Peripheral Intravenous Device Insertion Is The Most Commonly Performed Invasive

1) Summary of Article: Indwelling catheter use is common, but so are infections associated with them. About 80 percent of all urinary tract infections in hospitals are caused by catheters, and about 20 percent of all hospital infections total are UTIs. Evidence-based practice should be used for insertion, maintenance, and removal. Catheters should not be left in longer than they need to be. Unfortunately, this research shows poor administrative efforts are to blame for

Urinary tract infections are one of the most hospital-acquired infections in the country. With so much technology and evidence based practice, why is this still an ongoing problem worldwide? Could it simply be the basics of hygiene or just patient negligence? The purpose of this paper is to identify multiple studies that have been done to reduce or prevent hospital associated urinary tract infections. In these articles you will find the use of different interventions that will aid in lowering the risk of these hospital acquired infections.

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

The work of Burke, et al (2011) reports that a study with the objective of comparing the "efficacy of intradermal bacteriostatic normal saline with that of intradermal buffered lidocaine in providing local anesthesia to adult patients prior to IV catheterization." (p.1) The study concluded that intradermal buffered lidocaine was superior to intradermal bacteriostatic normal saline in providing local anesthesia prior to IV catheterization in this group of predominately white adults and should be the solution of choice for venipuncture pretreatment." (Burke, et al, 2011, p.1) Burke et al reports that surgery is something that most people fear with the fear of the unknown is combined with "apprehension about such anticipated procedures as insertion of an IV line." (2011, p.1) Burke additionally reports that patients admitted for same-day surgery "require IV access. Any venipuncture, including peripheral IV catheterization with a medium-to-large-gauge catheter, can cause some degree of pain. Using local anesthesia prior to IV catheterization has

Also another serious complication of CAUTI is BSI (Blood stream infections) that can be fatal if not caught and treated promptly. “The Clinical Performance of Quality Health Care, along with Joint Commission” offers standards and objectives for facilities to assess measure and improve their standards at the lowest cost possible. The database covers nursing care and education, along with guidelines on prevention. Moreover the JCAHO regulatory standards for catheterized patients are explained and the documentation that is expected when JCAHO inspections are rendered in a facility. The source “Stop orders to reduce inappropriate urinary catheterization in hospitalized patients” states that by following standard precautions with every patient these infections can be prevented. . Also the source explored whether catheters should be used at all in an effort to decrease the incidence of CAUTI’s. Intermittent catheterizations along with supra-pubic were explored with a decreased incidence of bacteria being present in the bladder afterwards. The source “Strategies to prevent catheter-associated urinary tract infections in acute care hospitals” offered ways of cleansing and disinfecting the skin before insertion to reduce the risk of infection. Many CAUTI’s are linked to bacteria harboring in or around the site at insertion. By using not only aseptic technique but also cleansing the skin with chlorhexadine can decrease he incidence of infection

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.

Signs of infection of the central venous catheter (CVC) site include redness, drainage, and the client will exhibit chills, fever, and an elevated white blood cell count (Ignatavicious & Workman, 2016). However, it is important to note that the incidence of CLABSIs in United States ICUs have decreased by 58% from 2001 to 2009, saving 3,000 to 6,000 lives as well as $414 million (Dumont & Nesselrodt, 2012). Some hospitals also report to have zero incidences of CLABSIs in their ICUs (Dumont & Nesselrodt, 2012). The pathogen that showed the greatest decrease was staphylococcus aureus (78% decrease), followed by Enterococcus (55% decrease), Candida (46% decrease) and Gram-negative bacteria (37% decrease) (CDC, n.d.).

Quality improvement in health care has been and will continue to be a beneficial process in helping with many problems faced in healthcare. According to U.S Department of Health and Human Services (2011) “quality improvement consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups” (p.1). These systematic and continuous actions have indeed led to many health care improvements throughout the years including reductions in infection rates, medication errors, and health care costs. One major current concern in the health care field is the presence of catheter associated bloodstream infections (CABSI’s). Provonost, Marsteller, and Goeschel (2011)

This article does not provide the search strategy including a number of databases and other resources which identify key published and unpublished research. In this article, both the primary sources and the theoretical literatures are collected and appraised in order to generate the research question and to conduct knowledge-based research. In the section of the literature review, nineteen professional articles are appraised in order to provide the significance and background of the study. Saint develops the research question based on these analyses. “Catheter-associated urinary tract infections in surgical patients: A controlled study on the excess morbidity and costs” is one of the primary sources written by Givens and Wenzel who conduct and analyze this study. In addition, “Clinical and economic consequences of nosocomial catheter-related bacteriuria” is a review of a literature article which is the secondary source. Although many studies state that patient safety is a top priority and CAUTI can be controlled by the caution of health care providers, the infection rate is relatively high among other nosocomial infections. One of the reasons Saint and colleagues uncovered is unawareness and negligence by health care

The Quality Improvement nursing process that I have chosen to research is patient safety. I have chosen to focus specifically on the topic of catheter associated urinary tract infections (CAUTI’s) during hospitalization and their preventions. It is estimated that 15-25% of hospitalized patients receive a urinary catheter throughout their stay, whether or not they need it. A large 80% of all patients diagnosed with a urinary tract infection (UTI) can be attributed to a catheter (Bernard, Hunter, and Moore, 2012). The bacteria may gain entry into the bladder during insertion of the catheter, during manipulation of the catheter or drainage system, around the catheter, and after removal.

The epidemiology of phlebitis is less well described for pediatrics than for adults. In addition studies have also failed to show an increased day specific risk of phlebitis for continuous IV cannula beyond second or third day after it was inserted(Webster J, Osborne S, Rickard CM2013)19. The Centers for Disease Control and Prevention (CDC) recommends that cannula should be removed every 72 – 96 hours to reduce the risk of phlebitis, but there have not been such recommendations for children (Andriyani R, Amalia P2013)1.There have been many theories on the pathophysiology of peripheral vein phlebitis. The current concept suggest that cannulation of vein leads to inflammation.(Pedro P, Salgueiro OA, Pedro

In Tabba Hospital I observed different issues, but mostly issues were related to medication errors and phlebitis. This reflection paper will talk about the phlebitis issue that how I and the management team of Tabba Hospital collaboratively makes efforts to resolve this problem. Phlebitis is the complication of peripheral intravenous catheterization in which inflammation of the vein wall occurs (Carretero, 2013). The symptoms of phlebitis appear in patient are pain, swelling, tenderness, warmth and redness at the affected site. There are numbers of factors involved in developing phlebitis like trauma of vein during insertion of cannula, type of cannula material used and many others. These factors are classified into three categories such as mechanical, chemical or bacterial phlebitis. Mechanical phlebitis depends upon location, size and material of cannula, and also cause due to incorrect method of cannulation. Chemical phlebitis is caused by irritant drugs or solutions. Bacterial phlebitis is

The use of intravenous therapy in the hospitals is now considered a routine therapy. In 2016, DeVries and Valentine stated that 70% to 80% of hospital patients have peripheral intravenous lines at some time during their stay. A peripheral intravenous (PIV) line is a small hollow tube (catheter) that is inserted into a vein and can be connected to special tubing. PIV line is commonly used to administer medications or fluids directly into the vein. The article “Intravenous Therapy: A Review of Complications and Economic Considerations of Peripheral Access,” states that the history of intravenous (IV) therapy dates back to the Middle Ages. Dr. Thomas Latta pioneered the use of IV saline infusion during the cholera epidemic and in the 20th century, two world wars established a role for IV therapy as routine medical practice (Dychter, Gold, Carson, & Haller, 2012).