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Neonatology Train-the-Trainer workshop 2019


Nurse Practitioner and Research Fellow Tricia Kleidon recently travelled to Malaysia with support from Vygon to facilitate a ‘train the trainer’ Neonatal PICC workshop with Dr. Willem Gysemans from Belgium. The workshop was well attended with over 40 neonatologists from various regions within Asia including; Philippines, Vietnam, Mynamar, Thailand, Cambodia, Indonesia.  After a day of didactic and practical sessions, the second day gave the attending clinicians the opportunity to share their hospital experience.  Tricia says “It was an honour to work with such dedicated clinicians to help improve PICC insertion, care and maintenance within health services with limited resources”.


Medical Imaging Nurses Association (MINA) Seminar 


Two valued members recently represented AVATAR at the Medical Imaging Nurses Association (MINA) Seminar, held at the Queensland Children’s Hospital (QCH) on the 23rd March 2019. Victoria Gibson (Project Manager and Clinical Nurse at Queensland Children’s Hospital) and Cat O’Brien (Research Nurse and Project Manager at Royal Brisbane and Women’s Hospital), were invited to speak on topics including (i) intravascular access devices dressing and securement; and (ii) the role of a Research Nurse in Medical Imaging. The event was a great success, with attendees showing a keen interest in the role of vascular access devices within the context of their own clinical environments. We look forward to partnering with MINA members in the future. 



Joint event: Simposio Internatcional de Accessos Vasculares e Terapia Infusional and World Congress Vascular Access in Brazil


Two of the biggest events in the world related to Infusion Therapy and Vascular Access together for the first time!  The SIAV - International Symposium on Vascular Access and Infusion Therapy has the honour of joining the Wocova - World Congress Vascular Access in Brazil to make the biggest Vascular Access and Infusion Therapy conference in the world on 15th-19th July, 2019 in Sao Paolo, Brazil.

The event will address topics in Infusion Therapy and Vascular Access, with the main objective of aligning the technology that involves infusion therapy and vascular access with intra and prehospital patients’ experiences. All topics supporting evidence-based intravenous therapy and the technological advances that guide safe practice will be under discussion, including: education, prevention, maintenance, quality, safety, complications and innovation.

A unique experience to deepen your knowledge, share experiences and meet the leading professionals in the market! 

More information on


Australian Vascular Access Society Scientific Meeting 2019, Sydney


Congratulations to everyone who had an abstract accepted to upcoming AVAS conference. We look forward to hearing your presentations about the great research and quality improvements that you have been doing!


AVAS 2019 National Scientific Meeting

12-14 May 2019

Park Royal Paramatta, Sydney, Australia
Visit the 
AVAS SM Website for more information.



Other Events


Infusion Nurses Society

18-19 May 2019

Baltimore, MD, USA


ICPIC 2019 International Conference on Prevention and Infection Control
10-13 September 2019
Geneva, Switzerland


AVA 2019 Association for Vascular Access Annual Scientific Meeting
4-7 October 2019
Caesars Palace
Las Vegas, NV, USA


8th International Australian College of Infection Prevention and Control Conference

8 November 2019

Perth, Australia



Congratulations to Dr Gillian Ray-Barruel, Senior Research Fellow with Queen Elizabeth II Hospital and Griffith University School of Nursing and Midwifery, who has received a highly competitive 2019 Endeavour Executive Leadership Award, sponsored by the Australian Government, to undertake leadership and research activities with Dr Vineet Chopra and colleagues at the University of Michigan in the USA for 3 months. This is a wonderful achievement and a marvellous opportunity to strengthen our partnership with our state-side partners in vascular access. While in Michigan, Gillian will be developing her skills in implementation science and collaborating with Michigan Health to test the I-DECIDED tool for peripherally inserted central catheters.

GRBDr Gillian Ray-Barruel, Senior Research Fellow with Queen Elizabeth II Hospital and Griffith University School of Nursing and Midwifery


Grant News

Associate Professor Makrina Totsika from Queensland University of Technology


Following on from research identifying the potential negative impact of the force of IV injection and infusion on vessel endothelium and blood components (Hawthorn et al JVA 2019), AVATAR researchers extrapolated the theory to the effect of micro-perforations in catheter design may have on PIVC failure. The perforated design of the catheter tip may hold the key to reducing PIVC failure more widely through its ‘diffusive’ action at the catheter tip in vivo, minimising endothelial and platelet activation from repeated injection and high-pressure infusion.  To test this, we were recently awarded two grants to conduct preliminary preclinical and clinical testing of the catheter.


