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IVOPINION

IVOPINION
Looking for IVTEAM?
July 31, 2016 at 11:44 pm 0
I am really pleased to announce that IVTEAM.com has an alternative domain name that we hope our visitors find useful. The new domain is IV.team Of course the original .com extension will continue to work. We just want to offer our visitors a shorter URL when visiting IVTEAM. I also think its a really cool domain name :-) If you still need a reminder it is IV.team Enjoy
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IVOPINION
Peripheral IV catheter care bundle
May 19, 2016 at 10:40 pm 0
IV bundles have become established as an essential component of safer IV care. However, examples of peripheral IV bundles are difficult to locate. This link will take you to an example of a peripheral IV catheter bundle from The Rotherham NHS Foundation Trust, UK. Other examples useful intravenous documentation that you find useful include: PICC passport Midline passport Peripheral cannulation patient information Fluid balance chart
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IVOPINION
Midline passport example
May 19, 2016 at 10:26 pm 0
We have recently shared an example of a PICC passport. As midline catheters gain in popularity you may also find this midline passport useful. Other examples useful intravenous documentation that you find useful include: PICC passport Peripheral IV bundle Peripheral cannulation patient information Fluid balance chart  
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IVOPINION
Example of a PICC passport
May 19, 2016 at 10:17 pm 0
Patient passports are seen as a method of ensuring care standards are transferred across health care providers. They also offer the patient an opportunity to record feedback on the PICC care they receive. PICC passports combine patient information, PICC details, a care plan and a patient diary into one convenient booklet. An example of a PICC passport can be found by clicking this link. Other examples useful intravenous documentation that you find useful include: Midline passport Peripheral IV bundle Peripheral cannulation patient information Fluid balance chart  
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IVOPINION
Which apps are the most useful to ease a busy professional and academic life?
March 25, 2016 at 12:32 pm 0
If, like me, you have a busy professional and academic life you will be looking for ways to ease the daily burden of constant activity. My first approach is to acknowledge that I am not alone with a busy schedule and dare I say the burden of procrastination (If this is not you… you have a charmed life). When desperate I often look for a Ted lecture to point me towards the path of wisdom and project completion. If you have multiple projects and a tendency to procrastination, then this Ted lecture is for you. If you are not burdened I suggest you still watch so that you have an understanding of those around you who are affected. Secondly, I look to technology to provide a solution. My use of technology tends to look at speeding up or possibly automating processes. These are the apps I find most useful: DeskConnect: How many times have you been working on one device and you want to send a file, photograph, pdf, presentation etc to another device. DeskConnect works between my iPhone, iPad, Mac and MacBook Air. Easy to setup and it works. The bonus is that is works at lightening speed. Whatever I send appears almost instantly on the other devices. No more emails to myself! Did I mention the app is free! Dragon Dictation: If you are a fan of dictating your work and you are looking for a way to convert voice to text this app should help. Easy to use. You can convert voice to text within the app. Also within the app you can review and amend the text then send the text to the location of your choice (Copy to clipboard and send via DeskConnect). Did I mention the app is free! RefMe: A number of referencing software choices exist. And I have tried most of them. RefMe is remarkable. I can search key words, titles, authors, DOI numbers all within the app. I can even scan barcodes directly from the book. The reference then auto populates. It even matches the reference style of your choice. Once you have your completed reference list it is easy to export the bibliography as text file (fully formatted in your referencing style) and add it to your work. Did I mention the app is free! Hope these recommendations help.
