Abstract

Purpose: To apply evidence-based practice when flushing central venous access devices (CVADs).

Background/Introduction: There is a lack of standardized flushing protocols for CVADs among health care institutions. Identifying best practice and assuring skillful implementation of evidence-based practice protocols is essential to maintaining catheter patency.

Review of Relevant Literature: Evidence supports the use of nonheparinized saline flush, positive-pressure valve caps, and proper flushing technique to maintain CVAD patency (Bowers, Speroni, Jones, & Atherton, 2008; Hadaway, 2006; & Jasinsky & Wurster, 2009). Reinforcement of proper flushing techniques has demonstrated improved patency rates of CVADs (Feehery, Allen, & Bey, 2003).

Methods: Corporate and individual in-services were conducted to improve nurses' skill and knowledge of evidence-based practice related to flushing CVADs. Outcomes were measured by comparing baseline data with data collected in the same manner post-education. Data was obtained by means of a questionnaire and direct observation of nurses' flushing technique.

Outcomes: The evidence-based practice project demonstrated a significant improvement (p <0.05) in both the nurses' knowledge and skill in flushing CVADs.

Conclusion: Continuing education and reinforcement of proper flushing technique is an appropriate strategy to increase knowledge of and compliance with evidence-based practice protocols.

Implications for practice: Providing continuing education and periodic reinforcement of nursing skills can lead to improved patient outcomes. These strategies, along with changing flushing protocols to non-heparinized saline, can also reduce health care costs. Future studies are needed to determine the appropriate frequency of in-service education.

Abstract

Purpose: To compare patient outcomes and evaluate safety features and costs associated with a new catheter system and securement dressing.

Background: The need to improve dwell times for short peripheral catheters and reduce complication rates, along with improvements in clinical practice in radiology and enhanced staff safety were driving factors leading to a change in peripheral catheters and securement systems.

Review of Relevant Literature: Several reports of catheter stabilization devices have shown improved clinical outcomes with their use. Currently available studies on this new catheter system include one small evaluation and a randomized trial comparing a traditional round hub catheter coupled with a supplemental securement device and the new catheter system with an integrated stabilization platform combined with a securement dressing. Passive safety mechanisms on peripheral catheters may produce fewer needlestick injuries than mechanisms requiring the user to activate the device.

Methods: After a learning period, the following seven months were designated the intervention period. Outcome data from the same seven-month period of the preceding year were used for comparison. The data were divided into scheduled and unscheduled restarts. Data from two hospitals are reported separately and in combination. Data from the two periods were analyzed for equivalence or noninferiority.

Results: Clinical outcomes for both periods are virtually equivalent, demonstrating that one system is not inferior to the other regarding catheter complications. However the catheter system with the integrated stabilization platform was less costly and safer due to a passive safety mechanism. Problems with high pressure injection in the radiology department were also solved with the new catheter system.

Conclusions: While any product change can be a challenging experience, we accomplished these changes in an orderly manner without negative impact on patient outcomes and reducing costs. Improvements in radiology were also attributed to these changes, along with enhanced staff safety.

Implications for Practice: The catheter designed with an integrated stabilization platform, a pre-attached extension set, and a passive safety mechanism produced benefits for radiology staff without negatively affecting patient outcomes in other clinical areas. These product changes were implemented in an organized manner and involved all stakeholders in the process.

Abstract

Introduction: The peripherally inserted central catheter (PICC) is being used more frequently in pediatric populations in both hospital and home care settings in order to provide secure vascular access. In 2007, the Power PICC was introduced to pediatric populations. In contrast to traditional PICCs, the power injectable PICC withstands higher flow rates and can deliver contrast injections. Although effectiveness studies of power injectable PICCs have been performed in adults, only limited published research is available regarding pediatric populations.

Purpose: This study aimed to develop criteria for identifying the ideal pediatric candidate for the power injectable PICC. A secondary aim was to identify contraindications and barriers to power injectable catheter use in pediatric populations.

Methods: Retrospective and prospective chart reviews were used to analyze complication rates for 97 power injectable PICCs placed in patients aged 4 months to 17 years.

Results: A low incidence of catheter complications was identified during and post- insertion. Our documented infection rate of 1.30 per 1000 catheter days was similar to the infection rate of 1.27 per 1000 catheter days found in the Abedin & Kapoor (2008) study.

Discussion: The introduction into a pediatric hospital of power injectable PICCs for power injection scans for contrast injection was safe and effective in patients with many disease processes.

Conclusion: In properly selected pediatric patients, the power injectable PICC is not associated with an increased risk to thrombosis or infection and can improve patient outcome.

Abstract

Peripheral intravenous therapy (PIV) is probably the most common acute care invasive procedure, estimated at 90 percent for all inpatients. Current standards of practice recommend the use of a manufactured catheter stabilization device to secure PIVs. At FirstHealth Moore Regional Hospital (MRH), the PIV policy requires the use of a stabilization device to achieve a 96 hour dwell time for the PIV. The hospital does not utilize an intravenous therapy team; all nurses can insert PIVs and apply the dressing. In 2009, as a cost reduction measure, MRH changed securement devices from a two piece dressing and securement device to the Sorbaview SHIELD (SHIELD). A clinical evaluation of the SHIELD was conducted in January 2010, with 109 medical-surgical patients with PIVs, to demonstrate the expected cost savings associated with the SHIELD by maintaining the PIV for 96 hours and meeting patient and staff expectations. In 91.5% of the patients, the PIV stayed in for their length of stay (if less than 96 hours) or for 96 hours, only eight patients had unscheduled restarts. Eighty-six percent of nurses surveyed rated the device as excellent to good. Ninety-one percent of patients reported no discomfort of their PIV site. Changing to this device in 2009 has resulted in an average annual cost savings of $120,000 over the two piece device and has improved compliance by nursing.