Securement Device Research Articles

Interventions to Prevent Temporary Hemodialysis Catheter-Related CLABSI

Project: It was recognized that a team approach to eliminate CLABSIs in our 13 and 16 bed ICUs was necessary. All components of the CL bundle recommended by the Institute for Healthcare Improvement (IHI) were implemented in 2006. CLABSI rates remained unacceptable. The CLABSI Team re-convened in 2008 to review current processes related to CLABSI prevention, recommend changes to current practice, identify resources needed, and implement andmonitor new practices. A gap analysis was done and found that CL insertion practice varied from unit to unit, CL cart was used inconsistently, time out sheet not always available, RNs did not feel empowered to stop a procedure when they observed a break in technique, practice was not compatible with policy, and securement device was not always used. Actions taken included: standardized CL cart available, daily baths with CHG impregnated cloths, resident training for CL insertion in Simulation Center, 2-person team for PICC insertions, daily line assessment, details of every CLABSI patient reviewed at the BSI Team and two additional committees. A system-wide team to examine CL maintenance issues began in October 2010. Objectives are to standardize cap, dressing, and tubing change policy/practice, reduce/batch blood draws through lines, use CL dressing with incorporated securement device/CHG, and educate staff on Scrub the Hub, dedicated TPN port, limiting blood draws, and how to stop a procedure when technique is breached.

Peripheral IV Securement Device Implementation to Reduce Phlebitis and Associated Infections

Background/Objectives: Hospital-associated infections (HAI) occur in 5 to 10% of hospitalized patients. In intensive care units (ICUs) these rates can be over 50%, with MROs accounting for over 1/3 of these infections and increasing. Despite recent attention to surface cleaning and hand hygiene programs MROs continue to be isolated from the hospital environment. We hypothesize that reservoirs of MROs exist in the environment as biofilms which are difficult to remove due to biofilms increased resistance to disinfectants. These biofilms periodically release planktonic (free swimming) bacteria back into the environment which then act as an infection source.

Nursing Considerations for Children Undergoing Delayed Sternal Closure After Surgery for Congenital Heart Disease

Nursing Considerations for Children Undergoing Delayed Sternal Closure After Surgery for Congenital Heart Disease

Using in-depth investigations to identify transportation safety issues for wheelchair-seated occupants of motor vehicles

In-depth investigations of motor-vehicle crashes involve detailed inspection, measurement, and photodocumentation of vehicle exterior and interior damage, evidence of belt-restraint use, and evidence of occupant contacts with the vehicle interior. Results of in-depth investigations thereby provide the most objective way to identify current and emerging injury problems and issues in occupant safety and crash protection, and provide important feedback on the real-world performance of the latest restraint-system and vehicle crashworthiness technologies. To provide an objective understanding of real-world transportation safety issues for wheelchair-seated travelers, the University of Michigan Transportation Research Institute (UMTRI) has been conducting and assembling data from in-depth investigations of motor-vehicle crashes and non-crash adverse moving-vehicle incidents, such as emergency vehicle braking, turning, and swerving, in which there was at least one vehicle occupant sitting in a wheelchair. The results of 39 investigations involving 42 wheelchair-seated occupants have been assembled and entered into a wheelchair-occupant crash/injury database. In addition, a biomechanical analysis of each case has been performed to identify key safety issues for wheelchair-seated travelers. The wheelchairs of 34 of the 42 occupants who were seated in wheelchairs while traveling in motor vehicles were effectively secured by either a four-point, strap-type tiedown system or a docking securement device, and all but one of these properly secured wheelchairs remained in place during the crash or non-collision event. However, 30 of the 42 occupants were improperly restrained, either because of non-use or incomplete use of available belt restraints, or because the belt restraints were improperly positioned on the occupant's body. Twenty-six of the 42 occupants sustained significant injuries and 10 of these occupants died as a direct result of injuries sustained, or from complications resulting from those injuries. These findings, when combined with the analyses of the individual cases, point to a need for better driver and caregiver education and training on how to properly secure wheelchairs and position belt restraints on wheelchair-seated passengers. They also point to a need for improved restraint systems used by wheelchair-seated drivers, and a need for wheelchair designs that facilitate the proper use and positioning of vehicle-anchored belt restraints.