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IVOPINION
Vascular access clinical evidence and clinical practice
March 10, 2016 at 2:32 pm 0
When you next read an article or attend a conference ask yourself who is the intended audience? I have often voiced the opinion that we sometimes have a disconnect between research and clinical practice. To clarify, I'm a big fan of research studies that are valid, reliable and demonstrate a degree of probability. We need them. But, what about the evidence produced from alternative sources such as review articles, case studies and experiential opinion. Moreover, who decided limit the definition of what is classed as evidence? And more importantly, what evidence is being denied a voice in the decision making and guideline development process. Why would I make these comments. Well the answer is simply really. Most of us have to either put research into practice or devise research studies to investigate practice. In addition, we have those amongst us that are working really hard to get non-specialist teams who deliver routine IV care to understand the standards we expect them to achieve. In other words. We need evidence that we can apply in a working world. I pleased to say that I am not just a lone voice in this debate on evidence and clinical practice. Hayes (1990) published a short conversation piece on the "Loose connections between peer-reviewed clinical journals and clinical practice".  The approach adopted by Hayes (1990) is a very interesting discussion on who publishes and who reads journal papers. The following is a summary of the lines of communication in biomedical journals as identified by Hayes (1990):
  • Scientist to scientist - These studies are usually preliminary in nature and are classed as a communication from scientist to scientist. They have the potential to add to the knowledge base and hopefully generate further more rigorous research. The danger of this type of publication is that it may be mistaken for communication between scientist and clinician.
  • Scientist to practitioner - These are articles describing rigorous trials that need to be communicated to those putting evidence into practice. The danger here is that the paper may be missed by a part of the clinical audience who do not routinely access the scientific journals.
  • Practitioner to practitioner - These are publications in clinical journals that are usually presented as a review article. The function of the review article is to inform current clinical practice and to enable the readership to identify gaps in their knowledge.
  • Practitioner to scientist - These publications usually take the form of case studies. A note of caution is raised with regard to using case studies to determine the general broad management of patient care. But, they do have a role in highlighting areas of interesting practice. Therefore, they have a role in understanding the complexities of care at what is usually a single patient episode. It is highlighted that case studies have a particular role in generating new research topics. Therefore, publishing case reports remains justified.
Viewing a publication or a conference paper presentation in light of who is the intended audience is a very liberating experience. I look forward to researchers, authors and presenters defining their intended audience in the future. Reference: Haynes, R.B. (1990) Loose connections between peer-reviewed clinical journals and clinical practice. Annals of Internal Medicine. 113(9), p.724-728. doi:10.7326/0003-4819-113-9-724
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IVOPINION
Which sessions will you attend at WoCoVA 2016?
February 16, 2016 at 5:54 pm 0
The #wocova16 preliminary scientific program is available now. At first glance, I would say that this program is the best the WoCoVA congress organisers have ever put together. On day one my eye is drawn towards various sessions. Evan Alexandrou will present the results of the OMG PIVC Study. Sergio Bertoglio will deliver a session on using an antiseptic lock with taurolidine and/or citrate. In addition, Lieve Goossens will offer a session that examines the issues associated with new and old securement devices (very interested in that). Towards the close of the first day Daniele Biasucci will present a session examining the new frontiers of ultrasound; examining the use of ultrasound for tip location and PNX detection. Day two, offers an equally diverse and broad set of sessions. Vascular access around the world is considered in the main auditorium. I guess the UK is considered in the European section. Is it possible that Ton Van Boxtel has an insight into the forthcoming UK referendum on wether the UK stays in the European Union or not! The session that I am most interested in on day two is the debate around peripheral IV access in 2016. You may or may not be aware that I have been an avid user of midlines for fifteen years. We use midlines for specific medications and our clinical outcomes demonstrate they are a very reliable vascular access device when used as part of strict criteria led vascular access service. looking forward to the debate already! The third and final day of WoCoVA 2016 does not disappoint either. You will find various sessions that examine the evidence base associated with vascular access. The session I plan not to miss is the debate on the role of vascular access teams around the world. Having developed, published around, assisted others to develop and continue to manage a vascular access team in the UK I can feel the debate hotting up already. Finally, is anything missing from the WoCoVA 2016 scientific program. Well, I guess only one thing. I would like to see more case studies offered as an evidence base. They provide a perspective on the actual world of vascular access and infusion therapy that we are all working within. They can demonstrate how, why and when the evidence is not applied or at least illustrate areas of future research. Flight and hotel are arranged. Say hello at #wocova16
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IVOPINION
Looking for extravasation pictures?
