Central Venous Catheter Care Research Articles

Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients


 
 
 Context: Central venous access device (CVAD) bundles for insertion and maintenance demonstrate a reduction in the frequency of complications and bloodstream infection when implemented with compliance monitoring, with the reported success of CVAD bundles. Aim: This study aimed to examine the effect of central venous catheter care bundle implementation on outcomes of critically ill patients. Methods: Quasi-experimental research (pre/post-test design) used to achieve the aim of this study. The study conducted at general and surgical intensive care units affiliated to Menoufia University and teaching hospital. Two study samples recruited in this study. All nurses working at the ICUs, as mentioned above, were recruited in this study. They were 6o critical care nurses. A convenient sample of all available critically ill patients at the time of the study was subjected to treatment via a central venous catheter. Four study tools used to collect the data of this study. These are a structured interview questionnaire, CVC nurses’ knowledge assessment questionnaire, nurses’ compliance assessment checklists, and patient complications assessment records.
 Results: The study result showed a highly statistically significant difference between pre and post-test knowledge scores of studied nurses regarding assisting line insertion, removal, maintenance, care, and infection control practices. Besides, a highly statistically significant difference between pre and post-test scores of nurses’ compliance to central venous catheter care practices of assisting in CVC insertion, blood sample withdrawal, medication and fluid administration, CVP measurements, CVC removal, and the management of central venous line complications. The study also revealed a highly statistically significant difference between the study and control group patients regarding the central venous catheter complications. However, signs of infection were the most frequent complications in both groups.
 Conclusion. The study concluded that a statistically significant difference between pre and post nurses’ knowledge and compliance with the CVC care bundle. The patients’ outcomes were also improved significantly after the implementation of the CVC care bundle compared to the controls. The study recommended the adoption of the current care bundle that should be disseminated and updated following the international organizations’ recommendation for implementing evidence-based practices for successful central line-associated bloodstream infection (CLABSI) prevention.
 
 

Failure of central venous catheter insertion and care bundles in a high central line–associated bloodstream infection rate, high bed occupancy hospital

Our hospital has several characteristics different from the settings in which the central venous catheter (CVC) care bundle has been implemented so far, that is, care bundles or protocols are not systematically used, and the prevalence of central line-associated bloodstream infections (CLABSI) is high, as is bed occupancy rate. We examined the effectiveness of CVC care bundles. Modified CVC bundles were implemented across all settings of our hospital. During both phases of the study, we collected data on CLABSI, and we monitored CVC insertion and management practices with direct observation audits. We have studied 913 CVC insertions (454 in PRE and 459 in POST) for 11,871 catheter-days. The incidence of CLABSI was 8.3 per 1,000 catheter-days PRE, and 7.6 per 1,000 catheter-days POST (incidence rate ratio,0.92; 95% confidence interval,0.60-1.40). Compliance with the CVC insertion bundle increased from 8.4%-74.3% (P<.0001). The CVC management bundle compliance also increased from 11.4%-57.7% (P<.0001). Despite improved compliance after the intervention, implementation of a modified CVC bundle failed to decrease CLABSI incidence. Higher bundle compliance rates may be necessary for a significant decrease in the incidence of CLABSI, along with the appropriate organizational culture and levels of staffing.

Effectiveness of An Educational Program on Knowledge and Practices Regarding Care of Central Venous Catheters among Dialysis Nurses

Effectiveness of An Educational Program on Knowledge and Practices Regarding Care of Central Venous Catheters among Dialysis Nurses

Yoğun Bakım Hemşirelerinin Santral Venöz Kateter İlişkili Enfeksiyonların Önlenmesinde Kanıta Dayalı Uygulama Farkındalıkları

Yoğun Bakım Hemşirelerinin Santral Venöz Kateter İlişkili Enfeksiyonların Önlenmesinde Kanıta Dayalı Uygulama Farkındalıkları

Surveillance of home health central venous catheter care outcomes: Challenges and future directions

