Methods for determining central venous catheter (CVC) tip placement vary among facilities. In most institutions, a single-view, anterior chest radiograph is used to visualize and evaluate the CVC catheter for malposition and/or position of the catheter tip. However, this method does not identify the posterior malposition of the catheter tip, which, on the anterior view, may appear correctly placed. In this article, the author (a) identifies the need for double-view chest radiographs for accurate determination of CVC tip placement and (b) emphasizes the importance of expertise of vascular access practitioners in the determination of catheter-tip placement and the identification of malposition and complication of CVC placement.
In 2002, the Infection Control Team in the authors' hospital noticed a significant increase of catheter-related bloodstream infections (CRBSI) at the extended care facility. The rate had increased from 0.5 per 1000 patient days to 1.2 per 1000 patient days and fluctuated between high and low infection rates. A process improvement team met to discuss the processes. Key elements affecting the increase in CRBSIs included lack of both supplies and time for nursing staff to change initial gauze dressings. The process improvement included using reverse-tapered peripherally inserted central catheters (PICCs), placing a chlorhexidine patch on day of insertion, increasing supplies, and educating core staff.
When a manuscript is submitted to the Journal of the Association for Vascular Access (JAVA). it undergoes a stringent review process by two to three peer reviewers who are experts in the field of vascular access. To ensure that authors are provided the most helpful review possible, JAVA's Publications Committee felt that an assessment of reviewer guidelines used in the past several years was in order. Therefore, a small taskforce of members from JAVA's Publications Committee reviewed the existing guidelines and, over a three-month period, updated them. The goal of these revised guidelines is for peer reviewers to be able to provide authors with highly detailed and informative reviews. For reviewers, the new guidelines will clarify the type of information required in a review, which in turn, will generate more detailed feedback for the authors. Both authors and JAVA reviewers will find these new guidelines important because they will ultimately improve the quality of the manuscripts published in the Journal.