Tricia Kleidon named the 2019 Janet Pettit Scholar

Congratulations to Tricia Kleidon for this prestigious international award. The Association of Vascular Access and the Pediatric Special Interest Group recognized Tricia as the 2019 Dr Janet Pettit Scholar in honor of the life work of Dr. Janet Pettit.

Tricia Kleidon is a Nurse Practitioner in Paediatric Vascular Assessment and Management at Queensland Children's Hospital in Brisbane, Australia, and a Research Fellow with AVATAR at Griffith University.

She is a nationally and internationally-welcomed speaker and educator for peripheral and central venous access devices and was AVATAR’s Researcher of the Year in 2017.

https://www.avainfo.org/page/JPSAward2019

Tricia Kleidon, 2019 Janet Pittet Scholar

I-DECIDED® Assessment and Decision Tool

Almost all hospital patients need a peripheral intravenous catheter, yet up to 69% develop painful complications or stop working. Regular, systematic assessment can help with prevention and early detection of complications.

I-DECIDED® is an evidence-based assessment and decision tool for intravascular devices. This simple checklist promotes comprehensive IV assessment, management, and timely removal of IV devices.

Please, watch the video here: I-DECIDED® Assessment and Decision Tool

For further information, please contact
Dr Gillian Ray-Barruel
AVATAR, Griffith University
Queensland, Australia
g.ray-barruel@griffith.edu.au

Dr Yasuda on the far left, Professor Rickard, and Dr Yasuda’s family.

Associate Professor Ullman from the far left, Professor Chopra, Professor Rickard, Dr Yasuda, Dr Ray-Barruel, and Ms Schults.

Next, we are growing our nursing links with the University of Tokyo. A recent meeting was held with Japanese nursing researchers led by Professor Sanada Director of the Nursing Research Centre. The University of Tokyo has published many high-quality research papers on intravenous therapy, particularly on peripheral IV catheters. There are plans for Prof Sanada to send a Japanese nurse for PhD studies with AVATAR and to grow the collaboration.

 

(from left) Professor Hiromi Sanada, Director Global Nursing Research Centre, Uni of Tokyo, Prof Claire Rickard, Yui Shintani, Prof Ryoko Murayama
 

International visitors

Dr Vineet Chopra, University of Michigan undertook an academic visit with AVATAR in Brisbane after the recent AVAS conference. This was an exciting chance to progress our work under the IMAGINE banner- Innovative Michigan And Griffith International NEtwork. Many research grants and publications were pulled apart and put back together again. Dr Chopra’s mentoring magic was also called upon (https://tinyurl.com/y553xtfx) with many of the team enjoying one-on-one meetings to reflect upon their goals in coming years. Of course there were also dinners aplenty, and chances to chuckle over Australian and North American similarities and differences!


Dr Vineet Chopra (in the front right) and the AVATAR members

Dr Jack LeDonne, a respected surgeon and expert in vascular access, also visited us in Brisbane after the AVA conference. He gave a well-received lecture at the Princess Alexandra Hospital and challenged us to think differently about some common aspects of central venous access device insertion and care.

 Professor Rickard (left) and Dr LeDonne (right) comparing mobility aids.

Prof Marie Cooke, Tricia Kleidon, Michael Zeglinas, Jocelyn Hill, Prof Sam Keogh, and Prof Claire Rickard (from left to right)

Finally, we were honoured to have vascular access/infusion therapy nursing expert Jocelyn Hill visit us from Providence Health Care, Vancouver, Canada. Jocelyn was on a national lecture tour but had time to have a quick meal with us that included seafood, sunset, and the Brisbane River.

Awards

Congratulation Dr Nicole Marsh for the Queensland Health Metro North Hospitals and Health Services 2019 Implementation Award.

