Cvc Case Studies

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

Usage of indwelling urinary catheters in critically ill patients can seem to be a permanent fixture in intensive care units. Most critical care nurse expect their patients to have an indwelling urinary catheter (IUC) in place without much regard to the risk of catheter associated urinary tract infections (CAUTI) or the ability to implement IUC alternatives. Critical care patients may require IUC usage due to diagnosis, need for accurate hourly intake and output measurements, or other specified documented reasons. The risk of acquiring a catheter associated urinary tract infections is a result of IUC usage. The Centers for Disease Control and Prevention’s Guideline for Prevention of Catheter-associated

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.

Urinary catheters have been directly linked to infection. Catheter are inserted in 25% of patients who are hospitalized (Center for Disease Control and Prevention (CDC), 2014). Fifty percent of these catheters are unnecessary. (CDC, 2014) Patients with urinary catheters are at risk for infection, including blood stream infections. Each day a catheter remains in place it increases the patient’s mortality rate by 3-7 %.Complications from urinary catheters, which can lead to death. In addition, catheters are source of discomfort to patients. Urinary tract infection caused by urinary catheters prolongs patient length of stay, which prevents patients returning home to their love ones or the comforts of their own home. A nurse driven indwelling

Intravenous infusion therapy is an infusion of fluids directly into the patient’s bloodstream via a vein using an intravenous catheter. It is frequently used in hospital settings for patients that require a rapid onset of medication and for those who are unable to receive medications orally. According to Adams and Urban (2012), intravenous (IV) infusion is considered to be the most dangerous route of receiving medications because medication cannot be retrieved once it enters the bloodstream. Patients receiving IV infusion therapy require close monitoring for adverse reactions, which can happen immediately or it can take a couple of days for it to take effect. There are three types of IV administrations: large volume infusions, intermittent infusions, and IV push (p. 37). Patients receive IV therapy to for a variety of reasons including maintaining, restoring or replacing fluids and electrolytes, to administer medications, blood and blood products, nutritional feeds, chemotherapy, and pain mediations.

This study focused on patients cared for in the adult CVICU who were supported by mechanical ventilation. Moreover, the target population was patients who had undergone cardiothoracic surgery, were supported by mechanical ventilation on postoperative days 1–5, and had no pre-existing cognitive dysfunction. Accordingly, this population was studied because patients who are supported by mechanical ventilation represent the largest population of patients at risk for the development of delirium (Jarman et al., 2013). In this situation, the target population included patients who were 18 years of age or older, as this is the age requirement criteria for admission to the adult CVICU. Equally important, patients must not have had a documented

Clinical problem: Catheter-related infections pose a detrimental threat to adult patients in intensive care units with a central line. Effects of an infection include: an increase in the patients’ length of hospital stay, morbidity and mortality rates, and hospital readmission rates.

Further disadvantages include post extraction hip pain and an increased need in blood cell transfusion (Passweg et al., 2012). The initial attempts of peripheral blood stem cell transplantation had negative results due to the low number of progenitor cells in the circulation. This problem has been solved by treating the donor with granulocyte colony stimulating factor (G-CSF) prior to the transplantation which mobilises the cells to the blood and are then collected by apheresis and transfused into the recipient. Studies have reported: PBS lowered morbidity and mortality (Prezepiorka, 1996), rapid haematopoietic reconstitution, shorter interval to neutrophil and platelet recovery (Champlin et al., 2000). According to Korbling and Freireich (2012), PB replaced BM in 100% of autologous transplants and 75% of allogeneic transplants. Higher doses of SCs can be collected in comparison to BM and the time to engraftment is also shorter. Additionally, PB as a source means surgical procedures are avoided. However, the PB consists to 10-100 times more T lymphocytes than BM which accounts for higher incidence of chronic GvHD (Storek et al., 1997) (Urbano et al.,

It is difficult to draw any conclusions regarding risk factors of inadvertent arterial catheterizations due to the lack of a control group. However, four of eleven (36 %) inadvertent arterial catheterizations were made urgently in patients with major trauma in Study III, whereas only 5 % of venous cannulations in Study IV were carried out in emergent situations, indicating that this truly is a risk factor. As indicated by our results, a diagnosis of inadvertent arterial catheterization is often obvious immediately or during initial clinical use due to local symptoms of bleeding or abnormal back-flow of blood through the catheter. Other clinical bedside signs facilitating this diagnosis – in normovolemic patients without central hypoxaemia – include the spout, at systemic pressure, of bright red and/or well oxygenated (confirmed on blood gas analysis) blood by the catheter (Shah 2004).

