Catheter Dressing Research Articles

Reducing Central Line-Associated Bloodstream Infections With a Multipronged Nurse-Driven Approach.

Despite implementation of central catheter bundles, central line [catheter]-associated bloodstream infections (CLABSIs) remain a preventable hospital-acquired infection. A new population of patients with pulmonary artery catheters was introduced to the cardiac progressive care unit, increasing central catheter days, device use, and CLABSI rate. A quality improvement project was conducted. Nursing staff implemented a standardized central catheter rounding process 3 days a week to critically assess all central catheter dressings, deter-mine the necessity of each central catheter, and educate patients on the importance of keeping central catheter dressings clean, dry, and intact. Data were collected during central catheter rounds for each patient, entered in an electronic survey tool via mobile devices, and analyzed. From July 2019 through June 2022, a total of 2692 rounds were conducted for 707 individual patients with 3064 central catheters. Main interventions were dressing management, monitoring insertion site bleeding that extended beyond edges of the chlorhexidine gluconate pad, treating patients' allergies to products, and maintaining sustainability within the unit. Central catheter rounds decreased the CLABSI rate from 1.86 to 0.0 despite the continued increase in central catheter days. Central catheter dressing assessment, intervention, and education help reduce CLABSIs. Central catheter rounds are an important adjunct to the CLABSI bundle. A central catheter dressing management algorithm helps nurses decide when to change a dressing and which type of dressing to use.

An innovative educational program for adolescents on home parenteral nutrition for the "transition" to adulthood.

The ATEP is designed in three sessions of five consecutive days, during school holidays over the year. It includes group sessions on catheter handling, disconnecting and connecting the PN and catheter dressing, dealing with unforeseen events (e.g., fever or catheter injury), but also sessions with psychologist, social worker, sports teacher, fashion specialist, meeting with adults who received HPN since childhood. Specific course for the accompanying parents were also provided. Six months after the last session, a 3-day trip to the attraction park "le Futuroscope," Poitiers, France, was organized without any parental presence. After 3 ATEP courses, a total of 16 adolescents have been enrolled. They were aged between 13 and 17 years (median 14 IQR: 14-16.25). All were on long term HPN started during the neonatal period except for four who started PN at a median age of 10 years old (IQR: 1-10). At the time of the ATEP, their median PNDI was 105% (IQR: 95.5-120.8) while receiving a median of six infusions per week (IQR: 5-7). Thirteen received Taurolidine lock procedure. After the ATEP, 11 adolescents could be considered as fully autonomous, 4 as partially autonomous and one failed to gain any autonomy. Course evaluation by adolescents or parents was good to excellent. Through the holistic and multiprofessional approach of this training and the group cohesion, the adolescents were not only able to handle catheter care and PN connections but were able to understand and accept better their illness and project themselves into their own future.

Feasibility of a VR Intervention to Decrease Anxiety in Children with Tumors Undergoing CVC Dressing.

Virtual reality (VR) represents a promising digital intervention for managing distress and anxiety in children with tumors undergoing painful medical procedures. In an experimental cross-over study, we administered a VR intervention consisting of relaxing games during central venous catheter (CVC) dressing. The VR sessions were compared with no-VR during CVC medication. We used the distress thermometer and RCMAS-2 scale to assess distress and anxiety levels. We also explored the satisfaction level in patients and families. We enrolled 22 children. The distress levels after medication were lower in the VR group than in those without VR (VR: median 2; IQR 0–2; no-VR: median 4; IQR: 3–5). No variation in anxiety levels was detected by VR intervention. Satisfaction for using VR was very high in children and their families although a total of 12% of children were disappointed by the effect of VR. Most healthcare workers felt that VR would be useful in routine clinical practice. A VR intervention is highly acceptable, may be efficacious in decreasing distress in children with cancer undergoing painful procedures, but it is less likely that it has a measurable impact on anxiety. Evidence from larger studies is needed to assess VR translation into the clinical workflow.

The Effectiveness of Bundle Applications in the Prevention of Central Line-associated Bloodstream Infections: Nine Years of Observation.

