Venous Catheter Care Research Articles

Cateter venoso central de curta permanência: produção de vídeos educativos para a equipe de enfermagem

ABSTRACT Objective to prepare and validate scripts and storyboards for the production of educational videos, in digital format, about the care and maintenance of the central venous catheters in adult patients. Method a methodological and descriptive study about the elaboration and validation of scripts and storyboards for the production of educational videos that was conducted in two methodological stages: pre-production and production. The pre-production stage was based on three phases: preparation of the video scripts, elaboration of the storyboards, and validation by experts. Validation of the scripts and storyboards was in charge of 9 specialist judges in the subject matter and 2 technical experts in video; the Content Validation Index (CVI) was calculated considering as acceptable a minimum index of 0.80 for each item of the instruments. Results three educational videos were created with the following themes: dressing, maintenance and exchange and removal of the central venous catheter. Concerning the validation by expert judges in the subject matter and expert video technicians, all items evaluated resulted in agreement with a CVI of 100.0. Conclusion and implications for the practice the educational videos were elaborated, validated and suitable to be made available; the judges' participation in the validation of this material was essential to ensure the theoretical and practical relevance of the result.

The implementation of an external ventricular drain care bundle to reduce infection rates

Background: The main complication of external ventricular drains (EVD) is infection. Implementation of evidence-based guidelines for central venous catheter (CVC) care resulted in significant declines in infections. We tested a comparable approach to EVD infection rates.Methods: An initial retrospective study evaluated the existing EVD infection rate, and identified contributory risk factors. Based on our results, and in corroboration with existing literature, an EVD care bundle was developed and implemented. A prospective study was then conducted to identify improvement.Results: A total of 275 EVDs (120 pre- and 155 post-EVD care bundle) inserted over a period of 1532 days were included. Pre-care bundle, the infection rate was 27%, with the predominant factor associated with infection being number cerebrospinal fluid sampling episodes. Following introduction of the EVD care bundle, the infection rate declined to 10% (p < 0.001) with the incidence from 21 to 9 cases per 1,000 EVD-days (p = 0.003). The infection rate was not found to be significantly associated with the number of accesses during this period (p = 0.910).Conclusions: Introduction of a well-implemented EVD care bundle can significantly decrease EVD infection rates.

Roles and Role Ambiguity in Patient- and Caregiver-Performed Outpatient Parenteral Antimicrobial Therapy

Complicated medical therapies traditionally performed in acute care hospitals are increasingly moving to the home, requiring patients and informal caregivers to perform complicated medical tasks. For example, in outpatient parenteral antimicrobial therapy (OPAT), patients and caregivers perform antimicrobial infusions and venous catheter care. The objective of this study was to characterize patient understanding of patient, caregiver, and health care worker roles in OPAT and barriers to fulfilling these roles, with the goal of understanding how to best support patients and their caregivers. A qualitative study using 40 semistructured telephone interviews and 20 contextual inquiries of patients and caregivers performing OPAT tasks was performed. Eligible participants were discharged from two academic medical centers on OPAT. Interview transcripts and notes from contextual inquiry were coded based on a human factors engineering model. Four main roles are described: communicator, advocate, learner-trainer, and lay health care worker doing "high-skilled tasks." Patients and caregivers experienced role ambiguity about OPAT task performance at the time of hospital discharge. Patients noted that their health care workers experienced role ambiguity as well, particularly regarding who was managing their care. Patients and caregivers used role transitions to achieve workload management, in which patients and caregivers transitioned OPAT tasks or non-OPAT tasks from one person to another. Clear delineation of roles in complicated home-based medical therapies and training of all who may perform these tasks could improve the safety and quality of home-based care.

Oncology Critical Care Nurse's Knowledge about Insertion, Care and Complications of Venous Port Catheters in Egypt

Implantable port catheter devices are frequently used to manage patients undergoing long term administration of chemotherapy. Though it has many advantages, they are not free from complications. Nurse's who are knowledgeable and competent in the basic aspects of port-a-cath care able to ensure specific child needs are met and prevent further complications. Aim: was to assess Oncology Critical Care Nurse's Knowledge about insertion, Care and Complications of Venous Port Catheters in Egypt. Research Design: A descriptive design was utilized. Setting: was conducted at critical care units at 57357 hospitals in Egypt. Subject: A convenient sample of 100 oncology nurses who cared for patients undergoing port-a-cath insertion were enrolled in this study. Tools: nurse's background and implantable port catheter care knowledge questionnaire were utilized. Results: In this study, 62% of oncology nurses received in-service training courses about the implantable port catheter. Also, it revealed two thirds of the studied subjects (69%) have got satisfactory knowledge level with the average mean 40.31+2.12 out of 50. Moreover, it showed high significant differences among the oncology nurses level of knowledge by their age and educational qualifications and total knowledge scores (X2=13.17, p=0.001 and X2=7.79, p=0.02 respectively), nurses' years of experience in nursing profession, experience in handling port-a-cath, attending training courses about port-a-cath (X2=23.48, p=0.0001; X2=20.89, p=0.0001 and X2=55.47, p=0.0001 respectively. Conclusion: The majority of the oncology nurses had got satisfactory level and there was significant correlation between the nurses' knowledge level and their demographic characteristics except their gender. Recommendations: periodic consideration of in-service training programs regarding port-a-cath implantation care according to the updated standards and guidelines.

