Central Venous Access Devices : An Investigation Of Oncology Nurses

For nurses, (P) on 2 South caring for patients with urinary catheters, will education, on the importance and proper use of a nurse -driven indwelling catheter removal protocol (I), change knowledge on the use of the nurse driven protocol, as compared to knowledge before receiving an education, (C), as evidenced by (O), change in knowledge in the use of the nurse -driven indwelling catheter removal protocol, and CAUTI rates as evidenced by, pre and posttest scores and CAUTI audits after three months? The project will utilize a

4) Significance: This research shows that there is a gap in the evidence, but that the primary concern for nursing staff is to ensure that catheters are removed as soon as it is possible to do so.

Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile

A nurse-driven protocol is the recommended tool to be used by the nurse to remove catheters without orders following set CDC guidelines and prevent CAUTI

Article by Clancy (2009) explained central lines were a result of an estimated 250,000 blood stream infections and accounted for 30,000 to 62,000 patient deaths, then adding that each infection cost upwards of $36,000 and cumulatively add up to at least $9 billion in preventable costs annually. The article also explains how the mindset has changed from the cost of having a central line in place and expecting complications to lowering infection rates by an intentional interventional process/s. The article speaks of 5 basic steps to reduce CLABSI, hand washing, insertion techniques, skin cleansing, avoidance of certain sites and earlier removal of the CVC. Studies showed that these guidelines were only followed 62% of the time. The system was changed to ascertain that all the clinicians were in compliance. This prompted 5 interventions, education, a CVC insertion cart with all necessary equipment, physicians having to validate central line necessity, a concise checklist for bedside clinicians and the empower of nurses to stop procedures if guidelines were not followed. These low cost interventions from 11.3/1000 in catheter days in 1998 to zero in the fourth quarter of 2002.

The accomplishment was made possible by maintaining the QC and constantly enforcing STARS, peer review, and quarterly evaluation in the unit. The nurses in MTU took action immediately to address CAUTI incidences. Staff huddles were given on every shift to reflect on CAUTI and hospital policy and protocols for urinary catheter care was reviewed (Patzer, 2017). In addition to huddle, every incidence was investigated by performing a root cause analysis from the safety team (Patzer, pc, 2017). The STARS posters were in every room to remind nurses of proper maintenance of tube, and it also served as an education tool to teach patients and family members (Patzer, pc, 2017). The result of the STARS program was evaluated by comparing with the SNI. Although the unit has reached the goal with no incident of CAUTI after the implementation of the STARS program, the unit will continue to work towards improving the quality of patient care (Patzer, 2017).

Staff nurses on the unit expressed their frustration with the current practice regarding the frequency of PIV catheter replacements, stating that it was “time-consuming” and contributed to “patient dissatisfaction.” The process of replacing a PIV can often be time consuming and may take multiple attempts in order to successfully insert a new PIV. Research supports a change in practice that address these concerns. A pilot study performed in 2012, by Rickard, Webster, Wallis, Marsh, McGrail, French and Whitby indicated that replacing PIV catheters only when clinically indicated did not lead to catheter-related complications, as previously

The focus of this paper is to compare the current hospital policy of Santa Clara Valley Medical Center’s (SCVMC) Central Venous Catheter (CVC) maintenance policies and procedure to current EBP suggestions. Current EBP practices suggest no differences of central line care SCVMC’s policies. This paper will

Peripheral I.V. rotation and care may differ from facility to facility. Although across the nursing community peripheral intravenous catheters are replaced every few days, they will be changed even if the vein is patent. If the site does not show signs of infection or phlebitis, it is protocol to change the site. Evidence-based practice says that there is no need to change the site routinely, instead the site should remain intact and changed only upon need such as inflammation, irritation, or lack of patency. Not changing the I.V. routinely gives comfort to the ill patient, while it also saves money for the hospital.

Almost all patients that are admitted into the acute care setting require peripheral intravenous therapy. PIV therapy is an important factor in the care of patients in the hospital and it is most often used to maintain or correct fluid and electrolyte balances, administer medications, and replace blood or blood products (Ignatavicius and Workman, 2013). PIV therapy is an invasive therapy that requires catheter insertion into the vascular system and access is gained through the patient’s skin. Because this is an invasive procedure, patients are at a risk of developing catheter related infections. Catheter related infections are preventable and as nurses it is our responsibility to maintain the PIV site and use the appropriate protocols and interventions to

Inserting an IV into a patient can be a painful experience, especially if the individual has veins that are hard to visualize or palpate. Some reasons for difficulty inserting IV catheters include obesity, veins that roll or blow easily, dark pigmented skin, and dehydration. With the help of modern technology, devices called Accuvein finders have made it a less painful process for patients. The author will discuss how these devices have compared to palpation and inspection on hospitalized patients in the last five years. This paper will focus on three articles that tested the Accuvein finders and the results of each.

Central venous catheters (CVC) have various uses for patients in both the inpatient and outpatient settings. Their purposes range from administration of total parenteral nutrition, to administration of vesicant medication, to providing access to patients with poor peripheral vascularity, as well as hemodynamic monitoring (Alexandrou, Spencer, Frost, Parr, Davidson, & Hillman, 2009, p. 1485). Traditionally, insertion of CVCs have been performed by surgeons and internal radiologists. However, with the advancement of roles in nursing, there has been ongoing research supporting the pro stance on the practice of nurse-led central venous catheter insertion.

Central venous catheters (CVC) have become the most efficient means to administer long-term, vital medical treatments in hospitalized patients. These catheters are used in almost all types of medical settings for purposes related to, “hemodynamics monitoring, parenteral nutrition, chemotherapy, hemodialysis etc.” (Gorji, Rezaei, Jafari, Cherati, 2015, p.1). Its clinical relevance has become extremely significant in relation to treating patients with all sorts of medical diseases who necessitate the administration of extravasation drugs that can solely be administrated by a CVC. Therefore, CVC have “led to reduction in duration of hospitalization, increment of safety and reduction of hospital charges” (Gorji et al., 2015, p.1). Its benefits

There are approximately 449,334 CAUTIs per year that are responsible for US$749-1007 per admission and have not been covered by Medicare since October 2008 (Meddings et al., 2013). One of the main causes of these CAUTIs are unnecessary prolonged duration of catheterization. The article states that “catheters have been reported to remain in situ beyond necessary, sometimes because health care personnel are not aware that the catheter is present” (Meddings et al., 2013). Another contributing factor is that the process of removing a urinary catheter can sometimes take hours to days. In most cases nurses need to request an order for discontinuation before they’re allowed to remove catheters. The physician then needs to determine if the catheter is still needed. The physician writes the order and then finally the nurse removes the catheter. As a result, hospitals are implementing strategies such as “stop orders” and catheter reminders to ensure prompt removal. Stop orders can “empower nurses to remove the catheter without requesting a physician’s order on the bases of an appropriate indiction list” (Meddings et al., 2013). Reminders are beneficial to ensure that the nurse is aware that the catheter is in place so that they can either obtain an order or discontinue according to protocol. Evidence gathered by a meta-analysis of 11 studies revealed that prompt removal

The placement of peripheral intravenous (PIV) catheters is the most common invasive procedure performed in the clinical setting. Up to 80% of all patients admitted to the hospital receive a PIV catheter, even though they may never be used (Do Rego Furtado, 2011). Nearly 330 million PIV catheters are purchased ever year in the United States, and can be used for variety of reasons including parenteral hydration and nutrition, administration of IV fluids, medications, and blood products, monitoring hemodynamic status, and providing hemodialysis.