Abstract

It has only been during the past decade that contamination of the intraluminal fluid pathway has gained recognition as a cause of CR-BSI. The IV connector is the gate keeper of the intraluminal fluid pathway. The care and maintenance of catheters is the complete responsibility of the primary nurse. The primary CR-BSI causative agent is biofilm formation. Biofilm formation depends on the number of cells, the presence of surface conditioning and the flow rate of the solution. Staph epidermis, and Staph aureus have surface cell receptors which assist in fibrin, fibrinogen location enabling the microorganisms to successfully adhere. Therefore, intraluminal contamination prevention strategies must be two-pronged - to prevent active and passive microorganism migration into the intaluminal fluid pathway and to prevent microorganism adhesion by minimizing fibrin build-up on the internal surface. The two care and maintenance procedures nurses use to protect the intraluminal pathway are swabbing the connector septum and flushing the connector after use. Individualizing the care based on the patient has not been studied. Since every patient is unique, different catheters and connectors are used, and even the nurse's experience and knowledge are different, achieving consistent positive outcomes using a one-size-fits-all approach has shown to have inconsistent outcomes. An overview of swabbing and flushing is discussed and then how IV connector design affects these practice and outcomes is reviewed. It is imperative to recognize what procedures are performed for improved patient outcomes, versus what procedures are performed to overcome IV connector design features. If flushing and swabbing procedures are standardized to general time requirements alone and connector design is overlooked, it should be understood that outcomes may vary and this variance may not be related to inconsistent nursing adherence to IV connector related swabbing and flushing procedures.

Abstract

Background: Long term venous catheters have been used to deliver specialized therapies since 1968. The ideal tip position of a central venous catheter provides reliable venous access with optimal therapeutic delivery, while minimizing short-and long-term complications. Ideal position limits have evolved and narrowed over time, making successful placement difficult and unreliable when depending exclusively on the landmark technique.

Objective: To review and analyze contemporary literature and calculate an overall accuracy rate for first attempt placement of a PICC catheter in the ideal tip position.

Methods: Key PICC placement terms were used to search the database PubMED-indexed for MEDLINE in June and October, 2009. The selection of studies required: a patient cohort without tip placement guidance technology; a documented landmark technique to place catheter tips; data documenting initial catheter placement and, that the lower third of the SVC and the cavo-atrial junction (CAJ) were included in the placement criteria. With few exceptions, articles written between 1993 and 2009 met the stated selection criteria. A composite of outcomes associated with tip placement was analyzed, and an overall percent proficiency of accurate catheter tip placement calculated.

Results: Nine studies in eight articles met the selection criteria and were included for analysis. Rates of first placement success per study ranged from 39% to 75%, with the majority (7/9) being single center studies. The combined overall proficiency of these studies calculated as a weighted average was 45.87%.

Abstract

Aim/Purpose: To tabulate the types of lines used for childhood cancer at our institution and risk factors for early removal.

Background/Introduction: Most children with cancer require central venous catheters for chemotherapy, support and monitoring, but infection, dysfunction (i.e. mechanical problems such as fracture and nonthrombotic obstruction) and thrombosis often necessitate unplanned removal. Timing and type of line chosen may determine central line longevity.

Review of Relevant Literature: A literature search revealed that there are minimal and conflicting data in the realm of pediatric central lines and reasons for their removal, especially in the ALL population.

Methods: We reviewed records of all children diagnosed with cancer at our institution from 2002 to 2003 to catalog types of lines and variables that impacted line survival.

Results: 174 children were diagnosed with cancer in 2002–2003; 175 lines in 103 children total were used in the study-117 were removed electively, 58 were removed non-electively. Several variables, including infection, predicted non-elective removal. External tunneled lines were associated with non-elective removal (OR: 11.9, p<0.01) and removal due to infection (OR: 10.41, p<0.01) more often than were tunneled ports. Patients with acute lymphoblastic leukemia (ALL) in which a tunneled port was placed at diagnosis were more likely to require non-elective removal than tunneled ports placed after induction chemotherapy (43% vs. 8%). While this difference did not reach significance due to low numbers of early placements, 43% of placements at diagnosis failed by 125 days, whereas 100% of lines placed late were still in place until 393 days and 72% were still in place up to 803 days.

Conclusions: Early central line removal in pediatric oncology is determined by interdependent factors and prospective studies are needed to guide the timing and type of line for individual patients. However, early line placement for ALL may be associated with poor line survival.