Background: Intravenous (IV) therapy using short peripheral IV catheters (PIVC) is commonplace with neonatal patients. However, this therapy is associated with high complication rates including the leakage of infused fluids from the vasculature into the surrounding tissues; a condition referred to as, peripheral IV infiltration/extravasation (PIVIE). Objective: The quality improvement project aimed to identify the prevalence of known risk factors for PIVIE in the neonatal intensive care unit (NICU) and explore the feasibility of using novel optical sensor technology to aid in earlier detection of PIVIE events. Methods: The plan, do, study, act (PDSA) model of quality improvement (QI) was used to provide a systematic framework to identify PIVIE risks and evaluate the potential utility of continuous PIVC monitoring using the ivWatch model 400® system. The site was provided with eight monitoring systems and consumables. Hospital staff were supported with theoretical education and bedside training about the system operations and best use practices. Results: In total 113 PIVIE's (graded II-IV) were recorded from 3476 PIVCs, representing an incidence of 3.25%. Lower birth weight and gestational age were statistically significant factors for increased risk of PIVIE (p = 0.004); all other known risk factors did not reach statistical significance. Piloting the ivWatch with 21 PIVCs using high-risk vesicant solutions over a total of 523.9 h (21.83 days) detected 11 PIVIEs (graded I-II). System sensitivity reached 100%; 11 out of 11 PIVIEs were detected by the ivWatch before clinician confirmation. Conclusions: Prevailing risk factors for PIVIE in the unit were comparable to those published. Continuous infusion site monitoring using the ivWatch suggests this technology offers the potential to detect PIVIE events earlier than relying on intermittent observation alone (i.e. the current standard of care). However, large-scale study with neonatal populations is required to ensure the technology is optimally configured to meet their needs.
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Swales are widely used Sustainable Urban Drainage Systems (SuDS) that can reduce peak flow, collect and retain water and improve groundwater recharge. Most previous research has focused on the unsaturated infiltration rates of swales without considering the variation in infiltration rates under extreme climate events, such as multiple stormwater events after a long drought period. Therefore, fieldwork was carried out to collect hydraulic data of three swales under drought conditions followed by high precipitation. For this simulation, a new full-scale infiltration method was used to simulate five rainfall events filling up the total storage volume of the swales under drought conditions. The results were then compared to earlier research under regular circumstances. The results of this study show that three swales situated in the same street show a variation in initial infiltration capacity of 1.6 to 11.9 m/d and show higher infiltration rates under drought conditions. The saturated infiltration rate is up to a factor 4 lower than the initial unsaturated rate with a minimal rate of 0.5 m/d, close to the minimum required infiltration rate. Significant spatial and time variable infiltration rates are also found at similar research locations with multiple green infrastructures in close range. If the unsaturated infiltration capacity is used as the design input for computer models, the infiltration capacity may be significantly overestimated. The innovative method and the results of this study should help stormwater managers to test, model, plan and schedule maintenance requirements with more confidence, so that they will continue to perform satisfactorily over their intended design lifespan.
Although permeable pavements have been used all over the world in recent years to infiltrate and treat stormwater, only limited research has been undertaken to investigate and compare the long-term performance of these sustainable urban drainage system devices. This paper presents the results of an extensive international review of research on the reduction of infiltration capacity of permeable pavements over time. The results of these studies, coupled with specific knowledge of the key environmental factors on the individual research locations and infiltration testing methods used, enables the maintenance of these SUDS to be strategically planned in order to meet specific European and international infiltration capacity guidelines.