Limited data are available regarding central venous catheter (CVC)-related complications that occur in home care. A practical out-of-hospital surveillance mechanism is needed. Home health/infusion agencies in 4 states submitted monthly data from January 2011 through March 2015. Data were collected by patient age and included number of patients on service with a CVC, device days, central line-associated bloodstream infection (CLABSI), CVC-occlusions, doses of fibrinolytics administered, and number of patients receiving fibrinolytics. Ten agencies from 4 states contributed data across the study period. A total of 913 occlusions and 73 CLABSIs occurred during the 51-month surveillance period. The CLABSI rates per 1,000 device days per year across the study surveillance period ranged from 0-0.40 for pediatric and from 0-0.37 for adult patients, whereas occlusion rates per 1,000 device days ranged from 0.26-1.59 for pediatric and from 2.59-33.29 for adult patients. Doses of fibrinolytic agents administered per 1,000 device days ranged from 0.26-1.80 in pediatric and 3.53-33.85 in adult patients. Opportunities exist to further expand efforts to quantify the presence of CVCs in home settings to enable improvements with measuring and tracking patient outcomes as they relate to CVC care. Exploration of continued sustainability of surveillance and data validation are warranted to optimize home health/infusion care practices and outcomes.

The Effect of a Guide Based Application Bundle on the Catheter-Related Infection.

Central venous catheters are used extensively in intensive care units but can sometimes lead to catheter related blood stream infections. This study was carried out to determine the effect of guideline-based care bundle on possible catheter-related bloodstream infection in the application and care of central venous catheter in patients receiving follow-up and treatment in anesthesia intensive care unit. The study is a retrospective and experimental one. The study population consisted of patients who were treated in an anesthesia intensive care unit of a university hospital between June 2015 and June 2016, to whom the central line was inserted in this unit by the team working in the unit and who required central line insertion for at least 48 hours. The patients in the study population also comprised the study sample. The guideline-based application and care bundle was administered under the supervision of the researcher in the intensive care unit and the patients were evaluated on a daily basis for bloodstream infection. When comparing data obtained from the study with data from the previous period, it was found that the guideline-based application and care bundle decreased the catheter-related bloodstream infection rate from 10.59/1000 to 2.88/1000 and this reduction was considered statistically significant (p<0.05). According to this study's data, the guideline-based care bundle is an effective and useful way to reduce infection.

Journal Club: Surveillance of home health central venous catheter care outcomes: Challenges and future directions

Journal Club: Surveillance of home health central venous catheter care outcomes: Challenges and future directions

TRAINING OF CHILDREN'S AND ADOLESCENTS' FAMILY MEMBERS IN HOME PARENTERAL NUTRITION CARE.

ABSTRACTObjective: To report the experience of the training in home parenteral nutrition (PN) directed to family members of children and adolescents participating in a multidisciplinary intestinal rehabilitation program of a tertiary public hospital.Methods: Cross-sectional descriptive study with family caregivers of patients from the Intestinal Rehabilitation Program of Hospital de Clínicas de Porto Alegre, RS, Brazil, from July/2014 to January/2017. Inclusion criteria: family members of children aged 30 days to 17 years and estimated PN use ≥8 weeks; and family members motivated to care for the child. The training covered: hand washing and disinfection; infusion pump handling; and central venous catheter (CVC) and PN care. Outcomes assessed: catheter-related bloodstream infection (CRBSI) rate, accidental CVC exit, end of PN infusion with more than 60minutes of delay or advance compared to the time predicted, mechanical obstruction, bleeding in the CVC insertion site, and death.Results: Twenty-seven family members of 17 children were trained. Their median age was 28 (18-60) years, and 63% were mothers. The mean CRBSI rate was 1.7/1,000 days of CVC use, and 29.4% of patients had at least one episode of accidental CVC exit. There were no complications related to PN infusion, bleeding, or death.Conclusions: The training of family caregivers allowed the safe implementation of home PN, with the active participation of families, making the procedure feasible in the public health system in Brazil.