Since 2014, the Nursing and Midwifery Research Centre Vascular Access (NMVA) research team have substantially increased their extensive program of research aimed at improving vascular access outcomes for patients. Within the last 12 months alone, the team has commenced, continued or completed over 10 research trials/studies, engaging all clinical specialities within Metro North Hospital and Health Services, including emergency; medical; surgical; cancer care; critical care; and women’s and newborn/neonatal disciplines. Their continuing efforts to decrease venous access device failure; improve patient-reported outcomes; and minimise economic inefficiencies has benefited Metro North substantially and has brought international recognition and praise. As a nurse-led team, their research is embedded heavily within daily clinical practice, using pragmatic research methods to identify research questions arising at the bedside, and meeting these needs with innovative technologies and care/maintenance strategies to reduce complications and costs.

Dr Nicole Marsh in the centre with team members

Congratulation Amanda Corley on receiving The Prince Charles Hospital 2019 Rising Star of Research Award.

Nurse Researcher and PhD candidate, Amanda Corley, is investigating an evidence-based securement bundle to address the current unacceptably high failure rate in peripheral intravenous catheters (PIVCs). She has recently presented the results of one phase of her PhD at the Australian Vascular Access Society Scientific Meeting in Sydney, entitled ‘Global trends in peripheral intravenous catheter dressing, securement and complications: a secondary analysis of 40,637 catheters’. The manuscript is currently under review with the International Journal of Nursing Studies.

Grant News

Congratulation Amanda Corley for receiving the grants:

ACIPC Cardinal Health Infection Control Scholarship for PhD "Optimal dressing and securement of peripheral intravenous catheters to prevent infection and failure"

Centaur Memorial Fund for Nurses Postgraduate Scholarship "The use of a securement bundle to prevent peripheral intravascular catheter failure”

The Prince Charles Hospital Foundation PhD Scholarship for 2 years.

Ms Amanda Corley on the left receiving Centaur scholarship from President Julie Finucane

Congratulation A/Prof Amanda Ullman, Dr Claire Rickard, Dr. Nicole Marsh, Emily Larsen, Natasha Roberts, Jolon Faichney, and Dr Joshua Byrnes

A/Prof Ullman and team have been awarded the 2019 Royal Brisbane Women’s Hospital Diamond Care Grant “Consumer-led innovation to implement improvements in central venous access device management: the Vascular Access Passport”.

Australian Vascular Access Society Scientific Meeting 2019, Sydney

The 3rd AVAS Scientific Meeting was held at the Park Royal Parramatta in May. With over 150 attendees and 60 presentations held over two days, this was a bustling educational event, with international guest speakers from the USA, Canada, Japan, New Zealand, and speakers from almost every state and territory in Australia. The catchy conference by-line ‘Walk the Line’ spurred plenty of references to the Man in Black, and several conference attendees could be heard humming tunes as they made their way between sessions. And of course, the AVAS Film Festival was an enormous hit. 

Vale Elie Kasindi Kabululu

We send our heartfelt condolences to the family and friends of our nursing colleague Elie Kasindi Kabululu from Democratic Republic of Congo. Elie was a dedicated nursing humanitarian, passionate about improving conditions for healthcare workers and providing infection control and evidence-based healthcare in a region struggling with the Ebola crisis amidst civil war and daily violence. 

Elie's life mission was to raise the awareness of the plight of the Congolese people and seek partnership and support from more affluent nations. Elie participated in and conducted many research projects at his hospital, Centre Médical Evangélique de Nyakunde, Beni, including the OMG study) (https://bit.ly/2H8zsGe); mosquito nets; HIV self-tests; hand hygiene compliance; antibiotic prescribing, and many others. Elie was an enthusiastic participant in many infection control programs, courses, and conferences, including SHEA, CDC, ICAN, ICPIC, GNLI, among others. Wherever he went, he sought to raise awareness of the plight of the Congolese people.

We extend our deepest sympathy to Elie's wife Yvette and his children and all his family and friends. Elie was a true nursing hero. May he rest in peace.

