BACKGROUND: The importance of the peripheral intravenous catheter (PIVC) practices on patient safety is increasing. Small and medium-sized hospitals play a central role in the provision of healthcare services in South Korea, but lack a system for quality improvement, leaving patient safety at risk. This study aimed to identify the extent to which the PIVC practice knowledge of nurses, the nursing working environment, and the patient safety-culture perception affect PIVC practices and thereby provide basic data for improving the PIVC practices in small and medium-sized hospitals.
METHODS: This study had a cross-sectional descriptive design to identify the factors affecting PIVC nursing practices in small and medium-sized hospitals. Questionnaires returned by 149 nurses collected data on general characteristics, practical knowledge of PIVC nursing, nursing working environment, patient safety-culture perception, and PIVC practices. The questionnaire data were analysed using descriptive statistics, the independent t-test, one-way ANOVA, Scheffé\'s test, Pearson correlation, and hierarchical regression analysis.
RESULTS: The mean score of PIVC practices was 4.60 out of 5. Length of clinical experience, practical knowledge of PIVC nursing and patient safety-culture perception were significant factors affecting the PIVC nursing practices, with these variables explaining 26.2% of the variance therein.
CONCLUSIONS: The PIVC practices of nurses in small and medium-sized hospitals can be improved by providing education and training based on the latest standard or guideline to facilitate the acquisition of knowledge and skills. And campaigns and programs to strengthen patient safety culture perception specific to small and medium-sized hospital should be implemented. to ensure the safety of PIVC practice.

OBJECTIVE: To assess Kazakh pediatric nurses\' knowledge and confidence in peripheral intravenous catheter (PIVC) management and examine the personal and professional factors that influenced them.
BACKGROUND: Despite the significance of having high levels of PIVC insertion and care knowledge and confidence among pediatric nurses, the literature portrays inadequacies in the knowledge of these nurses in various parts of the globe.
METHODS: This study is cross-sectional and observational, following the STrengthening the Reporting of OBservational studies in Epidemiology checklist in reporting.
METHODS: A convenience sample of 200 pediatric nurses working in the University Medical Center in Kazakhstan were surveyed from November to December 2022 using a paper-based questionnaire to assess the PIVC management knowledge and confidence.
RESULTS: The respondents had poor knowledge of patient assessment, PIVC insertion, maintenance, and removal. Participants reported high confidence in inserting and maintaining PIVCs among pediatric patients. Nurses\' education, pediatric nursing experience, and training in PIVC management in the last 12 months were significant predictors of the nurses\' knowledge. PIVC insertion and care knowledge directly influenced the nurses\' confidence in these procedures.
CONCLUSIONS: Despite the high confidence of the nurses, their actual knowledge of these skills needed to be higher. Some personal and professional factors influence the knowledge and confidence of pediatric nurses.

OBJECTIVE: As a safe and reliable alternative to central venous catheters (CVCs), peripherally inserted central catheters (PICCs) are commonly used in clinical practice. However, the insertion of PICCs by nurse practitioners (NPs), especially in Japan, has not been reported extensively. Thus, we investigated the safety and efficiency of PICC insertions by NPs.
METHODS: The participants were 1322 patients who underwent PICC insertion by NPs at Fujita Health University Hospital (FNPs). The basilic vein in the brachium was the preferred vein for insertion; the brachial vein was the alternative. Patients were monitored from the time of PICC insertion until its removal. Ultrasonography-guided puncture was used for all catheter insertions, and the catheter tip was replaced into the superior vena cava under fluoroscopic imaging with maximal sterile barrier precautions. The outcomes of the PICC insertions by the FNPs were evaluated retrospectively.
RESULTS: Overall, 23 FNPs inserted a collective total of 1322 PICCs, which remained in place for a collective total of 23,619 catheter days. The rate of successful PICC insertion was 99% (1310 patients). The median time taken for PICC insertion was 12 min (interquartile range, 10-15 min). Intraoperative complications occurred in two patients (0.2%). The confirmed incidence of central line-associated bloodstream infection was 3.4% (45 patients), and these infections occurred on 1.9 per 1000 catheter days. The median duration of PICC placement was 15 days (range, 10-23 days).
CONCLUSIONS: PICC insertion by NPs is safe and a potential alternative to CVC insertion by surgeons.

