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Children with chronic and complex health conditions frequently need intravenous devices. The current approach to intravenous device selection, insertion, and monitoring is inconsistent, and healthcare consumers are often negatively affected by siloed health information, and poor future planning. Despite child- and family-centred care being recognised as a pillar of paediatric nursing care, limited implementation for vascular access device planning and management is evident. To address this, we conducted a multi-phased approach to co-create, then evaluate, a mobile health (mHealth) application: IV Passport. Co-creation involved a prioritisation survey, followed by a Passport advisory panel consensus meeting. Following confirmation of the required content and features of the Passport, the mHealth application was designed and content validation achieved via survey. The prioritisation survey yielded recommendations for seven features (e.g., graphical presentations of current/past devices). Content for nine device types (e.g., totally implanted ports) was suggested, each with 10 related items (e.g., insertion site). Content items for device-associated complications, future vascular access plans, and educational resources were also suggested. Following design, the application was released through Apple and Android platforms; and adapted to a paper version. Content validation was established; 100% strongly agreed the application was easy to use; 80% agreed/strongly agreed that they would recommend the Passport to others. IV Passport embodies effective child- and family-centred care through consumer co-creation to empower patients and families manage vascular access devices. IV Passport remains active; and can be utilised across many healthcare settings and patient populations. • Current intravenous device selection, insertion, and monitoring is inconsistent. • The IV Passport has been co-created with consumers, such as children and families. • IV Passport promotes child- and family-centered care. • IV Passport remains active and can be utilised across many healthcare settings. [ABSTRACT FROM AUTHOR]

Ultrasound-guided peripheral intravenous catheter insertion has been identified as an effective method to improve the success rate of cannulation, thereby improving patient experience. However, learning this new skill is complex, and involves training clinicians from a variety of backgrounds. The aim of this study was to appraise and compare literature on educational methods in the emergency setting used to support ultrasound guided peripheral intravenous catheter insertion by different clinicians, and how effective these current methods are. A systematic integrative review was undertaken using Whittemore and Knafl's five stage approach. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. Forty-five studies met the inclusion criteria, with five themes identified. These were: the variety of educational methods and approaches; the effectiveness of the different educational methods; barriers and facilitators of education; clinician competency assessments and pathways; clinician confidence assessment and pathways. This review demonstrates that a variety of educational methods are being used in successfully training emergency department clinicians in using ultrasound guidance for peripheral intravenous catheter insertion. Furthermore, this training has resulted in safer and more effective vascular access. However, it is evident that there is a lack of consistency of formalised education programs available. A standardised formal education program and increased availability of ultrasound machines in the emergency department will ensure consistent practices are maintained, retained, therefore leading to safer practice as well as more satisfied patients. [ABSTRACT FROM AUTHOR]

• Bundled dressing and securement interventions for PIVCs are feasible and acceptable. • In this small sample, no significant differences were found in PIVC failure. • These bundled interventions should now be tested in a definitive trial. • They may be an innovative solution to the currently high PIVC failure rates. Peripheral intravenous catheters (PIVCs) are ubiquitous in acute care settings however failure rates are unacceptably high, with around half failing before prescribed treatment is complete. The most effective dressing and securement option to prolong PIVC longevity is unclear. To determine feasibility of conducting a definitive randomized controlled trial (RCT) investigating evidence-based securement bundles (medical adhesive tapes and supplementary securement products) to reduce PIVC failure. In this pilot non-masked 3-group RCT, adults requiring a PIVC for >24 hrs were randomized to Standard care (bordered polyurethane dressing plus non-sterile tape over extension tubing), Securement Bundle 1 (two sterile tape strips over PIVC hub plus Standard care) or Securement Bundle 2 (Bundle 1 plus tubular bandage) with allocation concealed until study entry. Exclusions: laboratory-confirmed positive blood culture, current/high-risk of skin tear, or study product allergy. Primary outcome: feasibility (eligibility, recruitment, retention, protocol fidelity, participant/staff satisfaction). Secondary outcomes: PIVC failure, PIVC dwell time, adverse skin events, PIVC colonization and cost. Of 109 randomized participants, 104 were included in final analyses. Feasibility outcomes were met, except eligibility criterion (79%). Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for Standard care. Incidence rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1 (95% confidence interval [CI] 0.4–2.7) and 2.1 (95% CI 0.9–5.1) for Bundles 1 and 2, respectively. A large RCT testing securement bundles is feasible, with adjustment to screening processes. Innovative dressing and securement solutions are needed to reduce unacceptable PIVC failure rates. Trial registration ACTRN12619000026123. [ABSTRACT FROM AUTHOR]