As many of you know, Elie had set up a fundraiser to raise money for the healthcare workers and their families in his region. If you would like to make a donation, here is the link: 

https://gogetfunding.com/need-of-assistance-of-the-d-r-c-health-provider-working-in-the-frontline-of-humanitarian-crisis/?fbclid=IwAR1tv-Htja9bCxCD8Aq6aXr4RrPCcIUVvrYquPtWdKGivGLmfXsRIU8lJns

Dr Gillian Ray-Barruel and Prof Claire Rickard

Upcoming conferences 

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

Australian Clinical Trials Alliance International Clinical Trials Conference

2-5 October 2019

Sydney, Australia

Abstract due on 8^th July, 2019

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

World Congress of Intensive Care

11-18 October 2019

Melbourne, Australia

8th International Australian College of Infection Prevention and Control Conference

8 November 2019

Perth, Australia

World Congress Vascular Access 2020

June 17-19

Athens

New Publications 

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

Ullman AJ, Kleidon TM, Turner K, Gibson V, Dean A, Cattanach P, Pitt C, Woosley J, Marsh N, Gavin N, Takashima M & Rickard CM. Skin complications associated with pediatric central venous access devices: prevalence, Incidence, and risk. Journal of Pediatric Oncology Nursing. 2019:104345421984957.

Two hundred and seventy-one CVADs were reviewed over 43,787 catheter days, with over one eighth of participants (14%; n = 37) having a CVAD-associated skin complication during their admission (0.95 per 1,000 catheter days, 95% confidence interval [CI; 0.61, 1.17]), most commonly contact dermatitis (11%; n = 29; 0.72 per 1,000 catheter days 95% CI [0.50, 1.04]). Within biweekly checks the median point prevalence of complications varied between 0.4% and 11% and clinical management was wide-ranging. A primary diagnosis of oncology (HR 2.89, 95% CI [1.10, 7.62]) or medical/surgical (HR 2.55, 95% CI [1.04, 6.22]) conditions; plain, nonbordered polyurethane dressings (HR 4.92, 95% CI [2.00, 12.13]); and poor dressing integrity (HR 2.64, 95% CI [1.18, 5.92]) were significantly associated with contact dermatitis. In conclusion, substantial numbers of pediatric patients experience CVAD-associated skin complications, and innovations are necessary to identify, prevent, and treat these health care–associated injuries.

Kaur P, Rickard CM, Domer GS, Glover KR. Dangers of Peripheral Intravenous Catheterization: The Forgotten Tourniquet and Other Patient Safety Considerations. Provisional Chapter. Vignettes in Patient Safety - Volume 4. Published: February 9th 2019. DOI: 10.5772/intechopen.83854

The most frequent nonmechanical peripheral venous catheterization adverse events (PVCAEs) include insertion site pain, phlebitis, hematoma formation, and infusate extravasation. The most common mechanical PVCAE is catheter obstruction/occlusion and dislodgement. Significant complications can also occur with the administration of incorrect type or wrong amount of IV fluids. Moreover, simultaneous infusion of incompatible medications can result in infusate precipitation. Finally, less frequent but significant complications have been reported, including bloodstream and local infections, air embolization, nerve damage, arterial puncture, skin necrosis associated with vasopressor infusions, and limb-threatening forgotten tourniquet events. Taken together, the above complications can lead to substantial patient discomfort, unnecessary or prolonged hospitalization, increased costs, and additional downstream morbidity. Efforts to prevent PVCAEs and improve patient outcomes should involve thorough provider education, clinical vigilance by all involved healthcare providers, health service level strategies, as well as the proactive participation of all stakeholders, including patients and their families.

Clark, JE, Graham N, Kleidon T, Ullman A. Taurolidine-Citrate Line Locks Prevent Recurrent Central Line-Associated Bloodstream Infection in Pediatric Patients. Pediatr Infect Dis J, 2019, 38(1), e16-e18. doi:10.1097/inf.0000000000002191 

This study describes a successful, targeted intervention in central venous access device routine care, to decrease central line associated bloodstream infection (CLABSI). Taurolidine-Citrate locks significantly reduced the rate of CLABSI, particularly Gram-negative organisms without adverse events.

