Happy Thanksgiving...the day after I hope!!!
We are exploring the use of the newer EDPIVs that are on the market...the Wand, PowerGlide, Flexicath M29 .... and are very interested to hear how they are working in real time with acute or intensively hospitalized patients. Top 5 Questions in our discussion here.
1. Who is being trained and competent to insert?
2. Is US being used? Always, Sometimes, Never?
3. Which patients are being found to benefit?
4. What are your thoughts and practices on the limitations on infused medications? (please don't quote INS standards) Do you infuse Vanco, Rocephin, Nafciillin, KCL, PPN?
5. Are these EDPIVs effectively and safely replacing the CVCs, PICCs or the 1" PIVs?
Thanks for your time and knowledgeable responses. I think a good discussion on clinical use of these catheters is necessary. We now also follow INS Position Statement on PIV assessment and avoiding routine site changes. Seeing 1" PIVs (When placed by an experienced IV Team RN) lasting weeks,,,> 2 weeks on some patients with infrequent and neutral infusions.
Scott Gilbert
Honolulu
Scott,
I'll try to brief with some answers. They reflect our practice at a 600+ bed tertiary center. We cover ED to several ICUs to med surg and everything in between.
4 Vascular Access RNs are trained to place the BD Powerglide.
We have tried the Wand, too cumbersome. We chose the Powerglide. We are considering a trial of the Flexicath. In real life, NONE of the devices allow for blood draws after 48 hrs....just doesnt happen.
We always use U/S. (~98.7% 1st stick success with U/S).
Pts who benefit: CF population (they can go home to complete a 14 D course of Abx w/o a PICC), obese pts, and the unfortunate pt who has been stuck numerous times over many days and we are finally called to see them for the 1st time, 3 days before they are being D/C'd....
We strongly advocate for a PICC and we won't knowingly place an "EDPIV/Midline" if a vessicant is being used or anticipated. PPN is used very infrequently. I cannot recall the last time we were denied a PICC insertion when it was clinically indicated and/or when a PIV was clinically contraindicated. We consider the Powerglide to be a Midline catheter, and place them per the industry guidelines and the IFUs.
You said:....."Seeing 1" PIVs (When placed by an experienced IV Team RN) lasting weeks,,,> 2 weeks on some patients with infrequent and neutral infusions."....
Agree !! We also use the BD Insyte 1.88" 20 & 18ga for U/S guided PIV insertions. The longer length catheters do seem to allow for longer dwell and fewer complications. (No hard data yet but working on it.)
Hope this helps.
PS: I think it would be prudent if I were to come to Honolulu & help with your research rather than do it in COLD NYS.....
Cheers,
DB
David Bruce RN
"Extended dwell" is not a category of catheters that is recognized in any guideline, standard, or set of recommendations. This is a marketing term. I totally agree that we need more evidence on clinical outcomes with these new types of catheters, however they are labeled as midline catheters, if you are including the ones I am thinking about. A midline label means they should be used as a midline rather than a longer peripheral placed in the lower forearm. For all catheters, the standard is to use the smallest size and shortest length of catheter to accomplish the safe infusion. For peripheral use, could these catheters be safelr if they were 2 inches instead of 3 inches? Do you need 3 inches in a forearm vein? Is the introducer method more successful than a traditional short peripheral catheter? What is the rate of phlebitis, infiltration/extravasation, thrombosis, nerve injury, etc with these catheters? I would encourage publications on these devices since that is the evidence used to write standards and guidelines documents. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861