Department of Laboratory Medicine and Department of Medicine, University Health Network, Toronto, Ontario, Canada.
University Health Network, Toronto, Ontario, Canada.
J Clin Apher. 2020 Aug;35(4):328-334. doi: 10.1002/jca.21800. Epub 2020 Jul 2.
Apheresis treatments require adequate venous access using peripheral intravenous (PIV) catheterization or central venous catheters (CVC). Ultrasound-guided PIV (USGPIV) can be used to decrease the need of CVC insertions for apheresis procedures.
A hybrid model of USGPIV and standard of care (SOC) for PIV access was developed. Nurses performed USGPIV on all patients considered for PIV access if felt SOC PIV access was not possible. Information was collected regarding nurses' confidence with access, number of attempts required, site of access, complications, and need for CVC.
In all, 226 PIV access attempts were made during a 2-month period. All apheresis procedure types were represented. A total 65% were accessed by SOC and 35% by USGPIV. USGPIV was successful on first try on 90% draw/inlet access and 87% successful on first try on return access. Access above the antecubital fossa was required in 31% of USGPIV for draw/inlet veins, and 22% of return veins. Nurses' confidence with accessing PIV was increased by USGPIV, based on 7-point Likert scale assessments. During the recording period, 2/226 (0.9%) apheresis procedures required a CVC. In a separate cohort of only hematopoietic progenitor cell collections, CVC insertion was required in 44/238 (18.5%) patients, in 7 months prior to adoption of USGPIV and 5/152 (3.3%) patients in 7 months following adoption of USGPIV.
A hybrid model of using SOC and USGPIV for PIV access for apheresis procedures resulted in decreased need for CVC access, high levels of successful initial access attempts, and increased nursing confidence in PIV access.
为了进行血浆分离治疗，需要通过外周静脉（PIV）置管或中心静脉导管（CVC）建立充足的静脉通道。超声引导下 PIV（USGPIV）可以减少为血浆分离治疗进行 CVC 置管的需求。
我们制定了一种 USGPIV 与 PIV 通路标准护理（SOC）相结合的混合模型。如果认为 SOC PIV 通路不可行，所有考虑进行 PIV 通路的患者均由护士进行 USGPIV。收集的信息包括护士对通路建立的信心、所需尝试次数、通路部位、并发症以及 CVC 的使用需求。
在两个月的时间内，总共进行了 226 次 PIV 通路尝试。所有类型的血浆分离治疗都有涉及。SOC 通路成功建立了 65%，USGPIV 通路成功建立了 35%。USGPIV 进行首次尝试时，90%的入口和 87%的返回都成功建立了通路。需要在上臂肘窝以上进行 USGPIV 通路建立的入口和返回分别占 31%和 22%。根据 7 分 Likert 量表评估，护士对 PIV 通路建立的信心因 USGPIV 而提高。在记录期间，有 2/226（0.9%）例血浆分离治疗需要 CVC。在仅进行造血祖细胞采集的另一组患者中，在采用 USGPIV 之前的 7 个月中，有 44/238（18.5%）例患者需要插入 CVC，而在采用 USGPIV 之后的 7 个月中，有 5/152（3.3%）例患者需要插入 CVC。
将 SOC 和 USGPIV 相结合用于血浆分离治疗的 PIV 通路建立，可减少 CVC 通路的使用需求，提高初始通路建立尝试的成功率，并提高护士对 PIV 通路建立的信心。