Kleidon TM, Keogh, Flynn J, Schults J, Mihala G, Rickard CM. Flushing of peripheral intravenous catheters: A pilot, factorial, randomised controlled trial of high versus low frequency and volume in paediatrics. J Paediatr Child Health. 2019 Apr 29. doi: 10.1111/jpc.14482. [Epub ahead of print]  

High PIVC failure rates indicate the inadequacy of current PIVC care and maintenance including flush technique in paediatric patients. This pilot trial demonstrated that the protocol in its current format is not feasible in the paediatric population due to eligibility issues. A study evaluating the effectiveness of slow continuous infusion versus intermittent flushing might be more feasible and would fill a longstanding knowledge–practice gap. Analysis of the clinical outcomes suggests clinicians could use 10 mL flushing volumes every 24 h with no increase in PIVC failure or cost; however, the small sample size associated with the pilot nature of this study precludes our ability to draw firm conclusions. Maintenance of PIVCs extends beyond intermittent flushing. A comprehensive programme of rigorous research to improve PIVC outcomes in paediatric patients is urgently needed to extend the functional dwell of PIVCs and generate high-level evidence to inform policy and practice.

Coventry L, Hosking JM, Chan DT, E Coral, Lim WH, Towell-Barnard A, Twigg DE, Rickard CM. Variables associated with successful vascular access cannulation in hemodialysis patients: a prospective cohort study. BMC Nephrology. Published: 31 May 2019. BMC Nephrology 2019 20:197. https://doi.org/10.1186/s12882-019-1373-3

This study demonstrated a low rate of miscannulation. Further research is required on ultrasound-guided cannulation. Identifying variables associated with successful cannulation may be used to develop a VA cannulation complexity instrument that could be utilised to match to the cannulation skill of a competency-assessed nurse, thereby minimising the risk of missed cannulation and trauma.

DeVries M. Revisiting CLABSI prevention strategies: Part 1. Follow the basics to keep your patients safe. American Nurse Today. May 2019 Vol. 14 No. 5. 

This is the first in a two-part series on central line–associated bloodstream infections (CLABSIs). Part 1 focuses on indications and insertions. Part 2 will discuss maintenance and what to do if a CLABSI occurs.

DeVries M, Lee J, Hoffman L. Infection free midline catheter implementation at a community hospital (2 years).  American Journal of Infection Control. 2019. ISSN 0196-6553. https://doi.org/10.1016/j.ajic.2019.03.001.

Vascular access choices require a clear understanding of patient needs, vessel health, and preservation concepts and length and nature of prescribed therapy. Guidelines, standards, and published literature offer an excellent starting point to determine appropriate device selection, but equally important is understanding the performance of those devices once placed within an organization by that facility’s available inserters and the staff who are providing care and maintenance. Using that information to continuously inform the inserters (and providers) can help ensure device selections remain evidence-based and with a clear understanding of patient safety implication. In our large, urban community hospital, infection prevention and vascular access teams were able to successfully launch a carefully controlled midline catheter program without any reported infections (with the primary device), maintaining an 80% completion of therapy, while at the same time helping decrease excess central line placements and their associated CLABSI risk.

August D, Ullman AJ, Rickard CM, New K. Peripheral intravenous catheter practices in Australian and New Zealand neonatal units: A cross-sectional survey. Journal of Neonatal Nursing. Available online 19 March 2019 

Peripheral intravenous catheters (PIVCs) are important tools for the provision of treatment for unwell and premature neonates. This study aimed to explore current PIVC practices (i.e. insertion, product selection, complications and management priorities) within Australian and New Zealand neonatal units, to identify areas for innovation and practice change.

Larsen E, Marsh N, Rickard CM. Peripheral venous catheter dressings- comparing the old with the new. Hospital+Healthcare. Autumn 2019. Pg18-19. hospitalhealth.com.au

The researchers postulated that while tissue adhesive in combination with a simple polyurethane dressing may not benefit patients at a whole hospital population level, these products should continue to be considered for high risk and ‘difficult IV access’ patients.

