Vascular Access Device Infections: Current Management Practices and the Role of Multidisciplinary Teams at a Large Hospital in Northern Italy

Antibiotics, Journal Year: 2025, Volume and Issue: 14(1), P. 27 - 27

Published: Jan. 3, 2025

Introduction: Vascular access device (VAD)-associated infections, including catheter-related (CRBSI) and catheter-associated bloodstream infections (CABSI), present significant challenges in patient care. While multidisciplinary VAD teams (VATs) are equipped with protocols for managing these adherence to guidelines real-life practice is inconsistent. This study aims evaluate the alignment between actual infection management practices VAT-recommended protocols. Methods: We conducted a retrospective, single-center at Luigi Sacco Hospital (May 2021-October 2023) involving non-ICU adult patients diagnosed CRBSI or CABSI. VAT experts independently reviewed choices, which were divided into eight specific procedural options. These options included variations removal, timing of repositioning, combinations antimicrobial lock therapy systemic therapy. Concordance recommendations was evaluated using Cohen's kappa coefficient. Results: Of 2419 placements, 146 (6%) developed (84 CABSI, 62 CRBSI). Clinicians removed VADs 66.4% cases compared 62.3% per recommendations, moderate overall agreement (Cohen's = 0.58). Analysis categories revealed low (unweighted 0.44, weighted 0.30) guidance, slightly improved concordance cases. Conclusions: Our findings underscore discrepancy protocols, suggesting need clearer, more accessible increased collaboration. Enhanced consultation simplified protocol dissemination may improve consistency ultimately lead better outcomes.

Language: Английский

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Medication Safety in Intravenous Therapy: Compatibility of Etoposide with Frequently Drugs Used in Tumour Critical Care During Simulated Y-Site Administration

Drug Design Development and Therapy, Journal Year: 2025, Volume and Issue: Volume 19, P. 1147 - 1161

Published: Feb. 1, 2025

Etoposide is an antineoplastic agent widely used to treat pediatric and adult cancers. Critically ill patients are expected receive several intravenous pharmaceutical drugs while admitted hospitals. When compatibility data available, may be administered simultaneously through the Y-site. This study aimed determine of etoposide during simulated Y-site administration with 45 continuous-infusion that commonly in tumor critical care units. was diluted a concentration 0.25 mg/mL 0.9% sodium chloride (NS) other intravenously tested were reconstituted according manufacturer's recommendations final clinical desired concentrations. vitro by mixing 5 mL medications under aseptic conditions 1:1 ratio. Compatible solutions withdrawn at certain time intervals (0, 1, 2, 4 hours) after visually, using Tyndall beam, pH, turbidity, insoluble particles, UV absorption as measures compatibility. compatible 38 (84%) within four hours. Glutathione human granulocyte colony-stimulating factor immediately showed incompatibility etoposide. Within 1 h, (cefuroxime sodium, ilaprazole mycophenolate, xuebijing) incompatible. one (ceftazidime) also found incompatible observation. Seven common h. If co inevitable drug infused port catheter, larger volume saline or dextrose 5% water (D5W) should flush catheter before infusion clean lumen catheter.

Language: Английский

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Physicochemical Characteristics of Cardiological Drugs and Practical Recommendations for Intravenous Administration: A Systematic Review

Scientia Pharmaceutica, Journal Year: 2025, Volume and Issue: 93(1), P. 13 - 13

Published: March 12, 2025

Most cardiological drugs need intravenous administration to have a fast effect in an emergency. Intravenous is linked complications, such as tissue infiltration and thrombophlebitis. Aiming supply effective tool for the development of appropriate policies, this systematic review provides practical recommendations about diluent, pH, osmolarity, dosage, vesicant properties, phlebitis rate most commonly used evaluated randomized controlled trials (RCTs) till 31 August 2024. The authors searched available IV RCTs PUBMED EMBASE®, EBSCO-CINAHL®, Cochrane Controlled Clinical trials. Drugs’ chemical features were obtained online, drug data sheets, scientific papers, establishing that with pH <5 or >9, osmolarity > 600 mOsm/L, high incidence reported literature, well drugs, require utmost caution during administration. A total 857 papers 316 studies included. 84 identified, which only (37%) can be safely infused via peripheral route. Thrombolytics anticoagulants are considered safest classes one flagged “red flag” medication. However, higher percentage other categories meet criteria, including antiarrhythmics (52%), antiplatelet agents (67%), diuretics antihypertensives (70%), (77%), vasoconstrictors inotropics (89%). Understanding physicochemical properties essential significantly improving patient safety preventing errors local side effects.

Language: Английский

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Femoral venous access: State of the art and future perspectives

The Journal of Vascular Access, Journal Year: 2023, Volume and Issue: unknown

Published: Nov. 13, 2023

In the past 5 years, non-dialysis femoral venous access has changed in terms of indications, techniques insertion, and expected incidence complications. To traditional non-emergency indication for catheters-obstruction superior vena cava-many other indications have been added, both intensive non-intensive care. The insertion technique evolved, thanks to ultrasound guided venipuncture, tunneling, based intraprocedural tip location. Insertion femorally inserted central catheters may be today regarded as a procedure with an extremely low post-procedural risk. risk infection is reduced by possibility exit site at mid-thigh, use cyanoacrylate glue sealing site, appropriate strategies prevention. catheter-related thrombosis low, due several concomitant strategies: proper match between vein diameter catheter caliber; accurate assessment location and/or intracavitary ECG; consistent venipuncture micro-introducer kits; adequate stabilization site. mechanical complications lumen occlusion are minimized when using polyurethane, power injectable catheters. All these novelties brought revolution field access, so that this route considered safe effective approaches catheterization.

