Review Of Long-Term Central Venous Access In Pediatric Patients At High Risk

Getting an infection from improper care during or after insertion of a central line is the last thing you want to get while in the hospital. This paper will discuss Kaiser Permanente’s policy on central venous catheter, also known as a central line, care and dressing change, and whether it follows the current evidence-based practice on preventing bloodstream infection in patients who have them inserted. I will explain about what a central line is, why evidence-based practice is important in the clinical setting, what Kaiser Permanente’s policy about central line care and dressing change is, if Kaiser is currently following evidence-based practice based on current articles about preventing central line associated bloodstream infections (CLABSIs), and what my role in using evidence-based practice is as a future registered nurse.

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.

Healthcare-associated infections from invasive medical devices are linked to high morbidity, mortality, and costs worldwide. Especially in central line–associated bloodstream infection (CLABSI) or catheter-related bloodstream infection (CRBSI) and

Central line associated blood stream infection, better known as CLABSI, are on a continual rise in critical patients. CLABSI are implemented to help improve vascular access in patients where venous access is minimal or reduced. They help to maintain intraveneous access to deliver medications to the body and in case of emergency. Central lines are not given to every patient admitted into the hospital, only those who are critical. The purpose of this paper is to provide reasoning and evidence behind my research strategy for this particular topic. In the critical populations, how does not using chlorhexidine containing dressing compare to using the dressings influence the central line associated blood stream infection rates over two years.

Central line bundle is a group of evidence-based practice strategy for patient with central catheters, when implemented together, produce better outcomes than implemented individually (Institute of health care improvement, 2010.). The main elements of central line bundle are hand hygiene, maximal barrier precaution upon insertion, Chlorhexidine skin antisepsis, optimal catheter selection, and daily review of line necessity with prompt removal of unnecessary lines Aseptic technique when using and caring for a central line catheter can decrease the chance of contamination in this critically ill infants. Staff education on adherence to aseptic technique and strict central line care guidelines are essential to decreasing bloodstream infections.

Upon completion of this project I learned that many times patients were unaware of the compilations such as infection that may occur with central lines. This has taught me the importance of proving education to our patients in addition to staff members. Patients can help decrease central line associated blood stream infections by being aware of their surroundings and ensuring that nurses, physicians, and visitors take proper steps in decreasing infections rate. Implementing a policy to place alcohol infused caps on all central line that are not currently infusing is best practice back by evidence based practice to significantly decrease infection rates. This project as helped me identify evidence based practice and incorporate these practice in our daily care to help improve patient outcomes. The first couple of days there was not any patients within the intensive care unit with central line.

Central lines are a common device used world wide in acute care settings for eligible patient populations such as those receiving chemotherapy, patients with poor venous access, or for those that require prolonged treatment of intravenous medications. Although central lines provide many advantages, they place patients at high risk for acquiring central line associated blood stream infections (CLABSI). CLABSI's are a serious complication associated with central lines and in some cases can be life threatening. There are many evidence based approaches that are used in acute care settings to reduce the incidence of CLABSI's such as meticulous skin care, daily bathing with chlorehexadine surgical scrub, and strict sterile technique when changing central line dressings. These prevention measures are a standard of care nationwide for patients with central lines since they are cost effective and evidence based. Unfortunately, even with proper implementation and compliance with these interventions, CLABSI's are still prevalent amongst vulnerable patient populations.

-A task force was created to address the increase number of central line associated bloodstream infections at Newark Beth Israel Medical Center from 1/12 to 12/12. However the study ended 12/13 as a control of the task forces implemented strategies. There were 68 adult patients which had a rate of about 14.7 per 1000 central line days in an adult inpatient patient. Most infections were in the ICU.