This study aimed to assess the effectiveness of chlorhexidine-impregnated dressing in a bundle of interventions to reduce the rate of central line-associated bloodstream infections (CLABSIs). We performed a bundle of interventions to reduce the CLABSIs from 2012. As one bundle component, we started using the chlorhexidine impregnated catheter dressing. We used a document describing applying central venous catheters for the practicing physicians and nurses, and we organized several educational meetings. An interrupted time-series analysis was performed. Seventy-six CLABSI events were detected in total between January 1, 2011, and December 31, 2019. Twenty-six cases were detected in the pre-intervention period (January 1, 2011, to December 31, 2011), and 50 patients were seen in the post-intervention term (January 1, 2012, to December 31, 2019). The annual CLABSI rate was 2.60/1000 catheter days in the pre-intervention period and 0.46/1000 catheter days (p=0.0328) in the post-intervention period. The CLABSI rate among hematology-oncology inpatients decreased from 3.39 to 0.71 (p=0.0101) in the same term. By using bundle form including chlorhexidine impregnated dressing, the rate of CLABSIs decreased significantly. This effect has been observed consistently for nine years, and the clinical pathway use has become the standard care protocol.

Psychological characteristics are associated with healthcare worker adherence to infection control practices

Most bloodstream infections related to vascular catheters can be avoided if evidence-based practices are applied during insertion and maintenance. In practice, adherence by health care workers (HCWs) is unsatisfactory and is the main current challenge. The objective of this study is to investigate associations between adherence to infection control practices and performance in psychological tests. We conducted a prospective observational study in 4 intensive care units involving HCWs. Physicians were observed for adherence to hand hygiene (HH). Nurses were observed during central venous catheter dressing and handling. HCWs were then evaluated psychologically. There were 7,572 observations of 248 HCWs. Adherence to different steps of central venous catheter manipulation ranged widely: from 13% for HH before procedure to 95% regarding the use of gloves. Adherence to HH ranged from 14% before to 99% after dressing. For physicians, HH ranged from 10% before touching patients to 98% after touching body fluids, and adherence was associated with age, self-esteem, and aggression. For nurses, adherence was positively associated with deference, and negatively associated with nurturance. Psychosocial variables affect the quality of care that HCWs provide. The next step would be to define what type of psychological interventions could be effective.

Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: A secondary analysis of 40,637 catheters

BackgroundWith over 2 billion peripheral intravenous catheters used globally each year, avoiding complications is crucial for patients and healthcare organisations. Effective catheter dressing and securement is a key nursing strategy to reduce catheter failure and resultant patient harm. ObjectivesTo describe global catheter dressing and securement practices and policy; and identify factors associated with catheter insertion site complications, and suboptimal dressing and securement. DesignSecondary analysis of a global cross-sectional study of peripheral intravenous catheter characteristics, management and outcomes. SettingFour hundred and seven rural, regional and metropolitan hospitals in 51 countries. ParticipantsPaediatric and adult patients with 40,637 catheters. MethodsPatient-, catheter-, and institution-related factors which could be associated with catheter site complications and suboptimal dressings were extracted from the parent database. Global trends in catheter dressing and securement policy and practice were described. Potential predictors of catheter and dressing complications were explored using logistic regression. ResultsDressing and securement practices, and local hospital policy regarding dressing change frequency varied. One fifth of dressings (21%, n = 8519) were not clean, dry and intact. The prevalence of catheter insertion site complications was 16% (n = 6503), with signs of phlebitis commonly observed (11.5%, n = 4587). Compared to non-bordered polyurethane dressings, sterile gauze and tape dressings were associated with fewer insertion site complications (odds ratio 0.58, 95% confidence interval 0.50–0.68) and better dressing integrity (odds ratio 0.68; 95% confidence interval 0.59–0.77); whereas, compared with no securement, non-sterile tape at the insertion site was associated with more site complications (odds ratio 2.39, 95% confidence interval 2.22–2.57) and poorer dressing integrity (odds ratio 1.64, 95% confidence interval 1.51–1.75). Two ‘bundled’ dressing and securement combinations were associated with fewer site and dressing complications, when compared with the reference category. Local catheter care guidelines which advocate 4th hourly insertion site inspection and dressing replacement between 1–3 days were associated with better catheter dressing integrity. ConclusionModifiable risk factors for peripheral intravenous catheter site and dressing complications were identified and are amendable to further interventional testing.