Language: Английский

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Development of an Evidence-Based List of Non-Antineoplastic Vesicants

Journal of Infusion Nursing, Journal Year: 2024, Volume and Issue: 47(5), P. 290 - 323

Published: Aug. 27, 2024

Infiltration of a vesicant, called extravasation , can result in severe patient injuries. Recognition vesicants and their relative risk injury is essential to prevention, early recognition, appropriate treatment. In this article, the Vesicant Task Force (VTF) updates previously published Infusion Nurses Society (INS) vesicant list from 2017. The 2024 INS diverges earlier lists, such as 2017 VTF list, by adopting stratification approach based upon documented outcomes, contrast reliance on expert consensus or only surrogate indicators, pH osmolarity. methodology used create updated explained, criteria for high- moderate-risk cautionary are defined.

Language: Английский

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Poland’s first vascular access team 3-year analysis: Insights and learnings

The Journal of Vascular Access, Journal Year: 2024, Volume and Issue: unknown

Published: May 6, 2024

Background: During the COVID-19 pandemic, Poland saw a surge in interest midline catheters (MCs) and Long Peripheral Catheters (LPCs) for intravenous therapy. Before this, MCs were not extensively utilised country, there was no formally established Polish vascular access team. MCs, which have been used years many countries, are now becoming increasingly common Poland. This study aimed to analyse use of 3-year perspective their introduction daily clinical practice based on nurse-led Vascular Access Team (VAT). Methods: The records adult patients who received therapy with 727 293 LPCs from January 2021 December 2023 at University Clinical Centre Medical Warsaw analysed. Results: main indication cannulation expected over 5 days (81.66%, n = 833), 71.37% ( 728) this group had concomitant difficult (DIVA). Over 6 years, centrally inserted central (CICCs) due DIVA reduced 108 2017 18 2023. end reason removal 64.6% 659), including death switch CICCs as well. Complications leading premature accounted 31.2%, such as: occlusion (14.6%), patient self-removal (7.1%) thrombosis (3.43%). Conclusions: possible option peripheral venous reduces CVCs. Developing programmes should be investing staff competencies, increases success rates. nurses physicians trained infusion care achieve better results LPCs. Increasing competence is necessary implementation full-service top-level functioning VAT.

Language: Английский

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Epidemiology and Clinical Insights of Catheter-Related Candidemia in Non-ICU Patients with Vascular Access Devices

Microorganisms, Journal Year: 2024, Volume and Issue: 12(8), P. 1597 - 1597

Published: Aug. 6, 2024

Vascular access devices (VADs), namely peripheral VADs (PVADs) and central venous (CVADs), are crucial in both intensive care unit (ICU) non-ICU settings. However, VAD placement carries risks, notably catheter-related bloodstream infections (CRBSIs).

Language: Английский

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Optimizing Infusate Flow Patterns for Minimizing Vein Wall Trauma: An Exploratory Study with a Modified off-Axis Catheter Tip Opening

Therapeutics and Clinical Risk Management, Journal Year: 2024, Volume and Issue: Volume 20, P. 559 - 566

Published: Sept. 1, 2024

Modifying the PIVC tip to direct infusates toward areas of highest hemodilution may reduce vein wall damage. This study compared flow patterns between a traditional with central opening and one an off-axis aperture.

Language: Английский

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Analysis of the Integrated Management Model of Medical Care and Medication in Intravenous Treatment for Critically Ill Patients

Journal of Multidisciplinary Healthcare, Journal Year: 2024, Volume and Issue: Volume 17, P. 4793 - 4801

Published: Oct. 1, 2024

To explore the effect of Integrated Management Model Doctor-Nurse-Pharmacist Collaboration on Safety Intravenous Therapy in Critically Ill Patients.

Language: Английский

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Correlation Between the Use of Vesicant Medications and The Incidence of Phlebitis in Pediatric Ward

Journal of Pharmacy And Bioallied Sciences, Journal Year: 2024, Volume and Issue: 16(Suppl 4), P. S4103 - S4106

Published: Dec. 1, 2024

Phlebitis is an inflammatory process that characterized by inflamed venous endothelial cells. Vesicant medications are found to be one of the causes phlebitis, especially in pediatric patients. To investigate correlation between use vesicant and phlebitis incidence. The study was descriptive observational conducted over period June-July 2022 a ward. inclusion criteria were male or female inpatients, aged 1 month-18 years, receiving medication via intravenous infusion for >24 hours. data obtained then analyzed correlations using bivariate multivariate analysis. A total 174 patients met criteria; 27.6% experienced 37.9% received medications. most frequently used ward gentamicin (74.24%). vesicants administration >3 drugs showed statistically significant results associated with incidence RR: 4.17 (P < 0.001; CI = 2.1-8.3) RR 2.6 0.012; 1.2-5.5), respectively. test risk factor OR 4.41 2.0-9.7). inpatient

Language: Английский

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