Journal of intravenous nursing : the official publication of the Intravenous Nurses Society
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Review Practice Guideline Guideline
Guidelines for the management of intravascular catheter-related infections.
These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications. ⋯ Therefore, the recommendations in these guidelines are intended to support, and not replace, good clinical judgment. Also, a section on selected, unresolved clinical issues that require further study and research has been included. There is an urgent need for large, well-designed clinical studies to delineate management strategies more effectively, which will improve clinical outcomes and save precious health care resources.
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Patients who do not report pain and healthcare providers who fail to assess for pain are major barriers to the relief of pain. Using pain as the fifth vital sign and being knowledgeable about pain assessment and management can help nurses and other healthcare providers overcome many of the barriers to successful pain control. A successful pain control plan includes establishing the pain diagnosis, treating the cause of the pain when possible, optimizing analgesic use, implementing nonpharmacological interventions to maximize physical and psychological comfort and function, and referring the patient for invasive pain management options when indicated.
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The microintroducer approach to obtaining initial venous access and threading a peripherally inserted central catheter (PICC) with and without imaging support is described. Equipment needed and steps to complete the procedure are described. Initial patient assessment and problem solving are discussed, as is application of the microintroducer technique in clinical practice. Potential complications and challenges are included.
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The role of the interventional radiologist in the care of patients requiring placement of central venous access devices is rapidly evolving. With experience gained from diagnosing and treating central venous catheter-related complications, interventional radiologists are assuming an increasing role in the placement of these devices. With imaging guidance, catheter and guidewire skills, and a commitment to providing a clinical service that includes management of catheter malfunctions and complications, central venous access by the interventional radiologist has proven a safe and effective alternative to standard surgical techniques.
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Based on patient condition, intravenous therapies, caregiver support, and organizational policy, correct device selection plays an integral part in the overall care and management of the alternate care setting i.v. therapy patient. This paper will identify the various aspects of appropriate device selection for i.v. therapy prescriptions.