Introduction: Peripheral intravenous cannulation is the preferred method to obtain vascular access, but not always successful on the first attempt. Evidence on the impact of the intravenous catheter itself on the success rate is lacking. Faster visualization of blood flashback into the catheter, as a result of a notched needle, is thought to increase first attempt success rate. The current study aimed to assess if inserting a notched peripheral intravenous catheter will increase first attempt cannulation success up to 90%, when compared to inserting a catheter without a notched needle. Design: In this block-randomized trial, adult patients in the intervention group got a notched peripheral intravenous catheter inserted, patients in the control group received a traditional non-notched catheter. The primary objective was the first attempt success rate of peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines and hospital policy. Results: About 328 patients were included in the intervention group and 330 patients in the control group. First attempt success was 85% and 79% for the intervention and control group respectively. First attempt success was remarkably higher in the intervention group regarding patients with a high risk for failed cannulation (29%), when compared to the control group (10%). Conclusion: This study was unable to reach a first attempt success of 90%, although first attempt cannulation success was higher in patients who got a notched needle inserted when compared to those who got a non-notched needle inserted, unless a patients individual risk profile for a difficult intravenous access.
MULTIFILE
Abstract Aims: To lower the threshold for applying ultrasound (US) guidance during peripheral intravenous cannulation, nurses need to be trained and gain experience in using this technique. The primary outcome was to quantify the number of procedures novices require to perform before competency in US-guided peripheral intravenous cannulation was achieved. Materials and methods: A multicenter prospective observational study, divided into two phases after a theoretical training session: a handson training session and a supervised life-case training session. The number of US-guided peripheral intravenous cannulations a participant needed to perform in the life-case setting to become competent was the outcome of interest. Cusum analysis was used to determine the learning curve of each individual participant. Results: Forty-nine practitioners participated and performed 1855 procedures. First attempt cannulation success was 73% during the first procedure, but increased to 98% on the fortieth attempt (p<0.001). The overall first attempt success rate during this study was 93%. The cusum learning curve for each practitioner showed that a mean number of 34 procedures was required to achieve competency. Time needed to perform a procedure successfully decreased when more experience was achieved by the practitioner, from 14±3 minutes on first procedure to 3±1 minutes during the fortieth procedure (p<0.001). Conclusions: Competency in US-guided peripheral intravenous cannulation can be gained after following a fixed educational curriculum, resulting in an increased first attempt cannulation success as the number of performed procedures increased.
MULTIFILE
Abstract—A survey was conducted among 20 Dutch hospitals about radiation protection for interventional fluoroscopy. This was a follow-up of a previous study in 2007 that led to several recommendations for radiation protection for interventional fluoroscopy. The results indicate that most recommendations have been followed. However, radiation-induced complications from interventional procedures are still often not recorded in the appropriate register. Furthermore, even though professionals with appropriate training in radiation protection are usually involved in interventional procedures, this often is not the case when these procedures are carried out outside the radiology department. Although this involvement is not required by Dutch law, it is recommended to have radiation protection professionals present more often at interventional procedures. Further improvements in radiation protection for interventional fluoroscopy may come from a comparison of dose-reducing practices among hospitals, the introduction of diagnostic reference levels for interventional procedures, and a more thorough form of screening and follow-up of patients
MSEs have encountered limitations while pushing the limits of catheter tip sensors performance. The limitations summarized: - sensors are not immune to electrical signal noise, cross talk, and EM fields; - sensors are not immune to high magnetic fields, i.e. not suitable for MR imaging; - extending the amount of sensors on the catheter tip is limited due to cluttering of wires. A fundamentally different approach using integrated optics is chosen for developing a new generation catheter sensors. The complexity of the design and production problems represents a knowledge gap, that can be bridged in the proposed consortium. This project consists of four work packages, total duration two years, subdivided into four phases. A crucial deliverable of the project is presented at the end of phase IV (WP4), namely a demonstrator integrating pressure and temperature sensors (obtained from WP1) with a newly designed readout system. This system is modularly extendable for future catheter tip sensors. In WP1, pressure- and temperature sensors are developed using two design approaches. In WP2 the influence of downscaling an ultrasound MZI device is explored and the microfabrication process parameters are studied. An additional goal of WP2 is to find the most suitable method for measuring lactate concentration. Among the deliverables five manuscripts: manuscript 1 includes simulations and measurements of the developed pressure and temperature sensors, manuscript 2 answers the question: can a grated fiber be used for measuring pressure and temperature on a tip? Manuscript 3 answers the question: which method is most suitable for measuring lactate concentration on a tip? Manuscript 4 answers the question: does a US intensity detector fit on a catheter tip while obeying the LoR? Manuscript 5 describes the performance of the demonstrator (Phase IV), i.e. integration of T/P sensing with a modular read out system.