NURSES' KNOWLEDGE OF INTENSIVE CARE UNIT ON CENTRAL VENOUS CATHETER DRESSING

Objective: to describe the knowledge of the nurses of an Intensive Care Unit on the dressing of Central Venous Catheter. Method: descriptive, exploratory research with quantitative approach, performed with nurses in an Intensive Care Unit. A closed questionnaire was used with questions about Central Venous Catheter dressing and for documentary analysis of the patients submitted to the procedure. Data collection took place in the period from February to April 2016. The study follows all ethical and legal precepts, being approved with nº53479016.4.0000.5541. Results: Participants (100%) were right regarding hand hygiene and protection barriers; while 50% were correct in relation to the puncture site and the first dressing with gauze and micropore; 50% were correct regarding the clear membrane dressing. Conclusion: nurses have satisfactory knowledge about the dressing of central venous catheter, however, there is a need for capacity building and greater adherence in relation to nursing prescriptions.

Effect of an acrylic terpolymer barrier film beneath transparent catheter dressings on skin integrity, risk of dressing disruption, catheter colonisation and infection

ObjectivesWe assessed the effect of a skin-protective terpolymer barrier film around the catheter insertion site on frequency of dressing disruptions and skin integrity issues (hyperaemia, skin irritation, residues of adhesives and moisture under the dressing). Secondary outcomes included colonisation of the central venous catheter (CVC) and rates of central line-associated bloodstream infection. Research methodologyA monocentric, open-label, randomised controlled trial was performed comparing a control group receiving standard transparent catheter dressings without the skin-protecting barrier film and an intervention group receiving a transparent chlorhexidine-impregnated dressing with use of the skin-protective acrylic terpolymer barrier film (3M™ Cavilon™ No - Sting Barrier Film, 3 M Health Care, St. Paul, MN, USA). ResultsSixty patients were enrolled and randomised in the study accounting for 60 central venous catheters and a total of 533 catheter days. Dressing disruptions occurred more frequently and at sooner time point in the control group. Skin integrity issues were significantly less observed in the intervention group. No differences in CVC colonisation or central line-associated bloodstream infection were observed. ConclusionsThe application of a barrier film creating a skin-protective polymer layer beneath transparent catheter dressings is associated with less dressing disruptions and skin integrity issues without altering the risk of infectious complications if used in combination with a chlorhexidine-impregnated catheter dressing.

Positive deviance as a strategy to prevent and control bloodstream infections in intensive care.

To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. In 90 days, 188 actions were observed, of these, 36.70% (n=69) were related to catheter dressing. In 81.15% (n=56) of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care. Descrever a aplicação do Positive Deviance como estratégia na prevenção e no controle da infecção de corrente sanguínea. Estudo de intervenção realizado na Unidade de Terapia Intensiva de um hospital universitário, com os membros das equipes de enfermagem e médica, de junho a dezembro de 2014. Foram aplicados os quatro passos da metodologia Positive Deviance: Definir, Determinar, Descobrir e Desenhar. Em 90 dias 188 ações foram observadas, destas, 36,70% (n=69) estavam relacionadas aos curativos dos cateteres. Em 81,15% (n=56) desses curativos, o uso da haste flexível estéril para realização da antissepsia do local de inserção do cateter e de sua placa de fixação foi a ação de maior adesão. O Positive Deviance auxiliou na implementação de propostas de melhorias de processo de trabalho e no desenvolvimento da equipe para os problemas identificados no cuidado com o cateter venoso central.

A comparison of strength for two continuous peripheral nerve block catheter dressings.

BackgroundDespite the benefits of continuous peripheral nerve blocks, catheter dislodgment remains a major problem, especially in the ambulatory setting. However, catheter dressing techniques to prevent such dislodgment have not been studied rigorously. We designed this simulation study to test the strength of two commercially available catheter dressings.MethodsUsing a cadaver model, we randomly assigned 20 trials to one of two dressing techniques applied to the lateral thigh: 1) clear adhesive dressing alone, or 2) clear adhesive dressing with an anchoring device. Using a digital luggage scale attached to a loop secured by the dressing, the same investigator applied steadily increasing force with a downward trajectory towards the floor until the dressing was removed or otherwise disrupted.ResultsThe weight, measured (median [10th–90th percentile]) at the time of dressing disruption or removal, was 1.5 kg (1.3–1.8 kg) with no anchoring device versus 4.9 kg (3.7–6.5 kg) when the dressing included an anchoring device (P < 0.001).ConclusionsBased on this simulation study, using an anchoring device may help prevent perineural catheter dislodgement and therefore premature disruption of continuous nerve block analgesia.