Allogeneic HSCT (hematopoietic stem cell transplantation) has been a path-breaking discovery in the field of hemato-oncology, proven to be a cure for many diseases like red-cell disorders and inborn errors. Technical and supportive care has resulted in survival rates that exceed 70% within the first two years after HSCT. However, long-term survivors carry a high burden of morbidity, including infections, treatment related organ toxicities, musculoskeletal disorders, endocrinopathies and immunological complications like Graft-versus-Host-Disease (GVHD). These usually affect multiple organs and tissues, and exhibit a variable clinical course, but in any case there should be an early recognition and the treatment has to be one of an aggressive

Within the intensive care unit (ICU), one of the most important items or equipment utilized in management of patients is the central venous catheters (CVCs). These are typically devices that can allow intravascular access while terminating at any site close in proximity of the heart or in the neck around the great vessels. CVCs are vital for the management of critically ill and hospitalized patients as they provide or facilitate the procedures such as the medication infusion, blood sampling as well as hemodynamic measurement. Despite their importance, the CVCs are associated with increased cases of central line associated blood-stream infections (CLABSIs) in the healthcare facilities. These CLABSI are among the noted cases of hospital acquired infections for which Medicare cannot reimburse; and apart from the issues of reimbursement, these CLABSI are associated with lengthened hospital stay for patients, increased direct and indirect costs of treatment as well as significant compromise on health and wellness of the patient.

A urinary catheter is a thin tube that is placed in the bladder to allow urine to drain. Urine flows through the tube into a collection bag. A urinary catheter is often used for several purposes: including the inability to void on one’s own, unconscious patient, unable to ambulate, malformation exists that prevents the flow of urine, or to keep an accurate record of the amount of urine being voided. Foleys are also inserted during the surgical process, as seen in most critical care patients for accurate measuring of urine output. During the intensive care admission, patients who have a urinary catheter are more prone to acquiring a urinary tract infection than patients without a catheter inserted (NICHE, 2012).

Central lines are widely used and plays a crucial role in the management of patient care for nutritional supplementation, hydration, long-term dialysis, as well as administration of intravenous medication treatments such as antibiotics, or chemotherapeutic agents. However, inappropriate use and handling of central lines can result in increased risk of central line-associated bloodstream infections (CLABSIs) which consequently increase the risk of morbidity and mortality, high health care cost, and extended length of hospital stay (Stevens, et al., 2014). Prevention of CLABSIs is an essential component of the delivery of safe, and quality care. If strictly followed, the recommended guidelines derived from extensive evidence-based research on

Their research had been developed on a basis of an observation of an HIV positive patient, who was undergoing treatment for leukaemia via the bone marrow transplantation method. This method is known to introduce new bone marrow into the immune system of the effected patient to revive the patient’s “new” immune system. The bone marrow that this patient had received was genetically mutated of its ∆32 CCR5 gene that resulted in the inactivation of the gene.

It is known that vaccinia virus (VACV) is a potent inducer of IL-12 and IL-18 (36), which can augment NK activity (37). We were interested in determining whether control of primary respiratory VACV infection in immunocompetent mice correlated with either the presence and/or recruitment of NK cells to the site of infection. To do this, cohorts of naive, wild type (WT) C57BL/6 mice were infected intranasally (i.n.) with the highly virulent, mouse-adapted VACV Western Reserve strain (VACV-WR; 1.25 x 104 PFU), and the kinetics of NK cell recruitment to the lung and peripheral tissues were determined.