In the healthcare, evidence-based guidelines are utilized to prevent complications that can be very significant to both the patient and the healthcare in general. Having worked in different health care settings including, home-health, long-term care facilities, rehabilitation hospitals, long-term acute care, and acute care, I have come across various healthcare associated infections (HAIs). For my project, I will focus on prevention of central line-associated bloodstream infections (CLABSIs). I have seen the importance of central lines in management of patient care, be it in nutrition supplementation, hydration, or medication treatments in all the mentioned different settings. I have also encountered infected central lines and the risk they pose to the patients. According to the Centers for Disease Control and Prevention (CDC), CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable (CDC, 2010).

Purpose: The purpose of this article is to review the updated Association of Perioperative Registered Nurses (AORN) recommended practices for prevention of transmissible infections in the perioperative practice setting to help perioperative nurses apply the recommendations in daily practice.

First, the article provides a short explanation regarding central line associated bloodstream infections (CLABSI) and CLABSI related deaths that occur annually in the US. A national campaign, ‘On the CUSP,’ is briefly discussed. This was a collaborative cohort study of 1,071 adult intensive care units (ICUs) in 44 states, Puerto Rico, and Washington D.C. Their goal was to evaluate the impact of the ‘On the CUSP’ campaign in relation to CLASI reduction. Extensive education and training was provided prior and during the intervention. The multi-level Poisson regression model showed CLABSIs dropped from 1.96 to 1.15 per 1,000 line-days, a 43% decrease. Limitations included: this was not a randomized controlled trial (RCT), lack of resources to validate CLABSI data or collect intervention compliance data. However, the study indicates CLABSIs are preventable with standardized nursing interventions, which improves patient outcomes.

They found that there was solid evidence that antimicrobial catheters are able to prevent or at least delay development of bacteriuria. This ability however varied greatly depending on population, catheter type, and other variables. Their review showed less advantage over control catheters for silver alloy coated catheters in current trials than in earlier trials. The authors hypothesized the possibility of this effect being due to an exaggeration of the effect of these catheters in earlier trials because of an advantage of newer silicone catheters over the older latex catheters which dilutes the effect in later trials. They also hypothesized that catheter care had improved over time. Another finding was that there seemed to be less of an advantage for silver alloy coated catheters over controls than for nitrofurazone impregnated catheters. Finally, this review noted many gaps in the literature such as the lack of comparison between treatment catheters and the lack of studies looking at symptomatic UTI as a primary outcome variable. These were recommended as a possibilities for future

A compressive health education and maintenance of appropriate care for central lines catheter (CVC), and peripheral inserted central catheter (PICC) with the appropriate use of the curos caps the prevention of central line associated blood stream infections (CLABSI) the proposal will be achieved as planned. Staff education is crucial, especially those people that are in direct care of the patient that include nurses and provided, and the patient and patient assistance also needs reinforcement in proper covering of the central line dressing to prevent it from getting wet. Also is crucial for nurses to have awareness of the number of CLABSI infections to have a mental picture and be able to visualize the plan of care for those patients.

Article reference (in APA style): Sofroniadou, S., Revela, I., Smirloglou, D., Makriniotou, I., Zerbala, S., Kouloubinis, A., & ... Iatrou, C. (2012). Linezolid versus Vancomycin Antibiotic Lock Solution for the Prevention of Nontunneled Catheter-related Blood Stream Infections in Hemodialysis Patients: A Prospective Randomized Study. Seminars In Dialysis, 25(9), 344-350. doi:10.1111/j.1525-139X.2011.00965.x

Nurses should also have patients demonstrate hand washing technique. Teaching patients about infusion therapy and how to avoid the risk of intravenous infection will help calm their fears and decrease their risks of obtaining an infection. Technology today can help by having patients either record a video of the steps on their smart phone or by writing the steps down. This can decrease patient’s anxiety and stress while increasing confidence. While this topic has been around for many years, both medical professionals and patients need to be educated and strict compliance needs to be followed in order to avoid intravenous and central line infections. Further research is needed in order to discover additional ways of decreasing intravenous and central line infections in the home