OBJECTIVE: to compare the effect of rapid cycle deliberate practice simulation training with skill-training simulation on peripheral intravenous catheter insertion for Licensed Practical Nurses.
BACKGROUND: The use of peripheral intravenous catheters is associated with high rates of complications, although it is widely used in clinical practice. Training strategies to ensure good performance can minimize the risks inherent to this procedure.
METHODS: A randomized simulation experimental pre-post interventional study.
METHODS: Sixty participants were allocated to intervention (n = 30) or control (n = 30) groups. Participants allocated to the intervention group were trained through the Rapid cycle deliberate practice simulation strategy, while participants in the control group were trained through the skill-training simulation strategy. A pre-test was applied before any intervention and a post-test after intervention. The primary outcome was the performance in the peripheral intravenous catheter insertion skill. The comparison of correct performance in the tests was analyzed intergroup and intragroup. The effect size of the interventions was also analyzed. The t-Student and Mann-Whitney tests compared the difference between the groups. The training effect was calculated by Cohen\'s dm and Glass\'s Δ measures.
RESULTS: Performance between the pre-post-test increased from 59.4% to 96% (p < 0.001) in the intervention group and from 57.8% to 93.5% in the control group (p < 0001). There was no statistical difference between the groups after intervention (p = 0225). Cohen\'s dm measurement was 2.95 and 3.59 in the control and intervention groups, respectively.
CONCLUSIONS: The rapid cycle deliberate practice simulation strategy resulted in Licensed Practical Nurses\' performance improvements in peripheral intravenous catheter insertion, evidenced by the increase of correct performance actions in the post-test compared to the pre-test. However, with no statistical difference compared to the skill-training simulation strategy.

UNASSIGNED: Peripheral intravenous catheter (PIVC) insertion is the most common invasive procedure in the hospital setting. Ultrasound guided PIVC insertion in specific populations and settings has shown patient care benefits.
UNASSIGNED: To compare the success rate of first attempts of ultrasound guided PIVC insertion performed by nurse specialists with conventional PIVC insertion performed by nurse assistants.
UNASSIGNED: Randomized, controlled, single-center clinical trial registered on the ClinicalTrials.gov platform under registration NTC04853264, conducted at a public university hospital from June to September 2021. Adult patients hospitalized in clinical inpatient units with an indication for intravenous therapy compatible with a peripheral venous network were included. Participants in the intervention group (IG) received ultrasound guided PIVC performed by nurse specialists from the vascular access team, while those in the control group (CG) received conventional PIVC by nurse assistants.
UNASSIGNED: The study included a total of 166 patients: IG (n = 82) and CG (n = 84), mean age 59.5 ± 16.5 years, mostly women (n = 104, 62.7%) and white (n = 136, 81.9%). Success rate on the first attempt of PIVC insertion in IG was 90.2% and in CG was 35.7% (p < 0.001), with a relative risk of 2.5 (95% CI 1.88-3.40) for success in IG versus CG. Overall assertiveness rate was 100% in IG and 71.4% in CG. Regarding procedure performance time, the medians in IG and CG were 5 (4-7) and 10 (6-27.5) min respectively (p < 0.001). As for the incidence of negative composite outcomes, IG had lower rates compared to CG, 39% versus 66.7% (p < 0.001), generating a 42% lower probability of negative outcomes in IG, 0.58 (95% CI: 0.43-0.80).
UNASSIGNED: Successful first-try insertion was higher in the group receiving ultrasound-guided PIVC. Moreover, there were no insertion failures and IG presented lower insertion time rates and incidence of unfavorable outcomes.

To evaluate complications after PICC use in cancer patients.
This was a clinical and retrospective study in which the risk factors and complications of PICC use were evaluated.
This study was carried out in the patient, emergency room, and intensive care units through the evaluation of electronic medical records. To assess the association between qualitative variables, the chi-squared test or Fisher\'s exact test was used, and to compare the reason for withdrawal, the Kruskal-Wallis test was applied.
A total of 359 patients (53.5% men) with 43.1 ± 14 years who had a PICC (88% with solid tumours) were evaluated. The most common complications were mechanical complications (61.2%), infection (38%), and thrombosis (57.1%). Patients with double-lumen catheters experienced thrombosis (85.7%). This study demonstrated the effectiveness of PICC and that patients with haematological cancer are more prone to multiple PICC passages and more mechanical complications and infections.

UNASSIGNED: Ultrasound-guided (US) peripheral intravenous catheters (PIVC) have a high failure rate with many failing prior to completion of therapy. Risk factors associated with catheter failure are poorly delineated. This study aimed to assess risk factors related to catheter failure including patient, procedure, catheter, and vein characteristics to further elucidate which variables may impact catheter longevity.
UNASSIGNED: This was a secondary analysis using an existing trial dataset that primarily compared survival of two catheters: a standard long (SL) and an ultra-long (UL) US PIVC. Adult emergency room patients with difficult intravenous access at a tertiary care suburban academic center were study participants. Kaplan-Meier was employed to estimate the median catheter survival time. Cox regression univariable and multivariable analyses were used to evaluate the primary outcome of catheter survival.
UNASSIGNED: Among 257 subjects, 63% of PIVCs survived until completion of therapy. In a multivariable Cox regression model, length of catheter in vein >2.75 cm (adjusted hazard ratio [aHR] 0.58, 95% confidence interval [CI] 0.37-0.90, p = 0.01) was associated with improved survival. First stick success decreased the risk of catheter failure (aHR 0.68, 95% CI 0.44-1.06, p = 0.09) but was not statistically significant. Factors associated with the increased risk of catheter failure included: depth of vein >1.2 cm (aHR 1.68, 95% CI 1.06-2.66, p = 0.03) and PIVC placement in right extremity (aHR 1.64, 95% CI 1.07-2.51, p = 0.02).
UNASSIGNED: This study demonstrated that catheter length in vein (>2.75 cm) was associated with improved US PIVC survival highlighting the value of longer catheters in US PIVC survival. Choosing targets in the non-dominant extremity with shallower depths (⩽1.2 cm) may also increase catheter survival.