To identify the prevalence and type of central venous access device–associated skin complications for adult cancer patients, describe central venous access device management practices, and identify clinical and demographic characteristics associated with risk of central venous access device–associated skin complications. A prospective cohort study of 369 patients (626 central venous access devices; 7,682 catheter days) was undertaken between March 2017 and March 2018 across two cancer care in-patient units in a large teaching hospital. Twenty-seven percent (n = 168) of participants had a central venous access device–associated skin complication. In the final multivariable analysis, significant (P <.05) risk factors for skin complications were cutaneous graft versus host disease (2.1 times greater risk) and female sex (1.4 times greater risk), whereas totally implanted vascular access device reduced risk for skin complications by two-thirds (incidence risk ratio 0.37). Central venous access device–associated skin complications are a significant, potentially avoidable injury, requiring cancer nurses to be aware of high-risk groups and use evidence-based preventative and treatment strategies. This study has confirmed how common these potentially preventable injuries are. Therefore, the prevalence of these complications could be reduced by focusing on improvements in skin assessment, reductions in central venous access device dressing variation and improving clinician knowledge of this injury. [ABSTRACT FROM AUTHOR]

• The RAND/ULCA Appropriateness Method can inform guideline creation for IP practice • In-line suction for patients with highly infectious respiratory disease is advised • In the absence of clinical trial data, the RAND/ULCA Method can be utilized The use of the RAND/UCLA appropriateness method is an innovative way to provide practical, evidence based clinical guidance to infection preventionist (IP) in the absence of clinical trial data. This brief primer aims to introduce the IP to the methodology, including a short case study demonstrating the utilization of the method in the arena of infection prevention and management. [ABSTRACT FROM AUTHOR]

Evaluate the feasibility of an efficacy randomised control trial (RCT) of paediatric peripheral intravenous catheter (PIVC) securement to prevent failure without resultant skin damage. A 3-arm, pilot RCT in an Australian paediatric hospital. Random assignment of 330 children to receive (i) bordered polyurethane dressing (BPU) + non-sterile foam (NSF), (ii) integrated securement dressing (ISD) + sterile foam (SF), or (iii) tissue adhesive (TA)+ NSF. Primary outcomes were feasibility and PIVC failure. Secondary outcomes included: skin/bloodstream infection; occlusion; infiltration; dislodgement; phlebitis; dwell; serious adverse events; acceptability and microbial colonisation of catheter tips, wound site, and foam. Most feasibility outcomes were confirmed; 98% of eligible patients consented, 96% received their allocated dressing and no patients were lost to follow up. Eligilbility feasibility (58%) was not met. 11 randomised patients did not require a PIVC. Of 319 patients receiving a PIVC (20,716 PIVC-hours), a significant reduction in PIVC failure was demonstrated with ISD, 31/107 (29%, p = 0.017) compared to BPU, 47/105 (45%). Although not statistically significant, compared to BPU, TA 34/107 (32%, p = 0.052) was associated with less PIVC failure. On Cox regression, no securement intervention significantly reduced PIVC failure. Older age (HR 0.92; 95% confidence interval [CI] 0.88–0.96; p = <0.01), no infection at baseline (HR 0.51; 95% CI 0.34–0.78) and insertion by vascular access specialist (HR 0.40; 95% CI 0.26–0.64) were significantly associated with reduced failure (p < 0.05). ISD and TA had reduced PIVC failure compared to BPU. A large efficacy trial to test statistical differences is feasible and needed. • Integrated securement devices (ISD) and tissue adhesive (TA) offer safe, acceptable options for paediatric PIVC securement. • The added securement of TA and ISD can prevent PIVC micromotion, limiting microorganism entry through skin insertion site. • Efficacy trial of paediatric PIVC securement is feasible and necessary to confirm the results of this study. [ABSTRACT FROM AUTHOR]

