Management of venous access devices by Advanced Practice Nursing teams: More research needed

status: publishe

Management of functional complications of totally implantable venous access devices by an advanced practice nursing team: 5 Years of clinical experience

PURPOSE: Our aim is to describe the number and distribution of requests addressed to an Advanced Practice Nursing team for functional problems of totally implantable venous access devices (TIVADs) and to describe, in detail, the malfunction management by the type and number of additional investigations and treatment modalities. METHOD: The Advanced Practice Nursing team recorded data about all requests for support as part of the standard care. A specific protocol, the Leuven Malfunction Management Protocol was used for troubleshooting. In this descriptive, retrospective study, data of 3950 consecutive requests for TIVAD-related functional problems in 2019 patients were analyzed. Data collection included (1) demographic information, (2) device-related details, and (3) malfunction and follow-up details. RESULTS: 'Easy injection, impossible aspiration' was the most frequently documented functional problem (66.9%) for all requests for help. Of all malfunctions, catheter tip was in an optimal position in 73.4%, thrombolytics were administered in 59.0%, and a linogram was performed in 4.9%. TIVAD removal/exchange was advised in 4.4% of the requests. CONCLUSIONS: TIVAD malfunction-defined operationally in terms of injection and/or aspiration problems-reflect all functional complications encountered in practice. Adherence to the Leuven Malfunction Management Protocol can ensure that, in most cases, catheter patency can be fully restored without removing or replacing the TIVAD. The Advanced Practice Nursing team coordinates the following treatments, investigations, and procedures: radiological catheter tip verification; thrombolytic agent administration and, if necessary, subsequent injection of solutions to dissolve drug precipitates or lipid deposits; linogram; percutaneous sleeve stripping; and TIVAD removal/replacement.status: publishe

Systematic review: Malfunction of totally implantable venous access devices in cancer patients

PURPOSE: Malfunction of totally implantable venous access devices is a common complication. The purpose was to identify definitions used to describe malfunction and to investigate the incidence of malfunction in different types of port and catheter designs. METHODS: Relevant studies were identified in PubMed that were published between January 1993 and February 2011. Empirical studies reporting functional outcomes in adults and where, at least 95% of the studied population consisted of onco-hematology patients with a newly inserted chest or arm port, were selected. The following data were extracted: patient and totally implantable venous access devices (TIVAD) characteristics, study design, definitions of malfunction, and functional outcomes. Two independent reviewers assessed the methodological quality of the series. RESULTS: Of the 4,886 potentially relevant articles, 57 were selected, involving 14,311 TIVADs. Twenty-nine percent of the studies explicitly defined malfunction. Malfunction incidence rates were expressed in six different ways, including the proportion of affected devices per inserted devices (incidence 0-47%); the number of affected devices per 1,000 catheter days (incidence 0-2.24 per 1,000 catheter days); and the number of malfunctions over the total number of accessing attempts (incidence 0-26%). CONCLUSIONS: Heterogeneity in the definitions used to describe device malfunction was evident. A broad range in the reported incidence of malfunction and in the kind of calculation and reporting methods was also found. Methodological quality of the studies was often poor. Standardization of definitions and accurate outcome measurement is needed. Calculation and report of malfunction incidence should be based on prospective data collected at the moment of an accession attempt.status: publishe

Functional evaluation of conventional 'Celsite(R)' venous ports versus 'Vortex(R)' ports with a tangential outlet: a prospective randomised pilot study