The Evaluation of Information Requirements in End-Stage Renal Failure Patients Care of Intensive Care Nurses

The Evaluation of Information Requirements of the Intensive Care Nurses in End-Stage Renal Failure Patients’ Care Purpose: This study was conducted to assess the information requirements of the intensive care nurses in caring of end-stage renal failure patients. Material and Method: This descriptive study was conducted in a teaching and research hospital. The practice has been completed with 133 nurses. Data collection form consists of 54 questions. Results: Twenty participants are male, mean age 28.2 ± 5.6 and 60.2% of the participants works in the surgical ICU. Average correct count is 32.7 ± 4,5 (min=11-max=40), the most correct answer count is 33 (n = 25). More than half of the nurses (55.6%) know how to control the arteriovenous fistula. However, 73.7% of the nurses do not feel competent themselves in ESRD patients care and 36.1% of the cases gave the wrong answer to the question about the need to use masks while doing hemodialysis catheter dressing. A statistically significant relationship were found between receiving training about ESRD and the count of correct answer (p=0.011). There is no statistically significant relationship between working time in intensive care unit, full operating time and the count of correct answer (p=0.45). Conclusion: Most of the participants (80%) answered at least 70% of the knowledge questions about ESRD correctly. It is suggested that standards must be created utilizing clinical practice guidelines to increase the effectiveness of nursing care. Education changes perceptions about issues especially in critical units such as intensive care units and acts by increasing the knowledge. There should be multidisciplinary training programs about ESRD and training programs should be organized related to the subject to intensive care staff.

Interventions other than anticoagulants and systemic antibiotics for prevention of central venous catheter-related infections in children with cancer

Use of central venous catheters (CVC) in treatment of children with cancer is associated with infective complications. Current evidence-based guidelines to prevent catheter-related infections are mainly relevant to the adult population. They are not cancer (especially not childhood cancer) specific. Two existing Cochrane reviews have looked at prophylactic antibiotics and anticoagulants to prevent CVC-related infections. The primary objective was to find which interventions, if any, were effective in preventing CVC-related infections in children with cancer. Further objectives were to examine the effectiveness of each intervention in the following subgroups: implanted versus external catheters, haematological versus non-haematological malignancies, and in those receiving haematopoietic stem cell transplants (HSCT) versus no HSCT. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2008, Issue 4), MEDLINE (January 1950 to January 2009), EMBASE (January 1980 to January 2009) and CINAHL(R) (January 1982 to March 2009). We also searched reference lists of relevant articles and proceedings of relevant international conferences (2004 to 2008). Randomised and quasi-randomised studies comparing any intervention (other than anticoagulants, systemic antibiotics and antibiotic lock techniques) versus no intervention, placebo or any other intervention to prevent CVC-related infections in children with cancer. Two authors independently selected studies, assessed trial quality and extracted data. Where necessary, we contacted study authors for further data and clarification of methods. Three trials involving two different interventions were included. Two trials involving 680 children compared flushing CVC with urokinase (with or without heparin) versus heparin alone. Neither of these trials reported on the primary outcome of catheter-related blood stream infection (CRBSI). There was a non-significantly decreased rate of catheter-associated infection (CAI) (Rate Ratio 0.72, 95% confidence interval 0.12 to 4.41) in the urokinase (with or without heparin) arm compared with the heparin arm.One trial involving 113 children compared frequency of catheter dressing change every 15 days versus every 4 days. It did not report on CRBSI or CAI. There were no premature catheter removals for infection in either of the trial arms. Three RCTs for only two types of interventions to prevent CVC-related infections in children with cancer have been identified. Flushing CVC with urokinase (with or without heparin) compared to heparin alone possibly leads to decrease in CAI rates. Changing catheter dressings every 15 days versus every 4 days does not lead to more premature catheter removals due to infection although data were insufficient to assess if catheter-related infection rates were changed.

Local infiltration of epinephrine-containing lidocaine with bicarbonate reduces superficial bleeding and pain during labor epidural catheter insertion: a randomized trial