To describe worldwide characteristics, performance and risk factors of peripheral intravenous catheters (PIVCs), in pediatrics. A secondary, subgroup analysis of pediatric (<18 years) data was undertaken, using a global, cross-sectional study of PIVCs. Practice characteristics included: demographic, diagnostic, utility, management, performance and resources. Multivariate regression identified complication risks factors. Data from 4206 children in 278 hospitals across 47 countries. Most PIVCs (outside of Australia, New Zealand) were inserted by nurses (71%; n = 2950), with dedicated teams only common in North America (23.2%; n = 85). Large gauges (≤18G) were mostly used in South America, Europe and Africa. Regions predominantly placed 24G (49%; n = 2060) except in Australia and New Zealand, who more commonly placed 22G (38.7%; n = 192). The most common placement was the hand (51%; n = 2143), however North America, Australia and New Zealand frequently utilised the antecubital fossa (24.5%, n = 90; 21.4%; n = 106). Polyurethane dressings were most used (67.1%; 2822), and many were not clean, dry and intact (17.1%; n = 715). Over 8% of PIVCs were idle, with the highest rates in North America (21.2%; n = 78). PIVC local complication risk factors included: >2 years age (odds ratio [OR] > 1.58; 1.2–2.1); ambulance/emergency insertion (OR 1.65; 1.2–2.3); upper arm/antecubital placement (OR 1.44; 1.1–2.0); poor dressing integrity (OR 5.4; 4.2–6.9); and 24–72 h dwell (OR > 1.9; 1.3–2.6). There is global inconsistency in pediatric PIVC practice, which may be causing harm. Improvements in pediatric PIVC placement, dressings, and gauge selection are needed. • Globally, pediatric PIVC practices are often inconsistent, and not evidence-based. • PIVC are often idle, with the highest rates of idle PIVC in North America. • Complications at the PIVC site are common. • PIVC practices are an under-recognised patient safety issue within pediatric healthcare. [ABSTRACT FROM AUTHOR]

• Exploration of factors impacting emergency department use of PIVCs is overdue. • Suboptimal PIVC practice was commonly reported by ED clinicians. • Data suggests challenging working environments contribute to suboptimal PIVC care. • Interventions are needed to enable staff to optimise adherence to Standards. Peripheral intravenous catheters (PIVCs) are commonly used devices in emergency departments (EDs), and yet relatively little is known about factors influencing Australian clinicians' adherence to the national PIVC quality and safety Standard. To explore attitudes and experiences of ED clinicians around PIVC insertion and care processes. This study used an exploratory qualitative approach to analyse written responses to open-ended questions included in an online national (mixed data) survey. Snowballing methods were used to gather responses. Deductive analysis was used to analyse open-ended questions regarding practice and Standard adherence. There were 340 written responses, mainly from nurses in public EDs, who reported suboptimal practices regarding idle catheters, lack of patient participation in care, antecubital fossa insertion, multiple insertion attempts, inadequate site preparation, poor documentation and insufficient review of PIVC. The main factors inhibiting ED clinicians from adhering to the Standard includes inadequate knowledge, perceptions of infeasibility, disbelief in evidence, ambiguous responsibilities, habitual practice, insufficient training, lack of recognition of good practice and inadequate engagement. The factors that impact ED clinicians' PIVC Standard adherence are complex and multifactorial. Strategies and interventions are needed to facilitate the implementation of the Standard into daily practice and achieve sustainable behaviour change. [ABSTRACT FROM AUTHOR]