Securing the Indwelling Catheter

Each year, millions of Americans are catheterized to ensure adequate bladder drainage. But despite the high rate of catheterization in acute care facilities, clinicians often pay little attention to the decision to insert an indwelling catheter, its optimal management, or especially its timely removal. A physician or NP typically orders the insertion of a urinary catheter, but a nurse often performs the catheterization and is responsible for its management. Reimbursement policy changes recently mandated by the Centers for Medicare and Medicaid Services-including one stipulating that Medicare will no longer cover the cost of treating catheter-associated urinary tract infections-have resulted in increased scrutiny of indwelling catheter management. This article explores one aspect of catheter management, the use of securement devices, and analyzes the standard practices, expert opinion, and clinical evidence concerning this intervention.

Towards the Next Generation of Wheelchair Securement—Development of a Demonstration UDIG-Compatible Wheelchair Docking Device

The main purpose of this study was to demonstrate that an auto-docking device (ADD) could be produced that would meet the requirements for the universal interface contained in the evolving International Standard Organization (ISO 10542-3) standard and also meet Americans with Disabilities Act (ADA) regulations within the United States. A secondary purpose was to produce a practical design that directly addressed the most pressing securement deficiencies being experienced by transit users and providers that had promise of transfer to commercial availability. ADD development has demonstrated that a standards-compatible ADD can be produced that meets the rigorous crash test requirements of ISO 10542-3. Follow-up in-vehicle testing indicated the need for design refinement in order to prevent movement of an occupied manual wheelchair in excess of the 2-in. maximum requirement stipulated in the 1990 ADA. A user focus group provided feedback on the utility of the overall universal auto-docking concept, as well as guidance for improvement to control interfaces that would be located in the wheelchair and driver stations. The partnership with Kinedyne Inc., a manufacturer of securement devices, provided the industry-based focus that resulted in the cost containment and marketing expertise necessary to make the ADD a viable commercial product.

Sutured Securement of Peripherally Inserted Central Catheters Yields Fewer Complications in Pediatric Patients

Pediatric peripherally inserted central catheters (PICCs) can be secured with tape, sutures, or sutureless securement devices. Despite widespread catheter use, no standardized method of securement has been proven superior. A prospective randomized trial of catheter securement with either tape or suture was undertaken in pediatric patients hospitalized at a tertiary children's hospital. Patient demographics, catheter dwell time, and all catheter complications were collected. All patients were followed for the entire dwell time of the catheter, including those discharged with lines still in place. Sixty-six patients completed the study, with 34 children in the suture group and 32 children in the tape group. Patients' ages ranged from 9 months to 19 years. Overall complication rate in our sutured group was 5.8%, and 32.4% in the tape group. In this study of children of varying ages, sutured PICCs were associated with significantly fewer complications than those catheters secured with tape (p=.005). The 3 most common complications included migration, occlusion, and leaking catheters.

Why Are We Stuck on Tape and Suture?

This review focuses on available prospective data comparing standard methods of catheter securement with a securement device. The data demonstrate that the device, specifically engineered for catheter securement, significantly reduces overall catheter-associated complications. This appears to be the result of improved securement and reduced catheter motion. These studies make the authors question their current practice of securing catheters with tape and suture when better alternatives are available.

The Advantages of a Precision-engineered Securement Device for Fixation of Arterial Pressure-monitoring Catheters: Clinical Investigations

A prospective, sequential, controlled trial was conducted to evaluate the clinical and cost consequences of securing arterial catheters with a precision-engineered securement device compared with tape and transparent membrane dressing (TMD). Tape and TMD securement resulted in an unscheduled catheter restart rate of 25%; the study device resulted in an unscheduled catheter restart rate of 12.8%. The difference was highly significant (P<.001).

Get a hold on costs and safety with securement devices

Evidence shows that commercially available catheter securement devices both reduce accidental needlesticks to healthcare workers and prevent catheter-related bloodstream infections by limiting catheter movement.

