INTRODUCTION: Vascular access devices (VADs) offer significant advantages both for patients, in terms of safe and effective administration of infusion therapy, and for healthcare professionals, who are responsible for monitoring their use in accordance with specific recommendations in order to prevent complications. However, to date, it is not possible to say with certainty whether this management is systematically documented using structured tools capable of ensuring continuous and appropriate monitoring of the patient's condition. MATERIALS AND METHODS: A quantitative study was carried out using descriptive observational methodology, the administration of an anonymous questionnaire, and the analysis of reports on VAD implants performed in 2024 at the hospitals of Ascoli Piceno and San Benedetto del Tronto. RESULTS: The study investigates how vascular access devices (VADs) are selected and managed by nursing staff working in the operating units of the Medical Department of the hospitals of Ascoli Piceno and San Benedetto del Tronto. The survey, conducted using questionnaires and analysis of 2024 implantation reports, involved a sample of 50 nurses. The results show significant heterogeneity in the criteria adopted for the choice of VADs, with a prevalence of factors such as the patient's vascular condition, the duration of therapy, and the type of treatment planned. There was a lack of uniformity in the training received and in monitoring practices, which were often based on paper documentation or non-integrated systems. The most frequently reported complications were infections, aspiration problems, thrombosis, and dislocation. The presence of standardized protocols and limited knowledge of guidelines contribute to significant clinical variability. ANALYSIS: The thesis analyzes the data using the questionnaire “on the right choice of vascular access devices (VAD),” administered to nurses in the Medical Department. The results are recorded and organized in Microsoft Excel linked to Google forms. The system automatically converts the responses into percentage values and explanatory graphs, anonymously to ensure the confidentiality of the participants. DISCUSSIONS: The survey analyzed the selection, management, and monitoring practices of vascular access devices (VADs) in two hospitals, comparing the data obtained with the literature and the main international guidelines. The results show reasonable adherence to the recommended clinical criteria, but also significant inconsistency in staff training, standardization of procedures, and knowledge of the guidelines. The variability in monitoring methods is particularly critical, compromising traceability and the prevention of complications. The high incidence of reported adverse events suggests the need to implement structured training courses, shared protocols, and computerized tools. The adoption of uniform company guidelines could be a fundamental step toward improving the quality, safety, and uniformity of care. CONCLUSIONS: The study highlighted differences between the hospitals of Ascoli Piceno and San Benedetto del Tronto in the selection of vascular access devices (VADs), with greater uniformity in the former. Critical issues related to training, protocol standardization, and complication monitoring emerged. In response, improvements are proposed, including shared protocols, dedicated teams, continuous training, and structured decision-making tools. KEYWORDS: “PICC”, “Midline”, “Nursing”, “Guideline”, “CICC”, “Accesses Vascular”, “Management”, “Definition”, “Epidemiology”.
INTRODUZIONE: I dispositivi di accesso vascolare (VAD) offrono vantaggi significativi sia per l’assistito, in termini di somministrazione sicura e ed efficace della terapia infusionale, sia per l’operatore sanitario, che ha il compito di monitorarne l’utilizzo seguendo specifiche raccomandazioni, al fine di prevenire l’insorgenza di complicanze. Tuttavia, ad oggi non è possibile affermare con certezza se tale gestione venga sistematicamente documentata mediante strumenti strutturati, in grado di garantire un monitoraggio continuo e appropriato delle condizioni del paziente. MATERIALI E METODI: È stato effettuato uno studio quantitativo attraverso la metodologia osservazionale descrittiva, la somministrazione di un questionario anonimo e l’analisi del report degli impianti VAD effettuati nel 2024 presso i presidi ospedalieri di Ascoli Piceno e San Benedetto del Tronto. RISULTATI: Lo studio indaga le modalità di selezione e gestione dei dispositivi di accesso vascolare (VAD) da parte del personale infermieristico operante nelle unità operative del Dipartimento medico dei presidi ospedalieri di Ascoli Piceno San Benedetto del Tronto. L’indagine, condotta mediante questionari e analisi dei report di impianto 2024, ha coinvolto un campione di 50 infermieri. I risultati mostrano una significativa eterogeneità nei criteri adottati per la scelta dei VAD, con prevalenza di fattori come la condizione vascolare del paziente, la durata della terapia e il tipo di trattamento previsto. È emersa una scarsa uniformità nella formazione ricevuta e nelle pratiche di monitoraggio, spesso affidate a documentazioni cartacea o sistemi non integrati. Le complicanze più frequenti segnalate sono risultate: infezioni, problemi di aspirazione, trombosi e dislocazione. La presenza di protocolli standardizzati e la limitata conoscenza delle linee guida contribuiscono a una variabilità clinica rilevante. ANALISI: La tesi analizza i dati tramite il questionario “sulla giusta scelta dei dispositivi di accesso vascolare (VAD”, somministrato agli