• To our knowledge this is the first systematic review to include chlorhexidine wipes. • Review evaluated 12 nonrandomized studies of moderate quality. • 2% chlorhexidine in alcohol wipes had less risk of CABSI compared to alcohol wipes. • 70% alcohol caps associated with reduced risk of CABSI compared to alcohol wipes. • Randomized controlled trials are needed to confirm or refute these results. The objective of this review was to compare the effectiveness of connector decontamination with 70% alcohol wipes, alcoholic chlorhexidine gluconate wipes, or alcohol impregnated caps to prevent catheter-associated bloodstream infection (CABSI). A systematic search was conducted in CINAHL, Cochrane Central Register of Controlled Trials, Medline, and PubMed. The primary outcome was CABSI, with randomized and observational studies included. The inclusion criteria were: English language, any age group, no date limitations, and reporting connector decontamination interventions to prevent CABSI. The exclusion criteria were: multimodal interventions, letters, and conference abstracts. Quality assessment with the Newcastle-Ottawa Scale, a narrative synthesis, and meta-analysis were conducted. Pooled data used a random effects model for pair-wise comparisons, due to clinical heterogeneity. Statistical heterogeneity was investigated by visual model inspection, χ², and I² statistics. Ten studies compared 70% alcohol wipes with 70% alcohol-impregnated caps, and 2 studies (n = 1,216) tested an alcoholic chlorhexidine gluconate wipe. Alcoholic chlorhexidine gluconate wipes were associated with significantly less CABSI than 70% alcohol wipes (risk ratio, 0.28; 95% confidence interval, 0.20-0.39). Alcohol-impregnated caps were associated with significantly less CABSI than 70% alcohol wipes (risk ratio, 0.43; 95% confidence interval, 0.28-0.65). Studies were of low to moderate quality. Alcohol impregnated caps and alcoholic chlorhexidine gluconate wipes were associated with significantly less CABSI than 70% alcohol wipes. This requires confirmation in randomized controlled trials. [ABSTRACT FROM AUTHOR]

Abstract Background Vascular access devices are widely used in healthcare settings worldwide. The insertion of a vascular access device creates a wound, vulnerable to irritation, injury and infection. Vascular access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. Objectives To estimate the incidence of vascular access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development. Design Secondary data analysis from 13 multi-centre randomised controlled trials and observational studies evaluating technologies and performance of vascular access devices in clinical settings between 2008 and 2017. Settings Six hospitals (metropolitan and regional) in Queensland, Australia. Participants The 13 studies involved paediatric and adult participants, across oncology, emergency, intensive care, and general hospital settings. A total of 7669 participants with 10,859 devices were included, involving peripheral venous (n = 9933), peripheral arterial (n = 341), and central venous access (n = 585) devices. Analysis Standardised study data were extracted into a single database. Clinical and demographic data were descriptively reported. Cox proportional hazards regression models (stratified by peripheral vs central) were used for time-to-event, per-device analyses to examine risk factors. Univariate associations were undertaken due to complexities with missing data in both outcomes and covariates, with p < 0.01 to reduce the effect of multiple comparisons. Results Over 12% of devices were associated with skin complication, at 46.2 per 1000 catheter days for peripheral venous and arterial devices (95% confidence interval, CI 42.1–50.7), and 22.5 per 1000 catheter days for central devices (95% CI 16.5–306). The most common skin complications were bruising (peripheral n = 134, 3.7%; central n = 33, 6.8%), and swelling due to infiltration for peripheral devices (n = 296; 2.9%), and dermatitis for central devices (n = 13; 2.2%). The significant risk factors for these complications were predominantly related to device (e.g., skin tears associated with peripheral arterial catheters [hazard ratio, HR 16.0], radial insertion [HR 18.0] basilic insertion [HR 26.0])) and patient characteristics (e.g., poor skin integrity associated with increased risk of peripheral device bruising [HR 4.12], infiltration [HR 1.98], and skin tear [HR 48.4]), rather than management approaches. Conclusions Significant skin complications can develop during the life of peripheral and central vascular access devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with vascular access devices. [ABSTRACT FROM AUTHOR]

