Abstract

Background and Significance: Many hospitalized patients require an intravenous (IV) catheter to maintain vascular access or for administration of fluids and medications. The best approach to attaining peripheral intravenous (PIV) access for long term therapy is unknown, particularly in patients with a history of difficult IV placement.

Purpose: To measure clinical outcomes using a Modified Seldinger Technique (MST) with ultrasound (US) guidance to achieve and maintain PIV for long term IV therapy.

Methods: Subjects were patients with a history of difficult peripheral intravenous catheter placement and need for IV therapy longer than 72 hours. Modified Seldinger Technique was used with US guidance to place all PIVs in the deep veins of the upper extremities.

Results: A convenience sample of 157 subjects was enrolled in the study. Mean dwell time for catheter duration was seven days. First attempt placement success was 95%, 88.5% of patients had completion of IV therapy, and a low overall complication rate (9.57/1000 catheter days).

Conclusion: Using MST for access for long term PIV therapy was associated with low complications and effective in our study population. Using MST requires specialized knowledge and skills, including the use of US and specialized insertion techniques. In patients who require extended PIV therapy with a history of difficult IV placement, this type of insertion technique may have benefit.

Abstract

Purpose: Many healthcare facilities require staff nurses to complete annual competency assessments on central line care. However, the question arises, could simulation provide a better assessment of competency and possibly help nurses retain competence longer?

Review of Relevant Literature: A thorough review of the literature revealed that limited investigation has been done regarding the perception or effectiveness of simulation as a tool for competency evaluation. Multiple authors have identified simulation as an advantageous method for training health care providers in central line care. Several studies have linked simulation based training with decreased central line associated bacteremia rates. There is also evidence in the literature that simulation has great potential as a competency validation technique.

Discussion: A sample of staff nurses participated in one of four central line care scenarios in a simulation environment. The participants were asked to complete a demographics survey as well as a self-assessment on central line competency prior to the simulation experience. Debriefing followed the simulation, offering the participant feedback on performance and verification of correct and incorrect actions. The self-assessment was then repeated to measure participant perception post-simulation.

Implications for Clinical Practice: No significant difference of performance in the simulation was inferred from baccalaureate-prepared nurses versus diploma or associate-prepared nurses. Almost all participants rated their competence in caring for a central line as either “competent” or “highly competent.” However upon demonstration of central line skills in the simulation, all but two participants omitted a critical step. Omitting these steps places the patient at risk for infection or other complications.

Abstract

Over the last two decades, our understanding of the pathogenesis of central line associated blood steam infections has improved significantly. Also, increased attention has been focused on reducing healthcare worker exposure to infectious agents. Best practice protocols have been developed to eliminate unnecessary morbidity, mortality and costs associated with these infections and exposures. Adoption of these best practices has been incomplete and non-compliance is a major factor preventing our infectious complication rates from reaching zero. Getting at the root cause of noncompliance is complex. Online surveys are uniquely positioned to help understand the human factors contributing to non-compliance. This article reviews some of the pros and cons associated with the use of online surveys. Using several relevant recent examples, this article explores how these surveys can be used to identify those factors that create barriers to compliance. By better understanding all the issues involved with non-compliance, we will be able to create strategies and engineer products to improve best practice protocol compliance and reduce the human factor contribution to our patient's infectious complications.