Auf das richtige Spülen kommt es an!

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Vernieuwingen binnen Intraveneuze Katheterzorg: kinderoncologie en hematologie

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Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit

Flushing and locking of intravenous catheters are thought to be essential in the prevention of occlusion. The clinical sign of an occlusion is catheter malfunction and flushing is strongly recommended to ensure a well-functioning catheter. Therefore fluid dynamics, flushing techniques, and sufficient flushing volumes are important matters in adequate flushing in all catheter types. If a catheter is not in use, it is locked. For years, it has been thought that the catheter has to be filled with an anticoagulant to prevent catheter occlusion. Heparin has played a key role in locking venous catheters. However, the high number of risks associated with heparin forces us to look for alternatives. A long time ago, 0.9% sodium chloride was already introduced as locking solution in peripheral cannulas. More recently, a 0.9% sodium chloride lock has also been investigated in other types of catheters. Thrombolytic agents have also been studied as a locking solution because their antithrombotic effect was suggested as superior to heparin. Other catheter lock solutions focus on the anti-infective properties of the locks such as antibiotics and chelating agents. Still, the most effective locking solution will depend on the catheter type and the patient’s condition

Een poortkatheter binnen oncologie en hematologie anders bekeken: hoe ervaren patiënten hun poortkatheter?

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Key strategies improving the outcome of patients with peripheral venous catheters: report of an international panel discussion

We report the opinions of a panel of infection prevention experts convened during the 2012 World Congress on Vascular Access. The panel reviewed topics related to the use of peripheral venous catheters (PVCs), with a specific focus on infection prevention. The international panel members agreed that lack of clinical evidence and scientific research regarding PVC management is a major cause of significant variances in practice. The panel members outlined a number of strategies that promote infection prevention during PVC use. However, overall agreement on all issues was not reached. Reasons for nonresolution were differences in the organization of health care systems among countries, differences in availability of materials among countries, and difference in national or supranational regulations.status: publishe

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

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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

Access of a fully rotated implantable port leads to extravasation

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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