Objectives To compare the available dressing and securement devices for central venous access devices (CVADs). Design Systematic review of randomised controlled trials. Data sources Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews and of Effects, NHS Economic Evaluation Database, Ovid MEDLINE, CINAHL, EMBASE, clinical trial registries and reference lists of identified trials. Review methods Studies evaluated the effects of dressing and securement devices for CVADs. All types of CVADs were included. Outcome measures were CVAD-related bloodstream infection, CVAD tip colonisation, entry and exit site infection, skin colonisation, skin irritation, failed CVAD securement, dressing condition and mortality. We used standard methodological approaches as expected by The Cochrane Collaboration. Results We included 22 studies involving 7436 participants comparing nine different types of securement device or dressing. All included studies were at unclear or high risk of performance bias due to the different appearances of the dressings and securement devices. It is unclear whether there is a difference in the rate of CVAD-related bloodstream infection between securement with gauze and tape and standard polyurethane (RR 0.64, 95% CI 0.26 to 1.63, low quality evidence), or between chlorhexidine gluconate-impregnated dressings and standard polyurethane (RR 0.65, 95% CI 0.40 to 1.05, moderate quality evidence). There is high quality evidence that medication-impregnated dressings reduce the incidence of CVAD-related bloodstream infection relative to all other dressing types (RR 0.60, 95% CI 0.39 to 0.93). There is moderate quality evidence that chlorhexidine gluconate-impregnated dressings reduce the frequency of CVAD-related bloodstream infection per 1000 patient days compared with standard polyurethane dressings (RR 0.51, 95% CI 0.33 to 0.78). There is moderate quality evidence that catheter tip colonisation is reduced with chlorhexidine gluconate-impregnated dressings compared with standard polyurethane dressings (RR 0.58, 95% CI 0.47 to 0.73), but the relative effects of gauze and tape and standard polyurethane are unclear (RR 0.95, 95% CI 0.51 to 1.77, very low quality evidence). Conclusions Medication-impregnated dressing products reduce the incidence of CVAD-related bloodstream infection relative to all other dressing types. There is some evidence that chlorhexidine gluconate-impregnated dressings, relative to standard polyurethane dressings, reduce CVAD-related bloodstream infection for the outcomes of frequency of infection per 1000 patient days, risk of catheter tip colonisation and possibly risk of CVAD-related bloodstream infection. Most studies were conducted in intensive care unit settings. More, high quality research is needed regarding the relative effects of dressing and securement products for CVADs. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of an intensive care unit (ICU) diary versus no ICU diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU. Design: Systematic review of randomized controlled trials (RCTs) and clinical controlled trials. Data sources: CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, PILOT; Web of Science Conference Proceedings, clinical trial registries and reference lists of identified trials. Review methods: Studies evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU were included. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs. We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to pre-specified criteria. Results: We identified three eligible studies; two describing ICU patients (N = 358), and one describing relatives of ICU patients (N = 30). No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, healthrelated quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (RR 0.29, 95% CI 0.07-1.19) or depression (RR 0.38, 95% CI 0.12-1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84-1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14-28), in comparison to no diary (median 28; range 14-38). Conclusions: Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members. [ABSTRACT FROM AUTHOR]

Summary: Background: Central venous catheters are important in the management of paediatric intensive care unit patients, but can have serious complications which worsen the patients' health, prolong hospital stays and increase the cost of care. Evidence-based recommendations for preventing catheter-related bloodstream infections are available, but it is unknown how widely these are known or practiced in the paediatric intensive care environment. Objectives: To assess nursing knowledge of evidence based guidelines to prevent catheter-related bloodstream infections; the extent to which Australia and New Zealand paediatric intensive cares have adopted prevention practices; and to identify the factors that encouraged their adoption and improve nursing knowledge. Design: Cross-sectional surveys using convenience sampling. Settings: Tertiary level paediatric intensive care units in Australia and New Zealand. Participants: Paediatric intensive care nursing staff and nurse managers. Methods: Between 2010 and 2011, the ‘Paediatric Intensive Care Nurses' Knowledge of Evidence-Based Catheter-Related Bloodstream Infection Prevention Questionnaire’ was distributed to paediatric intensive care nursing staff and the ‘Catheter-Related Bloodstream Infection Prevention Practices Survey’ was distributed to nurse managers to measure knowledge, practices and culture. Results: The questionnaires were completed by 253 paediatric intensive care nurses (response rate: 34%). The mean total knowledge score was 5.5 (SD=1.4) out of a possible ten, with significant variation of total scores between paediatric intensive care sites (p =0.01). Other demographic characteristics were not significantly associated with variation in total knowledge scores. All nursing managers from Australian and New Zealand paediatric intensive care units participated in the survey (n =8; response rate: 100%). Wide practice variation was reported, with inconsistent adherence to recommendations. Safety culture was not significantly associated with mean knowledge scores per site. Conclusions: This study has identified that there is variation in the infection prevention approach and nurses' knowledge about catheter-related bloodstream infection prevention. The presence of an improved safety culture, years of paediatric intensive care experience and higher qualifications did not influence the nurses' uptake of recommendations, therefore further factors need to be explored in order to improve understanding and implementation of best practice. [Copyright &y& Elsevier]

