Intravenous Therapy : A Review Of Complications And Economic Considerations Of Peripheral Access

Evidence-Base practice (EBP) is defined as: “based on problem identified from the practitioner’s area of practice; a combining of best evidence and professional expertise and an integration of this into current practice; about ensuring patients receive quality care, being part of quality improvement processes; about collaboration and requiring a team approach” (French, 1999). Scott and Mcsherry (2008) supported the French’s assertion, proposing the key elements of EBP are that it is a theory-driven process, which involves the use, evaluation and application of research; identification of best evidence; evaluation of care; problem solving; decision-making; clinical expertise; and requires patient involvement. Evidence-based practice is made of evidence, clinical expertise, patient preference, the context of care (Barker, 2013). In brief, evidence-based practice is the parameter in the nursing practice that it requires that the nurses gather and use clinical evidence to make decision for the patients so that in the nursing process they can deliver the quality of care for the patients (Ellis, 2013). In the other words, in the nursing practice all the nursing procedures performed by the clinical evidence supported.

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

A struggle exists in healthcare to implement Evidence-Based Practice (EBP) into clinical care. Implementation of EBP recommendations are important as they are the gold standards of clinical care that result in optimal outcomes for patients. However, the implementation of that care is seldom instinctive and most often rests on the shoulders of the clinical staff, primarily the nurses. Clinical nursing faces the challenge of finding a way to bridge the gap between EBP recommendations and practical clinical practices. The article by White-Williams et al. examined the factors preventing EBP from being implemented by nursing staff. The study collected and analyzed data regarding nurses’ knowledge, attitude, and use of EBP and EBP resources. The conclusions of that analysis place a high importance on attitude as a determining factor of EBP implementation. This essay intends to summarize the methodology, correlations, and conclusions of the White-Williams et al. article.

The objective of this paper is to explain the procedure for inserting non-tunneled central venous catheters and possible uses and complications.

Central venous catheters (CVC) have become the most efficient means to administer long-term, vital medical treatments in hospitalized patients. These catheters are used in almost all types of medical settings for purposes related to, “hemodynamics monitoring, parenteral nutrition, chemotherapy, hemodialysis etc.” (Gorji, Rezaei, Jafari, Cherati, 2015, p.1). Its clinical relevance has become extremely significant in relation to treating patients with all sorts of medical diseases who necessitate the administration of extravasation drugs that can solely be administrated by a CVC. Therefore, CVC have “led to reduction in duration of hospitalization, increment of safety and reduction of hospital charges” (Gorji et al., 2015, p.1). Its benefits

Research by Pasalioglu & Kaya (2008) looked at factors such as age, gender, number of catheterizations, the size of the catheter, anatomical site of the IV, administration of antibiotics, the duration the catheter remained in the vein, the cause of removal of IV and the level of phlebitis, if present, by utilizing a pre-determined staging key (Pasalioglu & Kaya, 2008). Pasalioglu & Kaya (2008) determined, the

Indwelling central venous catheters (CVCs) have been in use for the last 3 decades and offer a more simplified approach for children and adolescents who must endure frequent intravenous access for treatment {Hastings, 2002 #6}. Well-known complications are line infection, thrombosis, occlusion, migration, and fracture with possible subsequent embolization. Less common complication is retained CVC, following unsuccessful removal. This situation is reported in 0.4%–2% of all line removals {Maizlin, 2010 #8;Milbrandt, 2009 #7}. Adherent tunneled catheters can usually be removed by a surgical cut down, but in some cases the line can become stick to the wall of the central veins. In such cases, forceful traction can cause vascular injury, or fracture of the catheter {Field, 2007 #9}. We present challenging cases of a patients with stuck tunneled catheter, which could be securely removed by combined surgical and endovascular techniques.

A compressive health education and maintenance of appropriate care for central lines catheter (CVC), and peripheral inserted central catheter (PICC) with the appropriate use of the curos caps the prevention of central line associated blood stream infections (CLABSI) the proposal will be achieved as planned. Staff education is crucial, especially those people that are in direct care of the patient that include nurses and provided, and the patient and patient assistance also needs reinforcement in proper covering of the central line dressing to prevent it from getting wet. Also is crucial for nurses to have awareness of the number of CLABSI infections to have a mental picture and be able to visualize the plan of care for those patients.