UNASSIGNED: Peripheral intravenous (IV) access is a standard procedure in clinical settings. Nevertheless, previous studies have indicated that difficult peripheral IV access is prevalent in children. This study aimed to determine the prevalence and factors contributing to difficult peripheral IV cannulation in children admitted to a tertiary care hospital in Oman.
UNASSIGNED: This cross-sectional study was conducted from September to December 2015 at Sultan Qaboos University Hospital in Muscat, Oman. Nurses collected data concerning factors contributing to difficult IV access in children.
UNASSIGNED: A total of 511 children undergoing cannulation during the study period were included in the analysis. Overall, 23.3% of the children experienced two or more cannulation attempts. The study identified three variables associated with successful cannulation in cases of difficult IV access. Visible veins were 2.72-times (95% CI: 1.58-4.68) more likely to be associated with success (p < 0.001), while palpable veins were 2.22-times (95% CI: 1.29-3.83) more likely to be associated with success (p = 0.004). However, scarring from previous IV access attempts was half (95% CI: 0.31-0.77) as likely to be associated with successful cannulation (p = 0.002).
UNASSIGNED: We identified statistically significant variables related to difficult IV cannulation in children, which we used to develop a prediction tool to assess the likelihood of difficult IV access in pediatric patients. Further research is necessary to validate the use of the difficult IV access prediction tool in this population.

UNASSIGNED: Peripheral intravenous catheter (PIVC) placement is the most common invasive clinical procedure, often performed by nurses in hospitals worldwide. This study aimed to assess the effect of clinical guideline education on the knowledge and practice of nurses for PIVC placement based on short message service (SMS).
UNASSIGNED: In a quasi-experimental study with parallel groups, 66 nurses working in two general university hospitals in Iran were enrolled. Data was collected from 2017 to 2018. PIVC placement was assessed before, immediately, and 4 weeks after educational intervention based on SMS (twice a day for 10 days).
UNASSIGNED: Nurses\' knowledge score immediately after intervention versus before intervention was higher in the intervention group than in the control group (4.48 vs -0.70; p < 0.001). Nurses\' knowledge score in 4 weeks after intervention versus immediately after intervention was lower in the intervention group than in the control group (0.03 vs 0.42; p = 0.014). Nurses\' knowledge scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (4.52 vs -0.27; p < 0.001). Nurses\' practice score immediately after intervention versus before intervention was higher in the intervention group than in the control group (0.57 vs -0.18; p = 0.174). Nurses\' practice score 4 weeks after intervention vs immediately after intervention was higher in the intervention group than in the control group (-0.10 vs -0.38; p = 0.046). Nurses\' practice scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (0.47 vs -0.56; p = 0.001).
UNASSIGNED: Educational intervention by SMS had a significant effect on increasing the knowledge and practice of nurses toward clinical guidelines for PIVC placement. Therefore, it is suggested that educational intervention by SMS be conducted to improve nurses\' knowledge as an effective educational method.

Peripherally inserted central catheters (PICCs) are central venous catheters (CVCs) that are commonly used in onco-hematologic settings for chemotherapy administration. As there is insufficient evidence to recommend a specific CVC for chemotherapy administration, we aimed to ascertain PICC-related adverse events (AEs) and identify independent predictors of PICC removal in patients with cancer receiving chemotherapy.
Information on adult patients with cancer with a PICC inserted for chemotherapy administration between September 2007 and December 2014 was extracted from six hospital databases. The primary outcome was PICC removal due to PICC-related AEs (occlusion, infection, or symptomatic thrombosis). Independent predictors of PICC removal were identified using a multivariate Cox regression model.
Among the 2,477 included patients, 419 PICC-related AEs (16.9%; 1.09 AEs per 1,000 PICC-days) were reported. AEs increased when PICC was inserted at the brachial site (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.02-1.84) and with open systems (HR, 1.89; 95% CI, 1.24-2.88) and decreased in older men (HR, 0.63; 95% CI, 0.49-0.81).
Use of PICC for chemotherapy administration was associated with a low all-AEs rate. The basilic vein was the safer site, and valved systems had fewer AEs than open systems. More research is needed to explore the interaction between AEs, sex, and age.
These findings provide clinicians with evidence that peripherally inserted central catheters (PICCs) are safe for chemotherapy administration. They also suggest that clinicians should limit the use of open systems when long chemotherapy regimens are scheduled. Moreover, alternatives to PICCs should be considered when administering chemotherapy to young men.