Sepsis is a leading cause of death and disability in adults and children. Evidence suggests that early recognition and management can significantly improve patient outcomes, therefore education of healthcare workers around sepsis is critical. Little is known about the preparation of final year nursing students regarding recognition and response to sepsis. To explore Australian final year nursing student's exposure to and knowledge of sepsis, and their awareness of the importance of early recognition, escalation and management of patients with sepsis. An online 17-question survey was developed, validated and then used to evaluate final year nursing students' awareness and knowledge about sepsis. Multi-site, cross-sectional, study. Data were prospectively collected from final year nursing students from five university (graduate entry and undergraduate) programmes from four Universities in Queensland, Australia. Response rate of 22% (237/1075 eligible students responded). Final year nursing students possessed limited knowledge about sepsis (mean scores = 3.8/9; SD = 1.6), and very limited knowledge of paediatric sepsis (median 1[interquartile range 0–1]). Many participants (54%; 128/237) had heard of sepsis prior to commencing their nursing studies, however only 22% (53/237) reported formal dedicated educational units on sepsis. Sepsis education was delivered primarily through didactic lectures (32%; 77/237) and often as part of courses encompassing acute care (38%; 91/237). Only 6% (14/237) of participants recalled exposure to education dedicated to paediatric sepsis. The knowledge of final year nursing students in relation to recognising, escalating and managing sepsis was limited. There is an urgent need to design education which adequately and safely prepares nurses for the challenges they face when caring for patients with sepsis, particularly paediatric sepsis. Accrediting bodies should consider mandating inclusion of sepsis education as part of all nursing programmes. • Sepsis is a common and severe condition, however sequalae can be minimised by early recognition and effective management. • Final year nursing students demonstrated little knowledge about sepsis especially paediatric sepsis. • Few graduating nurses recalled receiving education on sepsis but those who did had an associated increase in sepsis knowledge. [ABSTRACT FROM AUTHOR]

With over 2 billion peripheral intravenous catheters used globally each year, avoiding complications is crucial for patients and healthcare organisations. Effective catheter dressing and securement is a key nursing strategy to reduce catheter failure and resultant patient harm. To describe global catheter dressing and securement practices and policy; and identify factors associated with catheter insertion site complications, and suboptimal dressing and securement. Secondary analysis of a global cross-sectional study of peripheral intravenous catheter characteristics, management and outcomes. Four hundred and seven rural, regional and metropolitan hospitals in 51 countries. Paediatric and adult patients with 40,637 catheters. Patient-, catheter-, and institution-related factors which could be associated with catheter site complications and suboptimal dressings were extracted from the parent database. Global trends in catheter dressing and securement policy and practice were described. Potential predictors of catheter and dressing complications were explored using logistic regression. Dressing and securement practices, and local hospital policy regarding dressing change frequency varied. One fifth of dressings (21%, n = 8519) were not clean, dry and intact. The prevalence of catheter insertion site complications was 16% (n = 6503), with signs of phlebitis commonly observed (11.5%, n = 4587). Compared to non-bordered polyurethane dressings, sterile gauze and tape dressings were associated with fewer insertion site complications (odds ratio 0.58, 95% confidence interval 0.50–0.68) and better dressing integrity (odds ratio 0.68; 95% confidence interval 0.59–0.77); whereas, compared with no securement, non-sterile tape at the insertion site was associated with more site complications (odds ratio 2.39, 95% confidence interval 2.22–2.57) and poorer dressing integrity (odds ratio 1.64, 95% confidence interval 1.51–1.75). Two 'bundled' dressing and securement combinations were associated with fewer site and dressing complications, when compared with the reference category. Local catheter care guidelines which advocate 4th hourly insertion site inspection and dressing replacement between 1–3 days were associated with better catheter dressing integrity. Modifiable risk factors for peripheral intravenous catheter site and dressing complications were identified and are amendable to further interventional testing. [ABSTRACT FROM AUTHOR]

Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure. The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956. Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009–0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47–5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047–0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2–86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7–41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27–4.57). Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate feasibility of an efficacy trial comparing peripherally inserted central catheter (PICC) dressing and securement techniques to prevent complications and failure.Materials and Methods: This pilot, 3-armed, randomized controlled trial was undertaken at Royal Children's Hospital and Lady Cilento Children's Hospital, Brisbane, Australia, between April 2014 and September 2015. Pediatric participants (N = 101; age range, 0-18 y) were assigned to standard care (bordered polyurethane [BPU] dressing, sutureless securement device), tissue adhesive (TA) (plus BPU dressing), or integrated securement dressings (ISDs). Average PICC dwell time was 8.1 days (range, 0.2-27.7 d). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were PICC complications, dressing performance, and parent and staff satisfaction.Results: Protocol feasibility was established. PICC failure was 6% (2/32) with standard care, 6% (2/31) with ISD, and 3% (1/32) with TA. PICC complications were 16% across all groups. TA provided immediate postoperative hemostasis, prolonging the first dressing change until 5.5 days compared with 3.5 days and 2.5 days with standard care and ISD respectively. Bleeding was the most common reason for first dressing change: standard care (n = 18; 75%), ISD (n = 11; 69%), TA (n = 4; 27%). Parental satisfaction (median 9.7/10; P = .006) and staff feedback (9.2/10; P = .002) were most positive for ISD.Conclusions: This research suggests safety and acceptability of different securement dressings compared with standard care; securement dressings may also reduce dressing changes after insertion. Further research is required to confirm clinically cost-effective methods to prevent PICC failure. [ABSTRACT FROM AUTHOR]

Central venous catheters are commonly used in healthcare, but they come with a range of potential complications. Over the last 15 years, an influx of securement and dressing products has been released, with unknown overall effectiveness to prevent these complications. To compare the effects of dressings and securement devices for central venous catheters on a range of common complications including catheter-related bloodstream infection, catheter tip colonisation, entry/exit-site infection, skin colonisation, skin irritation, failed catheter securement, dressing durability and mortality. Systematic review with meta-analysis. Following standard Cochrane methods, a systematic search of Cochrane Wounds Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, EBSCO CINAHL, and multiple clinical trial registries was completed in November 2022. Randomised controlled trials evaluating the effectiveness of dressing and securement devices for all CVC types were included. A random-effects model was used during the meta-analysis. Results were expressed using risk ratio (RR), rate ratio, or mean difference (MD), with 95 % confidence intervals (CIs). Methodological quality and bias were assessed. We included 46 studies involving 10,054 participants. All studies had either an unclear or high-performance bias. The blinding of outcome assessment was unclear in most studies. Chlorhexidine gluconate-impregnated dressings, compared with standard polyurethane dressings, may reduce the incidence (7 studies; N = 5816; RR 0.60, 95 % CI 0.44–0.83; low certainty evidence) and rate (4 studies; N = 4447; RR 0.51, 95 % CI 0.32–0.79; moderate certainty evidence) of catheter-related bloodstream infection and catheter tip colonisation (8 studies; N = 4788; RR 0.70, 95 % CI 0.52–0.95; very low certainty evidence). Medication-impregnated dressings may reduce the incidence of catheter-related bloodstream infection (6 studies; N = 5687; RR 0.60, 95 % CI 0.39–0.93; low certainty evidence) and catheter-tip colonisation (7 studies; N = 4769; RR 0.60, 95 % CI 0.47–0.76; low certainty evidence) relative to non-impregnated dressing types. Tissue adhesive may increase the risk of skin irritation or damage compared with integrated securement dressings (3 studies; N = 166; RR 1.88, 95 % CI 1.09–3.24; low certainty evidence) or sutureless securement devices (4 studies; N = 241; RR 1.64, 95 % CI 1.10–2.44; moderate certainty evidence). Tissue adhesive increased dressing durability compared with integrated securement dressings (MD 43.03 h, 95 % CI 4.88–81.18; moderate certainty evidence) and sutureless securement devices (MD 42.90 h, 4.64–81.16; moderate certainty evidence). Tissue adhesive increased failed catheter securement rate compared with suture (2 studies; N = 103; RR 9.33, 95 % CI 1.10–79.21; moderate certainty evidence). The findings of the review provide insights and guidance for clinicians in selecting the appropriate dressings and securements for catheters. Findings should be interpreted with caution due to heterogeneity in catheters and patient types. #CD010367. Time to implement chlorhexidine gluconate-impregnated dressings to prevent catheter-related bloodstream infections; a meta-analysis by @GraceNP and team. [ABSTRACT FROM AUTHOR]