SUN-PO021: The Role of Obesity in the Occurrence of Infections During Insertion and Care of Central Venous Catheters. A Prospective Observational Study in Greece

SUN-PO021: The Role of Obesity in the Occurrence of Infections During Insertion and Care of Central Venous Catheters. A Prospective Observational Study in Greece

Guidebook for renal dialysis patients: care of central venous catheters and arteriovenous fistula.

To design and validate the content and format of a guidebook for chronic renal failure patients about the care with venous access for hemodialysis at home. Methodological study, in which the steps for the guidebook design were: project planning, literature search, material content, and qualification selection. After analysis of the articles, the content to be included in the guidebook was selected. The first draft of the guidebook was submitted for content and format validation, with the participation of 12 specialists. The necessary adjustments for the design of the final version were made with the help of an illustrator. The designed guidebook, "Hemodialysis: Care of Venous Accesses and Intercurrences at Home," consists of educational material to help hemodialysis patients with daily care with central venous catheter and arteriovenous fistula practices in case of intercurrences.

P4.52: Preventing catheter-associated infections in parenteral nutrition in a pediatric gastroenterology unit, 2010–2018: impact of an educational program surveying policies for insertion and care of central venous catheters

P4.52: Preventing catheter-associated infections in parenteral nutrition in a pediatric gastroenterology unit, 2010–2018: impact of an educational program surveying policies for insertion and care of central venous catheters

The Effect of Central Venous Catheter Care on Infection Development: A Systematic Review

The Effect of Central Venous Catheter Care on Infection Development: A Systematic Review

Mobilizing Education to Nurses at the Bedside.

After a survey revealed practice gaps in central venous catheter care, one organization was challenged to identify a novel approach to educate nurses. Through a search for evidence, a project workgroup discovered an existing but beneficial teaching method, using a mobile cart to deliver meaningful education at the point of care. Successful outcomes and sustained practice change were realized.

Increased Incidence of Central Venous Catheter-Related Infection in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy.

Background: Cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) is a complex surgical intervention with associated risks. Central venous catheter (CVC) line sepsis is one of a number of potential morbidities. The aim of this study was to calculate the incidence of catheter-related infection (CRI) in a CRS and HIPEC patient population and to assess its influence on length of hospital stay. Methods: Data were collected on consecutive patients who underwent CRS HIPEC between August 2013 and October 2017. Data included patient demographics, timing of CVC insertion/removal, time spent in critical care, and CVC tip/blood culture results. Charts were reviewed for patients with both positive CVC culture and positive blood cultures to assess for evidence of catheter related infection and systemic inflammatory response syndrome (SIRS). Results: Data on 100 consecutive CRS HIPEC operations performed between August 2013 and October 2017 was analyzed. There were 11 CRIs in 100 CVCs, resulting in a CRI rate of 16.2 per 1,000 CVC days. Patients within the CRI group had a longer high-dependency unit (HDU) stay compared with the non-septic group (6 days vs. 4.07 days, p < 0.05). The CVC duration for the CRI and non-CRI group was 8.4 and 7.6 days, respectively (p = 0.12). The CRI group also had an increased total hospital length of stay (LOS; 20.8 days vs. 15.4 days, p < 0.05). On average, CRIs occurred eight days post-operative and four days post-HDU discharge. There was no association identified with longer CVC duration (p = 0.34). There has been an annual decline in CRI rates in CRS and HIPEC patients over the duration of the study period from 19.1 per 1,000 CVC days in 2016 to 8.2 per 1,000 CVC days in 2017. Conclusion: This is the first study to report on CRI rates in patients undergoing CRS and HIPEC. The CRI rate of 16.2 per 1,000 CVC days is higher than the overall national figure of 5.2 per 1,000 for CVC lines inserted in the operating room. Patients who developed line sepsis had longer HDU and longer overall hospital stay. Catheter-related infection was noted post-HDU discharge in all cases. Implementation of a CVC care bundle in the later years of the study period coincided with a reduction in CRI rates.

