve Central Line-Associated Bloodstream Infection Reduction in a Pediatric Cardiac Intensive Care Unit Central line-associated bloodstream infection (CLABSI) can result in increased length of hospital stay and increased costs for both patients and organizations. This article illustrates how a multidisciplinary collaboration and the use of scientific evaluation and implementation tools can facilitate a decrease in CLABSIs and have a positive effect on staff satisfaction when caring for central lines.

To Replace or Not to Replace? Replacing Short Peripheral Catheters Based on Clinical Indication Short peripheral catheters (SPCs) are the most frequently used medical devices in hospital settings. Many hospital policies state that SPCs be replaced at 96 hours, which can be unnecessary and costly. A pre–post quality improvement initiative was implemented following complications surrounding removal of timed SPC catheters compared with those removed by clinical indication, using the Visual Infusion Phlebitis (VIP) scale. Data collected included patient demographics, SPC characteristics, nursing time, and product use. SPCs replaced based on clinical indication remained intact longer and had fewer complications than those in the group with routinely replaced SPCs. Decreasing SPC replacements by use of clinical indication resulted in cost savings of $7263.60/unit/month.

Accepted but Unacceptable: Peripheral IV Catheter Failure: 2019 Follow-up EDITOR'S NOTE Still considered a "hot topic" 4 years later, JIN is pleased to reprint this classic article from May/June 2015, Issue 3. Since publication, "Accepted but Unacceptable: Peripheral IV Catheter Failure" has been downloaded nearly 400 times and cited dozens of times in other related research. Based on these data, we asked the lead author to update readers on the status of catheter failure and what has been improved since 2015.

Accepted but Unacceptable: Peripheral IV Catheter Failure Peripheral intravenous (IV) catheter insertion, the most common invasive hospital procedure performed worldwide, is associated with a variety of complications and an unacceptably high overall failure rate of 35% to 50% in even the best of hands. Catheter failure is costly to patients, caregivers, and the health care system. Although advances have been made, analysis of the mechanisms underlying the persistent high rate of peripheral IV failure reveals opportunities for improvement.

Alexandros Sfakianakis
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