2019  N Gavin, S Keogh, L Marquart, N Marsh, M Totsika, C Saxby Standard versUs peRForated peripheral intravenous catheter. The SURF trial: a pilot randomised controlled trial. $50,000, Metro North Hospital and Health Service/ Queensland University of Technology Collaborative Research Grant.


2018  S Keogh, M Totsika, K Alexander, N Gavin An evaluation of biofilm formation in Standard versUs peRForated peripheral intravenous catheters. Micro-SURF: an in vitro study. $10,000, Queensland University of Technology/ Institute of Health and Biomedical Innovation Collaborative Development Grant.



2018 F Coyer, J Dhani, S Keogh, F Huygens, S Parker. Evaluation of a closed loop-blood sampling system in intensive care: a pilot randomised controlled trial. The ENCLOSE trial. $40,000, Royal Brisbane and Women’s Hospital Foundation Research Grant.


New Publications 

Please find the articles under
 Our Publications on the AVATAR website.


Carr PJ, Rippey JCR, Cooke ML, Higgins NS, Trevenen ML, Foale A, et al. Derivation of a clinical decision-making aid to improve the insertion of clinically indicated peripheral intravenous catheters and promote vessel health preservation. An observational study. PloS one. 2019;14(3):e0213923.

Using the derived decision aid, clinicians could ask:- "Does this patient need A-PIVC?" Clinicians can decide to insert a clinically indicated PIVC when: (i) Admission to hospital is anticipated and when (ii) a Procedure requires a PIVC, e.g., computerised tomography scans and where an existing suitable vascular access device is not present and or; (iii) there is an indication for IV fluids and or medicines that cannot be tolerated enterally and are suitable for dilution in peripheral veins; and, (iv) the Clinician's perceived likelihood of use is greater than 80%.

Slater K, Cooke M, Scanlan E, Rickard CM. Hand hygiene and needleless connector decontamination for peripheral intravenous catheter care-time and motion observational study. Am J Infect Control. 2019 doi: 10.1016/j.ajic.2019.01.022. [Epub ahead of print]

Good hand hygiene and "scrub the hub" practices are important to prevent bloodstream infections. This observational study (n = 108) found high compliance with "scrubbing the hub," although scrub time was shorter than the recommended duration (average 6.1 seconds). Compliance with hand hygiene before medication preparation (33%) and before medication administration (43%) showed room for improvement compared with postadministration (65%), the emergency setting and glove use were associated with poorer compliance (P < .01).

Flynn JM, Larsen EN, Keogh S, Ullman AJ, Rickard CM. Methods for microbial needleless connector decontamination: A systematic review and meta-analysis. Am J Infect Control. 2019 Feb 27. pii: S0196-6553(19)30006-9. doi: 10.1016/j.ajic.2019.01.002. [Epub ahead of print] Review.

Alcohol impregnated caps and alcoholic chlorhexidine gluconate wipes were associated with significantly less catheter associated bloodstream infection (CABSI) than 70% alcohol wipes. This requires confirmation in randomized controlled trials.

Moureau NL, Marsh N, Zhang L, Bauer MJ, Larsen E, Mihala G, Corley A, Lye I, Cooke M, Rickard CM. Evaluation of Skin Colonisation And Placement of vascular access device Exit sites (ESCAPE Study). J Infect Prev. 2019 Jan;20(1):51-59. doi: 10.1177/1757177418805836. Epub 2018 Nov 9.

Skin microorganism load was significantly lower at the upper arm or chest, compared to the mid- or base neck. This may impact VAD site selection and subsequent infection risk.

Webster J, Osborne S, Rickard CM, Marsh N. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2019 Jan 23;1:CD007798. doi: 10.1002/14651858.CD007798.pub5. Review.