GOAL OF WORK: Totally implantable venous access ports are widely accepted in cancer patient treatment, but withdrawal occlusion (WO) can hamper the use of the device. A newly designed Vortex(R) VX port, with a tangential outlet, should allow better clearance of the chamber, thereby reducing occlusion of the device. The present study compared the Vortex(R) port to the classically shaped Celsite(R) port with regards to functional complications. MATERIALS AND METHODS: Two hundred cancer patients were included in a prospective, randomised controlled trial and randomly assigned to the implantation of a Vortex(R) or a Celsite(R) port. Insertion details such as used vein, catheter tip position and infusion or aspiration abilities were recorded. Data were collected concerning ease of access, and functional evaluation was performed each time the port was accessed, regarding the ability to infuse fluids with a syringe and to withdraw blood by measuring the filling time of a Vacutainer(R) blood tube. MAIN RESULTS: Ninety-nine patients received a Celsite(R) port, and 101 had a Vortex(R) port. Demographic variables and insertion details were comparable in both groups. All functional complications, including WO, total occlusion, sluggish inflow and sluggish withdrawal, were higher in the Celsite(R) group (16.12%) than in the Vortex(R) group (11.36%). This difference was not statistically significant. CONCLUSIONS: This study revealed that functional problems occurred less frequently in Vortex(R) compared to Celsite(R) ports. Differences were small and not significant, which indicates that functional problems may be related to other factors.status: publishe

Peptidergic innervation of the andrenocorticotropic hormone (ACTH)- and growth-hormone (GH)-producing cells in the pars-distalis of the sea bass (Dicentrachus Labrax)

Due to its unique organization, the teleost pituitary is an ideal model in which to investigate the relationship of the nervous system with the pituitary endocrine cells. A light microscope immunocytochemical study of the sea bass pituitary revealed six different neuropeptides in nerve fibers which projected into the pituitary neurohypophysis and bordered the adenohypophysial cells. Double staining showed separate nerve fibers immunoreactive for corticotropin-releasing factor (CRF), vasotocin (VT), somatostatin (SRIF), growth hormone-releasing factor (GRF), and neurotensin (NT) in the vicinity of the adrenocorticotropic hormone-releasing cells (ACTH-cells) in the rostral pars distalis (PD). In the proximal PD cholecystokinin (CCK)-, SRIF-, GRF-, and VT-immunoreactive fibers penetrated between the growth hormone-releasing cells (GH-cells). These results suggest a possible role for CCK, GRF, SRIF, and VT in the modulation of GH-cell activity, while the synthesis and/or secretion of the ACTH-cells might be affected by the release of VT, CRF, SRIF, GRF, and NT.status: publishe

The impact of aging on optic nerve regeneration in an emerging animal model - Nothobranchius furzeri

status: publishe

An abscisic-acid- and salt-stress-responsive rice cDNA from a novel plant gene family

A novel cDNA clone osr40c1, encoding a environment and belongs to a novel plant protein family that most probably has structural functions. abscisic acid (ABA)-responsive 40-kDa protein previously associated with salt tolerance (Moons et al. '1995' Plant Physiol 107: 177-186), was isolated from roots of rice seedlings (Oryza sativa L.). Exogenously applied ABA and salt shock induced a marked increase of the asr40c1 transcript level in roots of seedlings whereas constant osr40c1 mRNA levels were found in the shoot. The root-specific salinity-induced osr40c1 mRNA accumulation was rapid and gradually declined upon prolonged salt shock. Plant growth regulators, signalling the wounding and the pathogen response, did not enhance osr40c1 expression, indicating a salt- and osmotic-stress-specific response. The encoded OSR40c1 protein was found to be hydrophilic, rich in histidine residues (6%) constituting putative metal-binding domains, and to consist of a duplicated domain of 151 amino acids (75% identical), that can form amphiphilic a-helical structures. The gene osr40c1 belongs to a multigene family. Two osr40 genes were isolated, osr40g2 and osr40g3, tandemly arranged in an 8-kb region of the rice genome. Antisera raised against a conserved OSR40 peptide recognized different OSR40 proteins that accumulated in roots upon exposure to salt stress. The OSR40 protein family included 29-kDa proteins and two 40-kDa proteins, the latter most probably corresponding to OSR40c1 and OSR40g2 with duplicated domain structures. The osr40g3 transcript encoded a single copy of the OSR40 domain and exhibited a shoot-specific expression. Results indicate that OSR40c1 plays a role in the adaptative response of roots to an hyper-osmotic environment and belongs to a novel plant protein family that most probably has structural functions

“The Catheter is Occluded?” The Catheter Injection and Aspiration (CINAS) Classification Answers Your Question Accurately!