Utilization of a central venous catheter insertion care bundle in Taiwan: A cross-sectional analysis of the National Health Insurance Research Database.

Objectives:The objectives of this study are to explore medical care utilization associated with promoting the central venous catheter (CVC) care bundle plan using Taiwan's National Health Insurance Research Database (NHIRD).Materials and Methods:We performed a cross-sectional, secondary analysis of the data from patients who were admitted to a medical center for the first time between July 1, 2010, and June 30, 2012, in the NHIRD. The control group was patients who were admitted at nine medical center hospitals that participated in the pilot plan, and the study group was patients who were admitted at other ten medical center hospitals that did not participate in the pilot plan, and the differences between groups were analyzed.Results:After implementing the CVC care bundle, the average hospital stay decreased significantly (18.43 ± 12.96 vs. 15.49 ± 10.16, P < 0.05). In addition, the study group patients were clinically less likely to require antibiotics than the control group (odds ratio = 0.33, 95% confidence interval [CI] = [0.07, 1.71] vs. 0.62, 95% CI = [0.40, 0.96], P = 3768), and their medical expenses were lower (220, 618 ± 226, 419 vs. 208, 079 ± 193, 610, P > 05). Furthermore, the incidence rate of CVC-associated sepsis decreased from 12.59% to 5.66%.Conclusions:By implementing the CVC care bundle in clinical practice in accordance with national policies, medical utilization decreased, thereby considerably improving medical resource usage. These results confirmed that implementing the CVC care bundle possibly decreased medical utilization in clinical practice.

Comparison of Central Line Care Practice of Staff Nurses before and after Implementation of Guidelines

Central line associated blood stream infections in children can be prevented when evidence based guidelines are followed by the nurses for post insertion care and maintenance of central venous catheters. This study aimed to compare the central line care practices of staff nurses before and after implementing the guidelines in pediatric intensive care unit (PICU). This experimental quantitative study was done at 12 bedded PICU, St John's Hospital over a period of 3 months from October 2016-December 2016. A purposive sample consisting of 15 staff nurses who are working in PICU were selected for this one group pre-test post-test designed study. Central line care practices of staff nurses were observed twice using an observational checklist consisting of 50 items by the researcher before and after implementing the guidelines. The practices were analyzed and scored using descriptive and inferential statistics. The findings showed that the mean post-test score was higher than the mean pre-test score in the study group. There was a significant association of the pre-test practice score with years of experience in PICU. The central line care practice guideline can be used as an effective tool for the maintenance of central venous catheters of children.

CARE PROTOCOL WITH TOTALY IMPLANTED VENOUS CATHETER: A COLLECTIVE CONSTRUCTION

ABSTRACT Objective: to collectively construct a fully implanted central venous catheter care protocol with nurses from a highly complex oncology center. Method: a convergent care research, conducted at a hospital qualified as a highly complex oncology care unit in Minas Gerais, Brazil, from September 2017 to January 2018. The construction of the protocol was guided by Evidence Based Practice. Initially, data was collected from client records. After that, five workshops were held with the nurses, aiming to verify the material and human resources available, besides the viable care to compose the protocol. The analysis involved processes of apprehension, synthesis, theorization and transference. Results: most of the 219 medical records evaluated from clients with fully implanted venous catheters were female (77.1%), with a mean age 49.6 years old, breast cancer, and average catheter stay of 502 days. The nurses participating in the research were female, with a mean age 30.2 years old, time since graduation of 5.2 years and experience in oncology of 4.8 years on average. During the workshops, the participants reflected on the daily routine of the service, with a theoretical and scientific basis, which allowed, considering the professionals' opinion, to verify the care evidences and the practicability of the practices in the study scenario for the construction of a protocol. Care emerged related to puncture, manipulation, salinization and catheter clearance. Conclusion: the protocol construction process involved the participation of all oncology nurses, and all the mentioned care has scientific evidence for its use.

Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit: Risk factors and key preventive measures for eradication in record time

IntroductionIn November 2014, an extended-spectrum beta-lactamase producing Klebsiella pneumoniae outbreak was detected in the neonatal intensive care unit of a tertiary care hospital. ObjectiveOur aim was to determine the clinical, epidemiological and microbiological characteristics of the outbreak, to analyse the identified risk factors and to describe the preventive and control measures implemented for its eradication. MethodsWe conducted a case-control study. We performed univariate and bivariate analyses, defining statistical significance as a P-value of less than 0.05. The implemented preventive and control measures were aimed at establishing the magnitude of the outbreak, effective communication, the evaluation of health care processes and education on patient safety. Clinical samples were collected for molecular and phenotypic characterisation. FindingsThe sample consisted of 51 newborns, of who 17 were cases and the remaining 34 controls. The distribution of cases by birth weight was: 2 cases (11.8%) greater than 2500g, 4 cases (23.5%) between 1500 and 2500g, 5 cases (29.4%) between 1000 and 1500g, and 5 cases (29.4%) less than 1000g. In one case, the birth weight was not documented in the health record. The following risk factors for colonisation or infection were statistically significant in our study: presence of a central venous catheter (OR, 5.0 [95% CI, 1.4–17.8]; P=.016); parenteral nutrition (OR, 6.8 [95% CI, 1.8–25.7]; P=.006); urinary catheterization (OR, 5.9 [95% CI, 1.2–30.0]; P=.028) and birth weight (P=.035). We found statistically significant differences in the mean total length of stay in hospital (P=.004) and length of stay in the NICU (P=.002). All 17 cases presented antimicrobial resistance with presence of extended-spectrum beta-lactamase type CTX-M-14. ConclusionWorkplace interventions focused on patient safety need to be reinforced, especially those concerning practices with the potential to increase the extrinsic risk of colonisation or infection by extended-spectrum beta-lactamase-producing K. pneumoniae in the NICU, such as the insertion, care and maintenance of central venous catheter, parenteral nutrition and urinary catheterization.

Variation in infection prevention practices for peripherally inserted central venous catheters: A survey of neonatal units in England and Wales.

BackgroundThere is uncertainty about the variation in infection prevention practices for central venous catheters (CVC) in neonatal units (NNUs) and how practices relate to national guidance.AimTo evaluate evidence supporting infection prevention practices for CVCs recommended in national guidelines and to compare with reported practices for peripherally inserted central catheters (PICC), a type of CVC widely used in NNUs.DesignWe searched national guidelines for neonates and children to identify infection prevention practices for CVCs and conducted an overview of studies to determine the quality of evidence underpinning recommendations. We surveyed 134 NNUs in England and Wales to ascertain reported practice.ResultsWe found low quality evidence supporting CVC care bundles and use of 2% alcoholic chlorhexidine to decontaminate catheter ports and skin before insertion. Moderate quality evidence supported recommendations against routinely replacing CVCs and against chlorhexidine-impregnated dressings. 90% (44/49) of NICUs and 40% (34/85) of LNUs responded. 66% (48/73) of NNUs reported using CVC care bundles for insertion; 62% (45/73) used bundles for maintenance. 63% (32/51) of those using bundles reported monitoring adherence. 85% (61/72) of NNUs did not routinely replace PICCs and 89% (63/71) did not use chlorhexidine-impregnated dressings. Antiseptic use varied with alcoholic 2% chlorhexidine used for skin preparation in 33% (23/71) of NNUs and for catheter ports in 52% (37/71).ConclusionsLack of consistency across NNUs in antiseptic use and low rates of reported CVC care bundle use may reflect the low quality of evidence of the effectiveness and safety of these interventions in NNUs. Clinical trials are needed to quantify benefits and harms of infection prevention practices in NNUs.

Relation between Health Care Providers´ Compliance with Central Venous Catheter Care Bundle Elements and The Length of Stay in Cardiac Care Units, National Heart Institute.

Relation between Health Care Providers´ Compliance with Central Venous Catheter Care Bundle Elements and The Length of Stay in Cardiac Care Units, National Heart Institute.