There is moderate-certainty evidence of no clear difference in rates of CRBSI, thrombophlebitis, all-cause BSI, mortality and pain between clinically indicated or routine replacement of PIVC. We are uncertain if local infection is reduced or increased when catheters are changed when clinically indicated. There is moderate-certainty evidence that infiltration and catheter blockage is probably lower when PIVC are changed routinely; and moderate-certainty evidence that clinically indicated removal probably reduces device-related costs. The addition of two new trials for this update found no further evidence to support changing catheters every 72 to 96 hours. Healthcare organisations may consider changing to a policy whereby catheters are changed only if there is a clinical indication to do so, for example, if there were signs of infection, blockage or infiltration. This would provide significant cost savings, spare patients the unnecessary pain of routine re-sites in the absence of clinical indications and would reduce time spent by busy clinicians on this intervention. To minimise PIVC-related complications, staff should inspect the insertion site at each shift change and remove the catheter if signs of inflammation, infiltration, occlusion, infection or blockage are present, or if the catheter is no longer needed for therapy.

Webster J, Ray-Barruel G, Rickard C, Marsh N, Mihala G, Alexandrou E. "Just in case". Use of large bore peripheral intravenous catheters in parturient women: A global study. Vascular Access. Jan 2019; 5(1).

Large bore PIVCs are over-used for vascular access in perinatal women. Considering the associated risks, careful attention should be given to inserting the right gauge catheter for specific purposes and, if there is no indication, a catheter should not be placed in a vein at all.

Takashima M, Schults J, Mihala G, Corley A, Ullman A. (2018). Complication and Failures of Central Vascular Access Device in Adult Critical Care Settings. Crit Care Med, 46(12), 1998-2009. doi:10.1097/ccm.0000000000003370

Central venous access device complications and device failure is a prevalent and significant problem in the adult ICU, leading to substantial patient harm and increased healthcare costs. The high proportion of central venous access devices removed due to suspicion of infection, despite low overall central line-associated bloodstream infection and catheter-related bloodstream infection rates, indicates a need for robust practice guidelines to inform decision-making surrounding removal of central venous access devices suspected of infection.

Ullman AJ, Mihala G, O'Leary K, Marsh N, Woods C, Bugden S, Rickard CM. (2018). Skin complications associated with vascular access devices: A secondary analysis of 13 studies involving 10,859 devices. Int J Nurs Stud, 91, 6-13. doi:10.1016/j.ijnurstu.2018.10.006

Significant skin complications can develop during the life of peripheral and central vascular access devices, and these are associated with several modifiable and non-modifiable risk factors. Further research is needed to evaluate effectiveness technologies to prevent and treat skin complications associated with vascular access devices.

Kleidon TM, Cattanach P, Mihala G, Ullman AJ. Implementation of a paediatric peripheral intravenous catheter care bundle: A quality improvement initiative. J Paediatr Child Health. 2019 Jan 31. doi: 10.1111/jpc.14384. [Epub ahead of print] 

This project demonstrates that the implementation of a multimodal bundle of care, including education, visual aids and standardisation of equipment, improved many aspects of PIVC insertion and management. Understanding the patient and carer perspective through interviews contributed to the intervention design to improve the overall patient experience. This project used a pragmatic design to enable replication in other hospitals and provides a framework for clinicians in other paediatric health-care facilities to develop similar interventions based on local service needs. Although PIVC bundles significantly improved some aspects of care, it did not demonstrate a reduction in PIVC failure. This suggests that additional interventions, such as innovations in dressing and securement of PIVCs, are urgently required to achieve the ‘holy grail’ of SUCCESS PIVCS.

Ullman A, Bulmer A, Dargaville T, Rickard CM, Chopra V. Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety, Expert Review of Medical Devices, 16:1, 25-33, DOI: 10.1080/17434440.2019.1555466

A range of PICCs have been developed with antithrombogenic claims, using varying technologies. However, to date, there is no peer-reviewed laboratory research describing the individual PICCs’ effectiveness. Despite promising early clinical trials, adequately powered trials to establish efficacy, effectiveness, efficiency, and safety of all of the individual products have not yet been undertaken.