December 26, 2015 at 7:23 pm 0
Nothing demonstrates the devastating outcome of extravasation more than a photograph. Park et al (2015) provide both text and illustrations that fully explain the impact and treatment of extravasation complicated with compartment syndrome. This is a must read article for all vascular access practitioners. Click here for the full text. Reference: Park, H.J., Kim, K.H., Lee, H.J., Jeong, E.C., Kim, K.W. and Suh, D.I. (2015) Compartment syndrome due to extravasation of peripheral parenteral nutrition: extravasation injury of parenteral nutrition. Korean Journal of Pediatrics. 58(11), p.454-8. DOI: 10.3345/kjp.2015.58.11.454.
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IVOPINION
VIP score research
December 8, 2015 at 12:23 am 0
I have read with interest the research that has examined the measurement quality of phlebitis scores Ray-Barrel et al (2014). A theme that appears to have undergone some discussion in the literature is the level of reliability, validity and responsiveness of tools that monitor peripheral IV sites. In addition, the practical application of the tool should be considered. It is with this final point that I have decided to publish this short insight into the history and the practical use of the VIP score. In 1995 I was fortunate to obtain a specialist nursing post in intravenous therapy. Back in the day (the mid to late nineties), infusion phlebitis was common place and ownership of preventative methodologies was at best absent. For those who know me well they will recognise that I was consumed with a need to improve patient care. As infusion phlebitis was a) a problem affecting many patients and b) was a clinical issue that lacked any professional proprietorship, I decided to develop a tool that would have the following qualities:
  • Visual and thought provoking.
  • Easy to integrate into current systems e.g. care plans.
  • Deliver a consistent clinical message associated with IV site monitoring.
  • Identified early signs of phlebitis.
  • Empower professional groups to act on the earliest signs of phlebitis and remove the device.
  • Provide a system for grading more severe episodes of phlebitis.
  • Ensure clinicians are consistent with the documentation (clinical signs such as 'slightly red' could now be translated into a number).
  • When documentation is reviewed, the reviewer has a tool that defines what the clinician has documented about the condition of the peripheral IV site.
To conclude this section, the VIP score is a tool that encourages site observation, identifies the earliest signs of phlebitis and ensures device removal. In addition, the VIP score raises the profile of IV care and adds to the language of vascular access, in turn ensuring standard documentation. Future research associated with phlebitis scores should consider the impact of the introduction of the score. The impact it has on increasing the frequency and type of checks made to peripheral IV sites. How they have increased professional proprietorship following introduction. The impact of the introduction on associated issues such as device associated bacteraemia. Finally, the whole purpose of the VIP score was to identify the early signs of phlebitis and facilitate early device removal. During any future research design I recommend that this defining role of the VIP score score is acknowledged. I'm not sure if any of the research I have read to date has effectively reviewed the main reason why the VIP score has been so successful and effective. Conflict of interest: Andrew designed the VIP score. Read more about the VIP score Reference: Ray‐Barruel, G., Polit, D. F.,  Murfield,, J. E. and Rickard, C.M. (2014) Infusion phlebitis assessment measures: a systematic review. Journal of Evaluation in Clinical Practice. .20(2), p.191-202.    
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IVOPINION
IV dressing reactions unpicked
October 24, 2015 at 8:15 am 0
I'm sure most of us have seen intravenous dressing reactions. We may have also witnessed the responses to such reactions from dressing companies. The response I disagree with the most is "not allowing the cleaning solution to dry". I have even heard this response to a dressing reaction following a PICC placement. I can be pretty slick at putting in PICCs... however, I not sure if anyone is that quick... that they can place the PICC and apply the dressing long before the cleaning solution has dried! What could be going on? My favourite theory relates to shear forces. We learn about shear forces when preventing pressure area damage. So how could a shear force be applied with an IV dressing. To put it simply, I think we have a tendency to stretch dressings when we apply them. I think this shear effect could be the cause of some of our dressing reactions. In particular, if you notice dressing reactions and blistering associated with the edge of the dressing... you may want to consider stretching the dressing during application as a potential cause. Finally, remember... this is opinion not science!
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