Abstract
To reduce incidence of catheter-related infections caused by peripheral IV catheters (PIVC), hospitals have adhered to a practice of routine replacement every two to eight days. A review of available research articles suggests instead that reinsertion produced no evidence of reduced IV complications, but did impose repeated invasive procedures and discomfort upon the patients, as well as increased staff workload and hospital equipment costs. Alternatively, the collective research presents a practice of PIVC removal based solely upon clinical indication or medically determined need. In three different randomized controlled trials, each including adult patients 18 years or older, from multiple participating hospitals, the
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This paper examines research from Lopez, Vilela, Ferandez del Palacio, Corral, Marti and Portal, as well as two studies by Rickard (Rickard, McCann, Munnings and McGrail, and Rickard, Webster, Wallis, Marsh, McGrail, French, Foster, Gallagher, Gowardman, Zhang, McClymont and Whitby), to better understand which IV replacement policy provides greater iatrogenic complication prevention.
Purpose
It is intended, that by evaluating the available research comparing the routine IV replacement practice versus a clinically indicated removal practice, a best-practice approach could be determined. One that provides the best possible outcome for the patient health and overall satisfaction. These studies provide consideration for policy standards based upon the evidence of the effectiveness of each practice, rather than continuing to follow practices established solely on unproven, unchallenged theory.
Research Question
The focus of this research study is to consider the nursing question, “In hospitalized adults, how does routine, compared with clinically indicated replacement of peripheral IV catheters affect patients?”
Importance to nursing
Current IV replacement practice is not evidence-based, but based upon the assumption that it is the longer IV site dwell time, rather than IV insertion and site care practices that ultimately lead to IV complications. According to Rickard et al., as
Nurses lacked knowledge in the use and was unaware of the importance of the underlying evidence- base recommended criteria’s indicated on the nurse driven protocol to remove inappropriate UC’s. A nurse driven indwelling catheter removal protocol is an evidence base tool recommended by infection control organization and experts for the early removal of unnecessary or inappropriately placed urinary catheters (UC). Evidence shows that urinary catheters are the source of catheter associated urinary tract infection (CAUTI). CAUTI, is the leading cause of hospital acquired infections in the United States. The purpose of this evidence-based quality project is to evaluate the effectiveness of an educational intervention on the importance and use of the nurse driven protocol on nurses ' knowledge and CAUTI rates.
Getting an infection from improper care during or after insertion of a central line is the last thing you want to get while in the hospital. This paper will discuss Kaiser Permanente’s policy on central venous catheter, also known as a central line, care and dressing change, and whether it follows the current evidence-based practice on preventing bloodstream infection in patients who have them inserted. I will explain about what a central line is, why evidence-based practice is important in the clinical setting, what Kaiser Permanente’s policy about central line care and dressing change is, if Kaiser is currently following evidence-based practice based on current articles about preventing central line associated bloodstream infections (CLABSIs), and what my role in using evidence-based practice is as a future registered nurse.
An implemented change that would reduce the rates of CAUTI’s in acute health care facilities would be evidence based nurse lead protocols. The protocols would not only benefit the hospitals but they would also contribute to patient satisfaction scores.
The work of Burke, et al (2011) reports that a study with the objective of comparing the "efficacy of intradermal bacteriostatic normal saline with that of intradermal buffered lidocaine in providing local anesthesia to adult patients prior to IV catheterization." (p.1) The study concluded that intradermal buffered lidocaine was superior to intradermal bacteriostatic normal saline in providing local anesthesia prior to IV catheterization in this group of predominately white adults and should be the solution of choice for venipuncture pretreatment." (Burke, et al, 2011, p.1) Burke et al reports that surgery is something that most people fear with the fear of the unknown is combined with "apprehension about such anticipated procedures as insertion of an IV line." (2011, p.1) Burke additionally reports that patients admitted for same-day surgery "require IV access. Any venipuncture, including peripheral IV catheterization with a medium-to-large-gauge catheter, can cause some degree of pain. Using local anesthesia prior to IV catheterization has
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.
One object of the NIH is improving the health of Americans by building a scientific foundation for clinical practice through reach and training (NIH, n.d.). The NIH’s mission is to promote and improve the health of individuals, families and the community (NIH, n.d.). Gaining the support of the NIH is important because the organization promotes the use of evidence-based practice. NIH uses research to validate its findings through continuous research in the areas of acute and chronic diseases and ways to manage the disease. NIH would be able to provide numerous confirmations as to why early Foley catheter discontinuation is vital to patient care outcomes.
The clinician demonstrated evidence based practice in his care. By informing the patient about the procedure and waiting for a clear approval. He demonstrated great communication skills as well as keeping the client’s values and circumstance at the core of his care throughout. In addition, the five moments of hand hygiene, aseptic technique and the rights of medication administration of current best practice were utilised. Furthermore, clinical expertise were demonstrated the clinician completed the task in a timely manner with good dexterity highlighting that he has been administering IV therapy for quite some time and is experienced in the way he handled the
At my facility, 34 units are inpatient units and five critical care units. Initial surveys can be given out to assess the staff’s understanding of CAUTIs, experience with Foley insertion and the rate of nurse driven discontinuation. This will give vital information on how different units use and manage Foley catheters for educational purposes. Additional education needs are reported to the clinical educators to confer on per department and online educational material can be assigned to staff members. Collaborating with the physicians, unit managers, nurse practitioners will be important because they have influence on early Foley discontinuation. They can ask the question of whether the patient’s Foley is still needed or can be discontinued? In addition, collaborating with the nursing research team will be essential in gaining more information on evidence-base practice on latest research on Foley catheters. Volunteers to serve on the Foley rounding teams will need to make daily rounds through the facility and track the occurrences of CAUTIs that is reported to unit managers. At the next meet, managers can discuss with the staff the progression of the project, encourage efforts toward a zero occurrence of CAUTI and give credit to staff member that continuously
367). On the side of expert opinion, the CMS has had discourse regarding the potential broadening of events related to inadequate VTE prevention for both surgical procedures and medical patients (Maynard, 2016, p. 4).
According to a study conducted in 2011 by the government, approximately 80% of urinary tract infections associated with indwelling catheters, increase the hospital length of stay by one to three days, and according to the Centers for Medicare & Medicaid Services (CMS), have an annual cost of
In the second article, by authors Morgan, Lancaster, Walters,Owczarski, Clark, McSwain, and Adams, a retrospective study was done to determine and compare the outcomes between groups of patients who had surgery before and after the ERAS protocols were implemented. The purpose was to determine the impact that the ERAS protocols were having with regards to patient safety and efficiency. The study highlighted pre, intra and postoperative elements of ERAS and concluded that ERAS protocols are safe and effective at reducing morbidity, length of stay and cost. (Morgan , et al., 2016)
Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile
A nurse driven indwelling catheter removal protocol is an evidence base tool recommended by infection control organization and experts for the early removal of unnecessary or inappropriately placed urinary catheters (UC). Evidence shows that urinary catheters are the source of CAUTI’s. CAUTI, is the leading cause of hospital acquired infections in the United States. Seventy- five percent of urinary tract infections in hospitalized patients are associated with urinary catheters and more than 50% of these infections are preventable (Center for Disease Control and Prevention (CDC), 2015). A urinary catheter is a device inserted into the bladder for emptying. Roughly, 25 percent of hospitalized patients receive urinary catheters in the United States
Implementation are interventions that are delivered in a manner that minimizes complications and life-threatening situations (Bell, et.al, 2008). Diana, RN, on noticing the infiltrated IV, stopped the infusion and provided care to the hand. Careful documentation of the events were
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.