Schults JA, Rickard CM, Kleidon T, Hughes R, Macfarlane F, Hung J, Ullman AJ. Building a Global, Pediatric Vascular Access Registry: A Scoping Review of Trial Outcomes and Quality Indicators to Inform Evidence-Based Practice. Worldviews Evid Based Nurs. 2019 Feb;16(1):51-59. doi: 10.1111/wvn.12339. Epub 2019 Jan 2.

Vascular access outcomes reported in pediatric and neonatal RCTs are highly heterogeneous. Internationally, clinical registries currently collect minimal VA data with the exception of infection outcomes. A core dataset of reliable, relevant measures to children and clinicians for VA device quality is needed. This will enable a VA registry that facilitates inter-institutional and international benchmarking.

Pearse BL, Rickard CM, Keogh S, Lin Fung Y.  A retrospective explanatory case study of the implementation of a bleeding management quality initiative, in an Australian cardiac surgery unit. Australian Critical Care. 2019, 32(2), 92-99. doi:

This case study provides a comprehensive and systematic analysis of the implementation of a bleeding management QI in a cardiac surgery program at a tertiary hospital. The key successful components of the QI were revealed through the case study analysis as: (1) an appropriately skilled project manager to facilitate the implementation process; (2) tools to support changes in workflow and decision-making including a bleeding management treatment algorithm with POCCTs; (3) strong clinical leadership from the multidisciplinary team; and (4) the evolution of the project manager position into a perpetual clinical position to support sustainability. These findings can inform future QI initiatives, particularly those requiring evidence uptake and practice change by multidisciplinary clinicians in the acute inpatient setting.


Hawthorn A, Bulmer AC, Mosawy S,  Keogh, S. Implications for maintaining vascular access device patency and performance: Application of science to practice. The Journal of Vascular Access. 2019

 This review provides an update to our current knowledge and understanding of vascular physiology and the hemodynamic response, challenging some previously held assumptions regarding vascular access device maintenance, which require further investigation.




Vascular Access – Call for Papers


The deadline for submissions is 15 July 2019.


The Australian Vascular Access Society (AVAS) is an association of healthcare professionals founded to promote the vascular access specialty ( Our multidisciplinary membership strives to advance vascular access research, promotes professional and public education to shape practice and enhance patient outcomes, and partners with industry to develop evidence-based innovations in vascular access.


The electronic journal Vascular Access is the official publication of AVAS, and provides a venue for national and international scholars and practitioners to publish high-quality peer-reviewed research and educational reviews relevant to vascular access in Australia and globally. The journal also provides a space for evidence-based discussions and debate on issues of importance to patients requiring vascular access.


Vascular Access is published twice a year (April and October) and manuscripts pertaining to this specialty are invited. The editor welcomes manuscripts in the form of research findings, clinical papers, case studies, reports, review articles, letters and product appraisals. Video submissions are also welcomed. Submissions will be accepted from any country but must be in English.


For more information, please see the Author Guidelines or contact the Editor at

Vascular access


 EOI VA Editor position


Expressions of Interest 

Editor in Chief – Vascular Access 

Commencing May 2019 

Key Objectives: 

  • Guide the overall strategic direction of Vascular Access, in consultation with the AVAS board and the publisher 
  • Maintain a high level of quality in the manuscript review and journal editing process
  • Provide appropriate and timely communication to authors.
  • Screen all manuscripts submitted for publication to ensure they meet the aims and scope of Vascular Access and are appropriate for proceeding to peer review
  • Make sure all papers are reviewed by two independent reviewers
  • Maintain the integrity and confidentiality of the author’s work during the peer review process
  • Take appropriate action should a manuscript be found to be plagiarized
  • Contribute to any amendments or additions to the Author Guidelines to reflect developments in requirements from authors.
  • Engage members of the Editorial Board to acquire suitable contributions for the journal and undertake the timely review of manuscripts 
  • Represent and actively promote Vascular Access amongst colleagues and at conferences in order to generate submissions to the journal
  • Make a final decision on acceptability of manuscripts for publication
  • Mentor new members of the editorial team 
  • Manage ongoing performance of the editorial team

For further information or to submit an expression of interest, 


Alliance for Vascular Access Teaching and Research Group
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