Central Venous Catheters Case Studies

Lewis et al. explain in Medical-Surgical Nursing, a central line is a catheter placed into a large blood vessel for a patient who requires frequent or long-term access to the vascular system. The authors explain that catheters are used for the administration of high volume fluids, medications that are irritating (such as chemotherapy), long term pain medication, blood products, parenteral nutrition, and hemodialysis. Kaiser policy states four different types of central line used for patients: Centrally inserted catheters, peripherally inserted catheters, injection implanted ports and hemodialysis catheters. Centrally inserted catheters

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

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.

A peripherally inserted central catheter or PICC line “is a thin soft flexible tube” (Peripherally Inserted Central Catheter (PICC). (2015). It is usually inserted in the upper arm just above the elbow in a main vein that will lead to the heart where the blood flows more rapidly. Midlines are inserted usually into the vein in the arm. Sometimes you will need to use a leg vein when caring for infants. They last longer than a regular IV, but not as long as a PICC line. “It can usually be used for 2-4 weeks” (Peripherally Inserted Central Catheter (PICC). (2015). The central venous catheter is “placed into a large vein leading into the heart and comes out through a small opening in the chest area” (Peripherally Inserted Central Catheter (PICC). (2015). which they call the exit site. The big

Central venous catheters (CVC) have various uses for patients in both the inpatient and outpatient settings. Their purposes range from administration of total parenteral nutrition, to administration of vesicant medication, to providing access to patients with poor peripheral vascularity, as well as hemodynamic monitoring (Alexandrou, Spencer, Frost, Parr, Davidson, & Hillman, 2009, p. 1485). Traditionally, insertion of CVCs have been performed by surgeons and internal radiologists. However, with the advancement of roles in nursing, there has been ongoing research supporting the pro stance on the practice of nurse-led central venous catheter insertion.

The purpose of this paper is to identify an issue identified by the National Council of State Boards of Nursing NCLEX examination blueprint. The identified issue that I will be addressing for this paper is catheter associated urinary tract infections and is under the category of safety and infection control; according to (INSERT NCSBN CITATION) this issue falls under the overview of safe and effective care for patients. The importance of addressing this issue is one that can potentially aid in the patient having a higher satisfaction rate for the facility and the facility not potentially having to pay for services not covered by insurance after the infection develops.

One of the applications of NRL is urethral foley catheter. A Foley catheter is a sterile tube that collects urine from the bladder through the urethra. It is the most common type of indwelling urinary catheter. It is known as the indwelling catheter because it can be left in the bladder for a long period of time. However, Foley catheter cannot be used for too long because of the risk of catheter associated urinary tract infection and other adverse effects is high. Foley catheter is usually made of silicone rubber or natural rubber.

The hospital’s current practice for CAUTI prevention includes the use of the HOUDINI protocol. This protocol features the acronym for the strict indications required for the insertion and the continued use of the urinary catheter (hematuria, obstruction, urologic surgery, decubitus ulcer, intake and output, no code/comfort care, and immobilization). The physician places the original order for the catheter with HOUDINI protocol and chooses the indication that applies. The order empowers the nurse to assess the patient daily for the continued indications and to remove any urinary catheter that no longer meets the indications. Hospital wide the protocol has been successful at decreasing CAUTI rates, however the target for CAUTI rates is 0 and our current rate is 1.37 per 1000 catheter days. Intensive care units have higher urinary catheter usage than in medical surgical or telemetry units (Halm, O’Conner, 2014). In MICU the most common indication for a urinary catheter is the need for accurate intake and output on patients with hemodynamic instability. Staff nurses are required to assess the patient daily and readdress the continued indications. In the past month no urinary catheters were removed

Central line bundle is a group of evidence-based practice strategy for patient with central catheters, when implemented together, produce better outcomes than implemented individually (Institute of health care improvement, 2010.). The main elements of central line bundle are hand hygiene, maximal barrier precaution upon insertion, Chlorhexidine skin antisepsis, optimal catheter selection, and daily review of line necessity with prompt removal of unnecessary lines Aseptic technique when using and caring for a central line catheter can decrease the chance of contamination in this critically ill infants. Staff education on adherence to aseptic technique and strict central line care guidelines are essential to decreasing bloodstream infections.

Upon completion of this project I learned that many times patients were unaware of the compilations such as infection that may occur with central lines. This has taught me the importance of proving education to our patients in addition to staff members. Patients can help decrease central line associated blood stream infections by being aware of their surroundings and ensuring that nurses, physicians, and visitors take proper steps in decreasing infections rate. Implementing a policy to place alcohol infused caps on all central line that are not currently infusing is best practice back by evidence based practice to significantly decrease infection rates. This project as helped me identify evidence based practice and incorporate these practice in our daily care to help improve patient outcomes. The first couple of days there was not any patients within the intensive care unit with central line.

Peripherally inserted central catheters (PICCs) can be used for routine patient care for treatment and have been increasingly used over the past years. They are more invasive than a peripheral intravenous line (PIV); however, they can be inserted at the bedside, are easily removed, and provide many positive benefits. PICCs relieve patients from frequent venipuncture for serial lab draws, decreases frequent re-starts of PIVs, and the patient can be discharged home, if needed, for continued IV therapy. Although there are benefits to these easily inserted central lines, central line-associated bloodstream infections (CLABSI) are a possibility (Dumont & Nessselrodt, 2012).

The outcome of the audits on clinical practice which involved forty occasions of CVDC procedures revealed differences in routine practice. Nurses differ greatly in maintaining cleanliness of work area before opening the sterile supplies, preserving the dressing set’s sterility and if proper hand scrubbing was either finished or not before touching the catheter. There were also instances when either the patient or the nurse coughs and talks while the catheter was out in the open. Documentation audit results which included charts of fifty-five patients with CVDC demonstrated significant contrast of medical records in the bedside to the electronic database in the unit. It appears that logging of insertions and removals were done obediently on the electronic database compared to bedside medical records which accounts to merely 10 percent of catheter site appearance recorded and just 55 percent on documented CVC catheter care for each treatment. Based from the end results, the working party devised a standardised routine for managing central venous dialysis catheter in order to decrease differences in practise as well as to warrant evidence based practice. A standard haemodialysis treatment form has also been adjusted to include a part wherein the observations regarding the catheter exit site as well as dressing could be examined and recorded in every session of dialysis.

The focus of this paper is to compare the current hospital policy of Santa Clara Valley Medical Center’s (SCVMC) Central Venous Catheter (CVC) maintenance policies and procedure to current EBP suggestions. Current EBP practices suggest no differences of central line care SCVMC’s policies. This paper will

The nurse driven protocol was tested in 4 intensive care units. It included evidence-based orders for discontinuing, handling, and properly managing the catheters. One of the most important factors was the removal of the catheters in a timely manner. The data pre

4) Significance: This research shows that there is a gap in the evidence, but that the primary concern for nursing staff is to ensure that catheters are removed as soon as it is possible to do so.