Ray -Barruel G, Xu H, Marsh N, Cooke M, Rickard CM. Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review. Infect Dis Health. 2019 Apr 17. pii: S2468-0451(19)30016-1. doi: 10.1016/j.idh.2019.03.001

Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2-7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between 'low' and 'fair'. The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed.

Ray-Barruel G, Woods C, Larsen EN, Marsh N, Ullman AJ, Rickard CM. Nurses' decision-making about intravenous administration set replacement: a qualitative study. J Clin Nurs. 2019 Jun 26. doi: 10.1111/jocn.14979

Five key themes emerged from the analysis: (1) infection prevention, (2) physical safety, (3) patient preference, (4) clinical knowledge and beliefs, and (5) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts, and local policies, to aid their decisions. Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice. Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience, and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands.

Coventry LL, Hosking JM, Chan DT, Coral E, Lim WH, Towell-Barnard A, Twigg DE, Rickard CM. Variables associated with successful vascular access cannulation in hemodialysis patients: a prospective cohort study. BMC Nephrol. 2019 May 31;20(1):197. doi: 10.1186/s12882-019-1373-3.

We collected data on 1946 episodes of cannulation (83.9% fistula) in 149 patients by 63 nurses. Cannulation included use of tourniquet (62.9%), ultrasound (4.1%) and was by rope ladder (73.8%) or area (24.7%) technique. The miscannulation rate was 4.4% (n = 85) with a third of patients (n = 47) having at least one episode of miscannulation. Extravasation (n = 17, 0.9%) and use of an existing CVC (n = 6, 0.6%) were rare. Multivariable characteristics of successful cannulation included fistula compared with graft [OR 4.38; 95%CI, 1.89-10.1]; older access [OR 1.68; 95%CI, 1.32-2.14]; absence of stent [OR 3.37; 95%CI, 1.39-8.19]; no ultrasound [OR 13.7; 95%CI, 6.52-28.6]; no tourniquet [OR 2.32; 95%CI, 1.15-4.66]; and lack of post graduate certificate in renal nursing [OR 2.27; 95%CI, 1.31-3.93]. This study demonstrated a low rate of miscannulation. Further research is required on ultrasound-guided cannulation. Identifying variables associated with successful cannulation may be used to develop a VA cannulation complexity instrument that could be utilised to match to the cannulation skill of a competency-assessed nurse, thereby minimising the risk of missed cannulation and trauma

Carr PJ, Rippey JCR, Cooke ML, Trevenen ML, Higgins NS, Foale AS, Rickard CM. Factors associated with peripheral intravenous cannulation first-time insertion success in the emergency department. A multicentre prospective cohort analysis of patient, clinician and product characteristics. BMJ Open. 2019 Apr 2;9(4):e022278. doi: 10.1136/bmjopen-2018-022278.

A total of 1201 PIVCs were inserted in 879 patients. The mean age was 60.3 (SD 22) years with slightly more females (52%). The FTIS rate was 73%, with 128 (15%) requiring a second attempt and 83 (9%) requiring three or more attempts. A small percentage (3%) had no recorded number of subsequent attempts. FTIS was related to the following patient factors: age (for a 1-year increase in age: OR 0.99, 95% CI 0.983 to 0.998; p=0.0097); and target vein palpability: (always palpable vs never palpable: OR 3.53 95% CI 1.64 to 7.60; only palpable with tourniquet vs never palpable: OR 2.20, 95% CI 1.06 to 4.57; p=0.0014). Clinician factors related to FTIS include: clinicians with greater confidence (p<0.0001) and insertion experience (301-1000 vs <301: OR 1.54, 95% CI 1.02 to 2.34; >1000 vs <301: OR 2.07, 95% CI 1.41 to 3.04; p=0.0011). The final all factors model combining patient factors; clinician factors and product and technology factors has greater discriminative ability than specific factors models. It has a sensitivity of 74.26%, specificity of 57.69%, positive predictive value of 82.87% and negative predictive value of 44.85%. A clinical decision, matching patients who have no palpable veins and are older, with clinicians with greater confidence and experience, will likely improve FTIS.