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    Intraoperative Fragmentation and Retention of Endovascular Devices: Clinical Consequences and Preventative Strategies

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    Author
    Endicott, K.M.
    Drucker, C.B.
    Orbay, H.
    DuBose, J.J.
    Nagarsheth, K.
    Toursavadkohi, S.
    Sarkar, R.
    Date
    2020
    Journal
    Vascular and Endovascular Surgery
    Publisher
    SAGE Publications Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1177/1538574419886193
    Abstract
    Background: Expanded applications and increasing volumes of complex endovascular procedures have increased the risk of unintended intraoperative fragmentation and retention of catheters and sheaths. We describe a series of retained or fragmented endovascular devices, a quality improvement program to address this unmet need for improved detection of catheter fragmentation, and the results of this program. Methods: Cases utilizing endovascular devices that resulted in a retained catheter fragment were identified and analyzed during divisional quality improvement review. One consistent area of concern was operating room (OR) staff unfamiliarity with verifying the integrity of an endovascular device. In response, a slide-based training protocol of focused, endovascular nursing education was implemented. Following perceived lack of improvement after this approach, we developed a handheld visual reference display of the tips of common catheters and sheaths. Staff was surveyed before and after intervention to assess the educational value of the display and the impact on staff device familiarity. Results: All 4 described cases resulted in an unplanned return to the OR for retrieval of the fragmented catheter or sheath. No thromboembolic complications were observed, although associated intra-arterial thrombus was noted in 2 cases. Thirty-four OR nurses were polled to trial the visual reference display initiative, with 70% of those reporting primary surgical assignments outside of cardiovascular ORs. Introduction of the new visual reference display improved staff confidence in their ability to identify a broken device (2.4-3.7, P <.001). This improvement was most significant in OR staff with primary assignments in noncardiovascular services. Conclusion: Current OR standard operating procedures fail to address the potential for unintentionally retained catheters and wires during endovascular procedures. Our novel visual reference display of common endovascular items rather than conventional in-service training improved the ability of staff to identify device fragmentation at the time of the index procedure. Copyright The Author(s) 2019.
    Keyword
    endovascular procedures
    nursing education
    quality improvement
    retained foreign body
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85074871396&doi=10.1177%2f1538574419886193&partnerID=40&md5=0c02d6c702ca498674772fe8e37f456f; http://hdl.handle.net/10713/11638
    ae974a485f413a2113503eed53cd6c53
    10.1177/1538574419886193
    Scopus Count
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    UMB Open Access Articles 2020

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