Background A well-functioning intravenous catheter allows both easy injection and blood aspiration. Malfunction occurs when these procedures are difficult and/or impossible. Since malfunction is often vaguely described, misunderstandings may arise between healthcare providers. Consequently, the real problem remains uncertain and this may lead to erroneous prescription of thrombolytic drugs and to inadequate reports on functional outcomes. Purpose The heterogeneity in catheter function description led to the development of the CINAS classification tool. The CINAS is the first tool able to describe completely the catheter function based on assessment of both injection and aspiration abilities. It consists of nine scoring options combining three categories of functional outcome (1=easy; 2=difficult; 3=impossible). Project description We tested the validity and accuracy of the CINAS. First, all functional problems (n=3950) in all types of catheters for which an Advanced Practice Nursing team was consulted in our hospital over a five year period were classified along the CINAS. In a second phase, 111 nurses who were briefly informed about this classification, assessed implantable ports function of 150 patients during their daily practice. Their scoring results were compared to those of a reference standard to assess the accuracy. Results In 35 among 3950 malfunction events (1%), catheter function could not be classified. Therefore we added a fourth category “unspecified” to the CINAS. Nurses were able to use the CINAS for 150 port catheter function assessments. They scored in 99% correctly a well-functioning catheter and in 80% a malfunction into the correct malfunction class. Implications The CINAS is able to describe completely every catheter function assessment in clinical practice and for research purposes. In electronic patient records, malfunction management protocols may be linked to the different CINAS classes. Conclusions The CINAS classification is simple, clear, cheap and helps healthcare workers to document accurately the catheter function.status: publishe

SecurAstaP trial: securement with SecurAcath versus StatLock for peripherally inserted central catheters, a randomised open trial

OBJECTIVES: To assess the effect on needed nursing time for dressing change. DESIGN, SETTING, PARTICIPANTS: A parallel-group, open-label, randomised controlled trial in patients who are in need for a peripherally inserted central catheter insertion in one teaching hospital in Belgium. The follow-up lasted 180 days or until catheter removal, whatever came first. A computer generated table was used to allocate devices. Randomised patients were 105 adults (StatLock, n=53; SecurAcath, n=52) and primary analysis was based on all patients (n=92) with time measurements (StatLock, n=43; SecurAcath, n=49). INTERVENTIONS: StatLock which has to be changed weekly versus SecurAcath which could remain in place for the complete catheter dwell time. MAIN OUTCOME MEASURE: Needed time for the dressing change at each dressing change (SecurAcath) or at each dressing change combined with the change of the securement device (StatLock). RESULTS: Median time needed for dressing change was 7.3 min (95% CI 6.4 min to 8.3 min) in the StatLock group and in the SecurAcath group 4.3 min (95% CI 3.8 min to 4.9 min) (P<0.0001). The time in the SecurAcath group was reduced with 41% (95% CI 29% to 51%). Incidence rates of migration, dislodgement and catheter-related bloodstream infection were comparable across groups. Pain scores were higher with SecurAcath than with StatLock at insertion (P=0.02) and at removal (P<0.001) and comparable during dressing change (P=0.38) and during dwell time (P=0.995). User-friendliness was scored at insertion and removal. All statements regarding the user-friendliness were scored significantly higher for StatLock than for SecurAcath (P<0.05). Only for the statement regarding the recommending routine use of the device, which was asked at removal, no difference was found between the two devices (P=0.32). CONCLUSION: Use of SecurAcath saves time during dressing change compared with StatLock. Training on correct placement and removal of SecurAcath is critical to minimise pain. TRIAL REGISTRATION NUMBER: NCT02311127; Pre-results.status: publishe