Superficial bleeding after labor epidural catheter placement is a common phenomenon. In addition to delaying securing the epidural catheter, it may loosen the adhesive catheter dressing. The primary aim of this study was to determine whether skin infiltration with epinephrine-containing rather than plain lidocaine reduces superficial bleeding after catheter placement. Secondary objectives were to determine whether adding epinephrine and/or sodium bicarbonate affected infiltration pain. After institutional review board approval and informed consent, 80 healthy women receiving epidural analgesia during labor were randomly assigned in a double-blind manner to four local anesthetic mixtures (n=20 in each group): group L: lidocaine 1.5%, group LB: lidocaine 1.5% with 8.4% sodium bicarbonate, group LE: lidocaine 1.5% with epinephrine 1:200000, and group LEB: lidocaine 1.5% with epinephrine 1:200000 and 8.4% sodium bicarbonate. Clinical endpoints included the amount of superficial bleeding at the catheter site, pain during local anesthetic infiltration and epidural catheter movement during labor. Demographic data were similar among the groups. The addition of epinephrine to lidocaine significantly reduced superficial bleeding. Solutions containing epinephrine were well tolerated and caused no cardiovascular disturbances. The addition of epinephrine did not increase pain, while bicarbonate reduced it [verbal score (scale 0-10) 3.6+/-2.2 vs. 2.6+/-1.8; P=0.04]. There were no differences in epidural catheter movement among the groups; no catheters became displaced during labor. Local infiltration of epinephrine-containing lidocaine before epidural catheter insertion reduces superficial bleeding and the addition of bicarbonate decreases pain during skin infiltration.

Risk factors for bacterial catheter colonization in regional anaesthesia

BackgroundAlthough several potential risk factors have been discussed, risk factors associated with bacterial colonization or even infection of catheters used for regional anaesthesia are not very well investigated.MethodsIn this prospective observational trial, 198 catheters at several anatomical sites where placed using a standardized technique. The site of insertion was then monitored daily for signs of infection (secretion at the insertion site, redness, swelling, or local pain). The catheters were removed when clinically indicated (no or moderate postoperative pain) or when signs of potential infection occurred. After sterile removal they were prospectively analyzed for colonization, defined as > 15 colony forming units.Results33 (16.7%) of all catheters were colonized, and 18 (9.1%) of these with additional signs of local inflammation. Two of these patients required antibiotic treatment due to superficial infections. Stepwise logistic regression analysis was used to identify factors associated with catheter colonization. Out of 26 potential factors, three came out as statistically significant. Catheter placement in the groin (odds-ratio and 95%-confidence interval: 3.4; 1.5–7.8), and repeated changing of the catheter dressing (odds-ratio: 2.1; 1.4–3.3 per removal) increased the risk for colonization, whereas systemic antibiotics administered postoperatively decreased it (odds ratio: 0.41; 0.12–1.0).ConclusionColonization of peripheral and epidural nerve catheter can only in part be predicted at the time of catheter insertion since two out of three relevant variables that significantly influence the risk can only be recorded postoperatively. Catheter localisation in the groin, removal of the dressing and omission of postoperative antibiotics were associated with, but were not necessarily causal for bacterial colonization. These factors might help to identify patients who are at increased risk for catheter colonization.

Review: Transparent polyurethane-film catheter dressings for central or peripheral venous catheters compared with gauze dressings increases the risk for catheter-tip infections

EtiologySeptember 1, 1992Review: Transparent polyurethane-film catheter dressings for central or peripheral venous catheters compared with gauze dressings increases the risk for catheter-tip infectionsP. J. Brennan, MD, P. J. Brennan, MDP. J. Brennan, MDUniversity of Pennsylvania, Philadelphia, Pennsylvania, USA (P.J.B., P.J.B.)University of Pennsylvania, Philadelphia, Pennsylvania, USA (P.J.B., P.J.B.)Search for more papers by this author, P. J. Brennan, MDUniversity of Pennsylvania, Philadelphia, Pennsylvania, USA (P.J.B., P.J.B.)University of Pennsylvania, Philadelphia, Pennsylvania, USA (P.J.B., P.J.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1992-117-2-058 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationHoffmann KK, Weber DJ, Samsa GP, Rutala WA. Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection rates. JAMA. 1992 Apr 15;267:2072-6. Author, Article, and Disclosure InformationAffiliations: University of Pennsylvania, Philadelphia, Pennsylvania, USA (P.J.B., P.J.B.)University of Pennsylvania, Philadelphia, Pennsylvania, USA (P.J.B., P.J.B.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails September 1, 1992Volume 117, Issue 2Page: 58KeywordsAntibioticsAntimicrobialsBacteremiaBloodInformation storage and retrievalMedical risk factorsMorbiditySepsisSkin infectionsStem cells ePublished: 9 March 2020 Issue Published: September 1, 1992 Copyright & PermissionsCopyright © 1992 by American College of Physicians. All Rights Reserved.Loading ...

Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks

Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks

Transparent Polyurethane Film as an Intravenous Catheter Dressing: A Meta-analysis of the Infection Risks

Transparent Polyurethane Film as an Intravenous Catheter Dressing: A Meta-analysis of the Infection Risks