The placement of peripheral intravenous (PIV) catheters is the most common invasive procedure performed in the clinical setting. Up to 80% of all patients admitted to the hospital receive a PIV catheter, even though they may never be used (Do Rego Furtado, 2011). Nearly 330 million PIV catheters are purchased ever year in the United States, and can be used for variety of reasons including parenteral hydration and nutrition, administration of IV fluids, medications, and blood products, monitoring hemodynamic status, and providing hemodialysis.

There currently exists a struggle to bridge the theoretical with the real. This is struggle exists in healthcare as much as in any other aspect of the working world and in healthcare can be related directly to Evidence-Based Practice (EBP) and clinical nursing. The summarized definition of EBP for healthcare professionals is the method of practice that has been shown to result in optimal outcomes for patients according to the associated supporting evidence. EBP is the theoretical gold standard of care. However often the implementation of that care rests on the shoulders of nurses. Therefore, clinical nursing faces the challenge of bridging the gap between EBP and clinical practices and often falls short of full implementation. The Journal of Continuing Education in Nursing published an article in 2013 that studies the factors preventing EBP from being implemented by nursing staff as a whole. The study collected and analyzed data regarding nurses’ knowledge, attitude, and use of EBP and EBP resources. This essay intends to summarize the methodology, correlations, and conclusions of that study.

The purpose of this paper is to inform the reader about intravenous therapy (IV), intravenous locations, equipment that is used to start an IV and maintain an IV, the process of how to start an IV, how to change an IV dressing, and IV safety. This paper will also talk about central and peripheral lines, types of central lines, and what they are used for.

Central venous catheters (CVCs) insertion is an important component of management of patients receiving high dose chemotherapy for haematological malignancies and undergoing stem cell transplantation.1 All these patients are severely immunocompromised and have prolonged neutropenia. CVCs facilitate fluid and electrolyte management, chemotherapy and antibiotics administration and monitoring central venous pressures in this special group of patients. However, these indwelling catheters require continuous monitoring and special nursing care to prevent and reduce various infectious and non-infectious complications.2

My broader topic search of peripheral intravenous (PIV) lines and under reported PIV infections is now becoming narrower. With most hospital patient’s needing some type of infusion therapy, patient safe PIV access is imperative. After ten years of nursing, starting PIV lines has become so routine, that most days I do not think about the significance of what I am doing. When you research what could go wrong before, during and after PIV line placement on a patient, it is a weighty responsibility.

Medical care has become reliant on intravenous infusion for medications, fluids, and nutrient administration. Peripheral intravenous (PIV) catheters are the easiest and most frequently used method to deliver these infusions, but they also have complications (Shah, Ng, & Sinha, 2011). Some complications of PIVs include thrombosis, dislodgement, leaking, phlebitis, scar formation, and extravasation. Interventions have been researched and trialed to prolong the use of PIVs including intermittent heparin flushing. It is important to determine its effectiveness in prolonging the patency of PIVs, to deliver the best care possible to patients, but for this case, neonates specifically, with minimal complications occurring. Heparin also has its risks: abnormal coagulation profile, allergic reactions, heparin induced thrombocytopenia, and intraventricular/intracranial hemorrhage (Shah, Ng, & Sinha, 2011). Due to its risks, there needs to be further study and research to truly determine its effectiveness.

This paper will analyze the case study “Extravasation Follows Chemotherapy Administration. Potential Complications or Nursing Negligence” at lacano v. St. Peter’s Medical Center, 334 N.J. Super. 547-NJ (2000). In such case, analyzing the risks would be the best choice in order to identify and compare with another article. This scholarly journal “Complications of intravenous therapy” will give insight on risks due to potential complications. The journal did not discuss risk but it did talk about keeping the patient safe to avoid risks . The next journal “Prevention of Peripheral Venous Catheter Complications with an Intravenous Therapy Team” suggest some risk factors and how to avoid complications due to IV catheter insertion.