Reduction of ICU Nosocomial Catheter-Associated Urinary Tract Infections

ISSUE: The Infection Control Department is responsible for an annual review and update of the surveillance plan. Surveillance is extremely important in the context of continuous quality improvement because it makes use of objective data to improve organizational performance. Catheter-associated urinary tract infection (CA-UTI) rates were compared to data from the National Nosocomial Infection Surveillance System (NNIS). It was noted that infection rates in the intensive care unit (ICU) from October 2001 to September 2002 were consistently greater than the 90th percentile when compared to NNIS. PROJECT: An action plan was devised through a root-cause analysis identifying issues in practice, patient demographics, and human characteristics. The action plan included lecture and demonstration in handwashing techniques with a program that included the use of fluorescent lotion to help the staff with visualization of residue left on the hands after hand hygiene, encouraging the use of a waterless hand sanitizer (already available in all the ICU rooms), anonymous culturing of the hands of the ICU staff (for educational purposes), environmental culturing, trialing a new catheter securement device, and reviewing the CDC recommendations for prevention and/or reduction of CA-UTIs. RESULTS: The action plan was implemented from July through September 2002. The data collected from September 2002 to the present shows a consistent decline in the incidence of CA-UTIs in the ICU, with a rate of 2.8 infections per 1000 urinary catheter days, which falls between the 25th and 50th percentile when compared to NNIS. Annual statistics show a total of 13 infections per 1000 urinary catheter days from October 2001 to August 2002, and a total of 4 infections per 1000 urinary catheter days from September 2002 to September 2003, a decrease of 70%. LESSONS LEARNED: It is extremely important to continue to monitor and give feedback to the staff on all of the actions taken. Several monitoring systems were also put into place, one for the usage of the alcohol hand sanitizer and one for the use of the new catheter securement device.

The promise of novel technology for the prevention of intravascular device-related bloodstream infection. II. Long-term devices.

Intravascular devices (IVDs) are widely used for vascular access but are associated with a substantial risk of IVD-related bloodstream infection (BSI). The development of novel technologies based on our understanding of pathogenesis promises a quantum reduction in IVD-related infections in an era of growing nursing shortage. Infections of long-term IVDs (most are in place for > or =10 days), including cuffed and tunneled central venous catheters (CVCs), implanted subcutaneous central venous ports, and peripherally inserted central catheters (PICCs), are primarily due to microorganisms that gain access to the catheter hub and lumen. Novel securement devices and antibiotic lock solutions have been shown to reduce the risk of IVD-related BSI in prospective randomized trials. The challenge for the future will be to identify new preventative technologies and to begin to more-widely adapt those technologies that have already been shown to be efficacious and cost effective.

Sutureless Securement Device Reduces Complications of Peripherally Inserted Central Venous Catheters

This study was conducted to evaluate the performance of a sutureless adhesive-backed device, StatLock, for securement of peripherally inserted central venous catheters (PICCs). Earlier studies have demonstrated that StatLock significantly reduces catheter-related complications when compared to tape. The purpose of this study was to determine whether a sutureless securement device offers an advantage over suture in preventing catheter-related complications. 170 patients requiring PICCs, which were randomized to suture (n = 85) or StatLock (n = 85) securement were prospectively studied. Patients were followed throughout their entire catheter course, and PICC-related complications including dislodgment, infection, occlusion, leakage, and central venous thrombosis were documented. Catheter outcome data were compared to determine if statistically significant differences existed between the suture and StatLock groups. The groups had equivalent demographic characteristics and catheter indications. Average securement time with StatLock was significantly shorter (4.7 minutes vs 2.7 minutes;P <.001). Although StatLock was associated with fewer total complications (42 vs 61), this difference did not achieve significance. However, there were significantly fewer PICC-related bloodstream infections in the StatLock group (2 vs 10; P =.032). One securement-related needle-stick injury was documented during suturing of a PICC. The sutureless anchor pad was beneficial for both patients and health care providers. Further investigation to determine how StatLock helps reduce catheter-related blood stream infections is necessary.

Low-Temperature Insulation for Refinery Service

Abstract The problem confronting the refinery engineer in the selection, application, and maintenance of an insulation for low-temperature service involves consideration of factors that are, in general, of only minor significance in the high-temperature field. The principal basic factor in any insulation is, of course, conductivity. However, water absorption, upper-temperature limit, fire resistance, coefficient of expansion, and so on, also must be considered in selecting an insulant for particular service conditions. This paper presents a discussion of the more common insulating materials and the relative importance of the various properties and characteristics of these materials for low-temperature service in petroleum refineries. In addition to the care exercised in obtaining the proper insulating material, considerable attention must be devoted to the selection of accessory materials such as adhesives, vapor sealers, water and fireproof coverings, mechanical securement devices, and the like. These materials also will be discussed since they have a pronounced effect on the over-all effectiveness and life of the insulation.