Decúbito prono en paciente portador de dispositivo de extracción extracorpórea de CO2 Novalung®

ObjectiveTo describe the course of a patient with the extracorporeal CO2 removal device and discover the effect of Novalung on ventilation, considering the patient's prone position and its influence on the device's blood flow. To develop a protocol of managing and specific care of a patient with Novalung. Material and methodsA case report of a patient with Novalung in a tertiary hospital ICU unit is reported. Parameters considered are hemodynamic, respiratory, pharmacological, analytical, neuromonitoring, managing of the Novalung and length of decubitus prone cycles. Anova Test, Student's T test, Wilcoxon-Mann Whitney and Spearman correlation. Significance p <0.05. ResultsA 46-year old women with nosocomial pneumonia and acute respiratory failure with indication of Novalung to decrease hypercapnia and optimize ventilatory management of refractory hypoxemia. ICU Stay 26days, MBP 82±9mmHg, HR 110±6lpm during the admission, monitoring PICCO 5 days CI 3.2±0.8 l/min/m2, ELWI 33±4ml, continuous hemofiltration 13.2days with a median removal 50cc/h. Norepinephrine dose 0.68±0.79μ/kg/min for 15days. Respiratory parameters during the admission: PO2 59±13mmHg, PCO2 68±35mmHg, SatO2 85±12%, PO2/FIO2 69±35, tidal volume 389±141cc. Novalung® 13days, heparin dose 181.42±145 mIU/Kg/min, Cephalin time 57.56±16.41sec, O2 flow 7±3l/min, median blood flow 1030cc/h, interquartile range 1447-612cc/h. Prone cycles 4, duration 53±27hours. With Novalung® PCO2 decreased regardless of position 66±21:56±9, p=0.005. Tidal volume 512±67:267±72, p=0.0001. Blood flow on supine-prone position 1053±82:113±112, p=0.001. There was no link between blood flow and PCO2 (p=0.2) and between O2 and PO2 flow (p=0.05). Specific care: pedal and tibial pulse monitoring, keep circuit safe to prevent and detect signs of bleeding, femoral arterial and venous catheter care, coagulation monitoring. CommentsDuring the use of Novalung protective, ventilation, low tidal volumes, decreased pressure plateau, PEEP and hypercapnia were achieved. Blood flow decreased in prone position, but the PCO2 did not increase. The device did not coagulate.

Beyond Bundles: Justification for a Central Venous Catheter (CVC) Care Team Program for the Prevention of Bloodstream Infections

ISSUE: The BSI rate for our Neurotrauma intensive care unit (NTICU) for the first quarter of 2004 was 8.8 bloodstream infections (BSI)/1000 line days (near the NNIS 90 th percentile of 9). Initial efforts focused on implementation of the IHI “BSI bundle” (hand hygiene, appropriate site selection, chlorhexidine use, aseptic technique, maximum barriers, and prompt line removal). Nevertheless, the lack of significant impact precipitated an administrative query regarding programs to control these infections more efficiently. PROJECT: A CVC care team program was piloted by instituting a “dedicated CVC care nurse.” This nurse was assigned to assist in all line insertions and perform all line care (twice weekly). She had a proactive role in keeping track of line days and the condition of the CVC's, and advising physicians when sites looked infected. She investigated line infections as they occurred and provided real time feedback to the unit. The CVC care nurse worked the morning shift on weekdays. RESULTS: The rate of infections decreased from 8.8 BSIs/1000 line days during the first quarter of 2004 to 6.5-6.9 BSIs/1000 line days during the 2 nd and 3 rd quarters when the BSI bundle was in place. Implementation of the CVC care team pilot program on the 4 th quarter decreased the rate to 4.3 BSI/1000 line days. As seen in the table, using expected and actual infections, as well as literature and cost estimates from our own hospital, we calculated that the CVC care team project has the potential to avoid between $20,000 to $315,000 in excess healthcare costs per ICU per quarter. LESSONS LEARNED: Implementing the BSI bundle only decreased the infection rate by approximately 25%, with multiple sustainability issues. The CVC care team program decreased the infection rate by approximately 50%, having potentially less sustainability issues due to total control of the process, assuring compliance with the BSI bundle. Having unit staff (physicians, PA's, nurses, etc.) buy-in of the program was essential. Cost avoidance estimates easily justify the full implementation of a comprehensive line team program. Financial Savings Period Rate/1000 line days Interventions Infections avoided Conservative savings @ $4,000/BSI Average savings @ $40,000/BSI Aggressive savings @ $63,000/BSI 1Q04 8.8 Baseline Baseline Baseline Baseline Baseline 2Q04 6.5 BSI bundle 3 $12,000 $120,000 $189,000 3Q04 6.9 BSI bundle 2 $8,000 $80,000 $126,000 4Q04 4.3 CVC care team 5 $20,000 $200,000 $315,000

80 Skin disinfection with octenidine dihydrochloride for central venous catheter placement and care — a randomized controlled trial

80 Skin disinfection with octenidine dihydrochloride for central venous catheter placement and care — a randomized controlled trial

Central venous catheter care in parenteral nutrition: a review.

Central venous catheter care in parenteral nutrition has been described in numerous publications. These descriptions include care of both short- and long-term catheters. Important aspects in the prevention of infection in central venous catheters used for parenteral nutrition have included: the method of central venous access, subcutaneous tunneling, dressing change techniques, therapeutic uses of the catheter, and catheter-intravenous tubing connection care. Methods of predicting infection and evaluating catheter sepsis have been described. The efficacy of intervention by specialized nutrition support teams in infection control related to these catheters has been demonstrated. Newer partially implantable and completely implantable venous access devices have been used for parenteral nutrition. Methods of infection control and prevention of mechanical damage of these types of catheters have been examined with various results. Care and composition of central venous catheters have been shown to have some role in thrombus formation in the central veins. The use of heparin to prevent thrombosis and catheter occlusion, and the varying degrees of success obtained, have been described. Medical treatment of the occluded catheter with urokinase may be a necessary alternative to discontinuance of that catheter. Overall consideration of research methods used to reach conclusions for catheter care should be considered in the evaluation of appropriate care in each situation.