The Medical Technology And Science

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.

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.

CLABSI’s, or Central Line Associated Bloodstream Infections, are a worldwide problem of bloodstream infections from the unsterile insertion or unclean maintenance of a central line catheter, which are inserted in large veins and are in place for weeks or months (CDC, n.d.). CLABSIs have a high morbidity and mortality rate, increases cost of medical treatment and extends the length of hospitalization (Poderman & Girbes, 2002). Implementing evidence based practices have significantly reduced these CLABSI rates (Latif et al., 2015). CLABSI prevention research shows overlap in these five areas of evidence-based prevention: appropriate hand hygiene, skin preparation, use of full barrier preparations, avoidance of femoral site for central line

PICCs lines have become well recognized as reliable central venous access devices (VADs), with lower potential for complications than short-term central venous catheters. PICCs first gained popularity in the 1980s, and their use has grown steadily since then. They were initially popular in many parts of the United States due to the need for venous access in home care patients. They have grown in popularity because of their reduction in potential complications and costs compared with short-term central venous catheters, and because PICCs can be inserted by registered nurses who have been trained in the procedure.

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

1. Although medical technology brings numerous benefits, what have been some of the main challenges posed by the growing use of medical technology in the United States?

As common with past iterations, the update makes it possible to develop clinical recommendation practices based on the theoretical rationale, applicability and the effectiveness of the intervention, and scientific data. The recommendations usually range from those being implemented at the time of carrying out a particular treatment procedure on a patient during insertion of the central venous catheter to those related to institutional practices geared towards reducing the CLABSI. Central line infection impacts organizations as well as patients’ cultural background. This health problem has posed a great challenge to individuals and organizations that are forced to spend lots of money in finding proper treatment to those infected. Since central line infection is increasingly becoming common, attention is focused on developing preventive measure to reduce the rate of deaths in patients who develop the infections. Moreover, with the realization that central line infection can be curtailed through evidence-based practices, the prevention of these infections is becoming an attainable goal for many health facilities, health care systems as well as payers. These efforts underscore the need to successfully implement the CLABSI prevention initiatives across the globe through engagement in enlightenment of staff about central line infection and

A nurse driven indwelling catheter removal protocol is an evidence base tool recommended by infection control organization and experts for the early removal of unnecessary or inappropriately placed urinary catheters (UC). Evidence shows that urinary catheters are the source of CAUTI’s. CAUTI, is the leading cause of hospital acquired infections in the United States. Seventy- five percent of urinary tract infections in hospitalized patients are associated with urinary catheters and more than 50% of these infections are preventable (Center for Disease Control and Prevention (CDC), 2015). A urinary catheter is a device inserted into the bladder for emptying. Roughly, 25 percent of hospitalized patients receive urinary catheters in the United States

One of the most reliable long term central venous access devices is a Port-a-Cath. There are numerous health professionals that have confirmed that implanted port devices have a lower risk of any complications and infection. Typically, this type of access devices is also used because of the variety of medications that maybe pumped into this device without causing much damage to the vasculature. The intention of this paper is to show evidence based practice implications with the use of the Port-a-Cath device, as well as analyze any barriers to the practice implications.

The authors studied multiple articles and used a total of 20 articles to validate their results concerning CAUTIs. The author studied how urinary catheter placement was one of the biggest reasons of hospital-acquired infections today. The authors also studied current percentages of catheters placed where no need of one is indicated. They also studies education regarding compliance, appropriate uses, nurse derived initiatives and overall prevention of infections. The citing of references were properly placed and had a sufficient reference page. Majority of the articles were up to date. Fifteen of the twenty articles were written since 2010 and nine in the past three

Central venous catheters, usually called CVCs, are extremely important for patients in any type of intensive care unit. It is because of their crucial role in the care of these patients that their troublesome risk of catheter-related bloodstream infections, sometimes referred to as CR-BSIs, has developed into such a problem. There are approximately 80,000 CR-BSIs diagnosed each year in the United States alone. These infections lead to nearly 28,000 patient deaths in intensive care units. Not only is this a dreadful loss of life; it is also incredibly expensive. Extra care and treatment for a patient suffering from a CR-BSI can cost an average of $45,000. In fact, these infections can cost as much as $2.3 billion for the United States each

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

Peripheral intravenous device insertion is the most commonly performed invasive procedure in hospitalized patients, with an estimated 150 million placed each year in North America alone (Rickard, McCann, Munnings & McGrail, 2010). They are important for maintaining hydration, administering medications, providing blood and blood products and even nutrition to the patient, but are not without their complications. These complications include thrombophlebitis, infiltration and blood stream infection. Thrombophlebitis is among the most common complications of having intravenous access. Symptoms of phlebitis include pain, redness, tenderness upon palpation, swelling and warmth at the IV site and are all related to the inflammation of the vein (Uslusoy & Mete, 2008). Several studies were completed with the aim to determine predisposing factors that lead to a patient developing phlebitis. The other research articles discussed looks at the acceptance of a policy that is supposed to prevent phlebitis and other complications associated with IV access.

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).