Creating Vascular Access Teams (VAT) provides an expert nursing role that contributes to the training and continuous improvement of healthcare personnel. They can offer greater clinical safety, reducing complications and costs. Peripherally inserted central catheters (PICCs) and midline catheters (ML) can be safe and cost-effective alternatives to other types of venous access (VA). The aim of the study was to analyse our centre’s VAT first 12 months of activity. The primary outcome was reported complications. Secondary outcomes were cause of catheter removal, consultancy activity and economic impact of VAT implantation.

Background Peripheral intravenous cannula (PIVC) insertion is a universal intervention for hospital inpatients. Previous studies have demonstrated that more than a third of inserted PIVCs remain unused in the emergency department and that there is inadequate documentation regarding the insertion and use of PIVCs. Additionally, the use of PIVC is associated with cannula-related complications. Using the PIVC care bundle attached to the guideline should help prevent cannula-related complications. As part of a quality improvement project, we aimed to perform an initial audit (1st cycle), implement interventions for improvements, and then perform a re-audit (2nd cycle) of our adherence with the use and completion of the care bundle for PIVC. Methodology An initial audit (1st cycle), followed by implementation of interventions, and then a re-audit (2nd cycle) of our adherence with the use and completion of the PIVC care bundle was performed. The standards/criteria used for both the 1st cycle and 2nd cycle of the project were obtained from our PIVC care bundle and comprised of documented evidence of the date of cannula insertion, site of cannula insertion, indication for cannula insertion, whether the cannula was inserted in a non-common site (e.g., lower limbs), cannula assessment at least every 24 hours, cannula-related complications, and whether the cannula care bundle was completed for the patient. A score of less than 75% was considered not adherent, 75-90% was partially adherent, 90-100% was adherent, and a score of 100% was considered fully adherent. The target adherence score for each standard/criterion was set a priori to 90-100%, and the results were compared between both cycles. An increase in the adherence score in the 2nd cycle over the 1st cycle was taken to indicate improvement, while a negative difference indicated challenges. Results There were 28 patients in the 1st cycle and 40 patients in the 2nd cycle of this project. The commonest initial indications for PIVC insertion were intravenous fluids and intravenous antibiotic administration. The hand and forearm were the commonly used sites of insertion, and none of the patients had a cannula-related complication. Compared to the 1st cycle, the results of the 2nd cycle demonstrated improvements in the adherence scores for all the standards/criteria, with the scores for documenting the site of insertion and using a commonly used/acceptable site indicating full adherence (100%). The score for documenting the indication for insertion indicated adherence (90-100%). The score for ensuring that the cannula was being assessed at least every 24 hours and the score for completing the care bundle both indicated partial adherence (75-90%). The score for documenting the date of cannula insertion indicated non-adherence (

Creating Vascular Access Teams (VAT) provides an expert nursing role that contributes to the training and continuous improvement of healthcare personnel. They can offer greater clinical safety, reducing complications and costs. Peripherally inserted central catheters (PICCs) and midline catheters (ML) can be safe and cost-effective alternatives to other types of venous access (VA). The aim of the study was to analyse our centre’s VAT first 12 months of activity. The primary outcome was reported complications. Secondary outcomes were cause of catheter removal, consultancy activity and economic impact of VAT implantation.

One-third of peripheral intravenous catheters (PIVCs) fail from inflammatory or infectious complications, causing substantial treatment interruption and replacement procedures.

Introduction: A central line-associated bloodstream infection (CLABSI) is quite common in an intensive care unit (ICU) and results in a prolonged stay with multiple complications. This study tried to reveal existing knowledge deficits among the newly recruited nursing staff about central venous line (CVL) care. This study also highlights the usefulness of "flipped classroom' and "interactive practical classes" techniques in re-educating nursing staff about CVL basics and management and their impact on nursing staff performance in managing CVL. Methods: This is a cohort study conducted at a tertiary care centre from August 2021-January 2022. A total of 20 newly recruited nursing staff (with 1 to 3 years of nursing experience) underwent a pre-test comprising 25 questions about central venous line (CVL) basics and management. All the 20 newly recruited nursing staff had at least 6 months of prior experience of working in an ICU at different hospitals. This was followed by an intervention in the form of "flipped classroom' and "interactive practical classes' with individualized attention. A post-test was conducted following these classes to assess the knowledge gained. A total score of pre-test and post-test activities was calculated for each nurse. Results: The mean age of the participants was 24.6 years. All the 20 participants had exposure to the CLABSI prevention guidelines during their initial days of training at their respective nursing colleges. 20 participants scored a mean of 21.4 2.4 during the pre-test. A post-test mean score increased to 23.1 ± 1.0 in Section-A. Similarly, 20 participants scored a mean of 8.4 ± 0.94 during the pre-test. A post-test mean score increased to 9.4 ± 0.94 in Section-B. Conclusion: Our study showed that with the help of newer learning techniques, the overall knowledge and management skills in managing CVL of newly recruited nurses increased significantly.

Antimicrobial stewardship (AMS) has traditionally been the domain of doctors and pharmacists but there is a growing recognition that successful stewardship incorporates a multidisciplinary approach that includes nursing staff. This literature review explores nurses’ perceptions of their role in antimicrobial stewardship within the hospital environment and provides new insights to inform future practice. Methodology

Peripherally inserted central venous catheters (PICCs) have a potential advantage in preventing central line-associated bloodstream infection (CLABSI) compared with the centrally inserted ones (CICCs). However, due to a limited number of studies with insufficient statistical evaluation, the superiority of PICCs is difficult to be generalized in adult hematology unit. We conducted a single-center retrospective study and compared the risk of CLABSI between 472 CICCs and 557 PICCs inserted in adult patients with hematological disorders through conventional multivariate models and a propensity score-adjusted analysis. The overall CLABSI incidence in CICCs and PICCs was 5.11 and 3.29 per 1000 catheter days (P = 0.024). The multivariate Cox regression analysis (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.31–0.75; P = 0.001) and Fine-Gray subdistribution analysis (HR: 0.59; 95% CI: 0.37–0.93; P = 0.023) demonstrated that PICC was independently associated with a reduced risk of CLABSI. Moreover, the stabilized inverse probability of treatment weighting analysis, which further reduced the selection bias between CICCs and PICCs, showed that PICCs significantly prevented CLABSI (HR: 0.58; 95% CI: 0.35–0.94; P = 0.029). Microbiologically, PICCs showed a significant decrease in gram-positive cocci (P = 0.001) and an increase in gram-positive bacilli (P = 0.002) because of a remarkable reduction in Staphylococci and increase in Corynebacterium species responsible for CLABSI. Our study confirmed that PICC was a superior alternative to CICC in preventing CLABSI in the adult hematology unit, while it posed a microbiological shift in local epidemiology.