infermieri del Dipartimento Medico i risultati vengono registrati e organizzati in Microsoft Excel collegato a Google moduli. Il sistema converte automaticamente le risposte in valori percentuali e grafici esplicativi, in forma anonima per garantire la riservatezza dei partecipanti. DISCUSSIONI: L’indagine ha analizzato le pratiche di selezione, gestione e monitoraggio dei dispositivi di accesso vascolare (VAD) in due presidi ospedalieri, confrontando i dati emersi con la letteratura e le principali linee guida internazionali. I risultati evidenziano una discreta aderenza ai criteri clinici raccomandati, ma anche una disomogeneità significativa nella formazione del personale, nella standardizzazione delle procedure e nella conoscenza delle linee guida. Risulta particolarmente critica la variabilità nelle modalità di monitoraggio, che compromette la traccia abilità e la prevenzione delle complicanze. L’alta incidenza di eventi avversi segnalati suggerisce la necessità di implementare percorsi formativi strutturati, protocolli condivisi e strumenti informatizzati. L’adozione di linee guida aziendali univoche potrebbe rappresentare un passo fondamentale per migliorare qualità, sicurezza e uniformità dell’assistenza. CONCLUSIONI: lo studio ha evidenziato differenze tra i presidi ospedalieri di Ascoli Piceno, San Benedetto del Tronto nella selezione dei dispositivi di accesso vascolare (VAD), con maggiore uniformità nel primo. Sono emerse criticità legate alla formazione, alla standardizzazione dei protocolli e al monitoraggio delle complicanze. In risposta, si propongono interventi migliorativi tra cui protocolli condivisi, team dedicati, formazione continua e strumenti decisionali e strutturati. KEYWORDS: “PICC”, “Midline”, “Nursing”, “Guideline”, “CICC”, “Accesses Vascular”, “Management”, “Definition”, “Epidemiology”.
Management dei VAD all’interno delle strutture ospedaliere: studio osservazionale dell’AST 5 Ascoli Piceno
PRATTICHIZZO, FRANCESCA
2024/2025
Abstract
INTRODUCTION: Vascular access devices (VADs) offer significant advantages both for patients, in terms of safe and effective administration of infusion therapy, and for healthcare professionals, who are responsible for monitoring their use in accordance with specific recommendations in order to prevent complications. However, to date, it is not possible to say with certainty whether this management is systematically documented using structured tools capable of ensuring continuous and appropriate monitoring of the patient's condition. MATERIALS AND METHODS: A quantitative study was carried out using descriptive observational methodology, the administration of an anonymous questionnaire, and the analysis of reports on VAD implants performed in 2024 at the hospitals of Ascoli Piceno and San Benedetto del Tronto. RESULTS: The study investigates how vascular access devices (VADs) are selected and managed by nursing staff working in the operating units of the Medical Department of the hospitals of Ascoli Piceno and San Benedetto del Tronto. The survey, conducted using questionnaires and analysis of 2024 implantation reports, involved a sample of 50 nurses. The results show significant heterogeneity in the criteria adopted for the choice of VADs, with a prevalence of factors such as the patient's vascular condition, the duration of therapy, and the type of treatment planned. There was a lack of uniformity in the training received and in monitoring practices, which were often based on paper documentation or non-integrated systems. The most frequently reported complications were infections, aspiration problems, thrombosis, and dislocation. The presence of standardized protocols and limited knowledge of guidelines contribute to significant clinical variability. ANALYSIS: The thesis analyzes the data using the questionnaire “on the right choice of vascular access devices (VAD),” administered to nurses in the Medical Department. The results are recorded and organized in Microsoft Excel linked to Google forms. The system automatically converts the responses into percentage values and explanatory graphs, anonymously to ensure the confidentiality of the participants. DISCUSSIONS: The survey analyzed the selection, management, and monitoring practices of vascular access devices (VADs) in two hospitals, comparing the data obtained with the literature and the main international guidelines. The results show reasonable adherence to the recommended clinical criteria, but also significant inconsistency in staff training, standardization of procedures, and knowledge of the guidelines. The variability in monitoring methods is particularly critical, compromising traceability and the prevention of complications. The high incidence of reported adverse events suggests the need to implement structured training courses, shared protocols, and computerized tools. The adoption of uniform company guidelines could be a fundamental step toward improving the quality, safety, and uniformity of care. CONCLUSIONS: The study highlighted differences between the hospitals of Ascoli Piceno and San Benedetto del Tronto in the selection of vascular access devices (VADs), with greater uniformity in the former. Critical issues related to training, protocol standardization, and complication monitoring emerged. In response, improvements are proposed, including shared protocols, dedicated teams, continuous training, and structured decision-making tools. KEYWORDS: “PICC”, “Midline”, “Nursing”, “Guideline”, “CICC”, “Accesses Vascular”, “Management”, “Definition”, “Epidemiology”.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/24208