• Approximately 50% of all peripheral venous catheters (PVCs) are used to administer intravenous antibiotics. • Subsequently, 11% and 19% of PVCs lead to irritation and vessel injury, respectively. • Flucloxacillin, lincomycin and vancomycin were confirmed to increase the risk of PVC failure. • This study newly identified cefepime and ceftazidime as significant risk factors for PVC failure. • Methods to improve antibiotic delivery are necessary to improve patient care. Peripheral venous catheters (PVCs) are used to administer antimicrobials, but many fail prior to completion of therapy. While some antimicrobials are known to increase the PVC failure rate, risk profiles for many are unclear. To synthesize data from prospective PVC studies conducted between 2013 and 2019 to determine associations between common antimicrobials and PVC failure. A secondary analysis was undertaken of seven randomized controlled trials and two prospective cohort studies from three quaternary hospitals (two adult and one paediatric) in Australia between 2013 and 2019. The primary outcome was PVC failure due to vessel injury (occlusion, infiltration or extravasation) or irritation (pain or phlebitis). Associations between antimicrobial use and PVC failure were explored using multi-variable Cox regression. In total, 5252 PVCs (4478 patients) were analysed; vessel injury and irritations occurred in 19% and 11% of all PVCs, respectively. Vessel injury was significantly associated with cefepime hydrochloride [hazard ratio (HR) 2.50; 95% confidence interval (CI) 1.44–4.34], ceftazidime pentahydrate (HR 1.91, 95% CI 1.11–3.31), flucloxacillin sodium (HR 1.84, 95% CI 1.45–2.33), lincomycin hydrochloride (HR 1.67, 95% CI 1.10–2.52) and vancomycin hydrochloride (HR 1.73, 95% CI 1.25–2.40). Irritation was significantly associated with flucloxacillin sodium (HR 2.58, 95% CI 1.96–3.40). This study identified several antimicrobials associated with increased PVC failure, including some that were already known to be associated and some that had not been identified previously. Research is needed urgently to determine superior modes of delivery (e.g. dilution, infusion time, device type) that may prevent PVC failure. [ABSTRACT FROM AUTHOR]

Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes. Secondary analysis of twelve prospective studies performed between 2008 and 2020. Australian metropolitan and regional hospitals including one paediatric hospital. Participants were from medical, surgical, haematology, and oncology units. Multilevel mixed-effects parametric survival regression was used to identify factors associated with all-cause peripheral intravenous catheter failure, phlebitis, occlusion/infiltration, and dislodgement. We studied patient (e.g., age, gender), device (e.g., gauge), and provider (e.g., inserting clinician) variables. Stepwise regression involved clinically and p <0.20 significant variables entered into the multivariable model. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CI); p <0.01 was considered statistically significant. Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), phlebitis 12% (n = 1,421), and dislodgement 7% (n = 779) of catheters. Patient factors significantly associated with failure and complications were: female gender (phlebitis; (HR 1.98, 95% CI 1.72–2.27), (infiltration/occlusion; HR 1.45, 95% CI 1.33–1.58), (failure; HR 1.36, 95% CI 1.26–1.46); and each year increase in age (phlebitis; 0.99 HR, 95% CI 0.98–0.99), (failure; 0.99 HR, 95% CI 0.99–0.99). The strongest provider risk factor was intravenous antibiotics (infiltration/occlusion; HR 1.40, 95% CI 1.27–1.53), (phlebitis; HR 1.36, 95% CI 1.18–1.56), (failure; HR 1.26, 95% CI 1.17–1.36). Catheters inserted by vascular access teams were less likely to dislodge (HR 0.53, 95% CI 0.42–0.67). Device risk factors most associated with all-cause failure were wrist/hand (HR 1.34, 95% CI 1.23–1.46), antecubital fossa peripheral intravenous catheters (HR 1.29, 95% CI 1.16–1.44) and 22/24 gauge (HR 1.27, 95% CI 1.12–1.45) catheters. Factors identified, including the protective aspect of vascular access team insertion, and high catheter failure associated with intravenous antibiotic administration, will allow targeted updates of peripheral intravenous catheter guidelines and models of care. [ABSTRACT FROM AUTHOR]