Abstract

Reducing central line-associated bloodstream infections (CLABSI) to zero is especially challenging in long-term acute care (LTAC) hospitals because patients usually have the line in place at admission. The central venous line may have been in place from days to weeks before admission. The LTAC thus has no control over the site selection, catheter selection, insertion protocol, and care and maintenance the catheter received before admission. Using comprehensive practice-based evidence for clinical practice improvement, our LTAC used different needleless connectors during a 3-year period to achieve zero CLABSIs. The sample data offers a rare opportunity to compare different needleless connectors and in a wide sample of complex patient diagnoses. Needleless connector design in combination with nursing care and management can achieve zero CLABSI,s even in the challenging LTAC environment.

Abstract

Purpose: To determine maximum flow rates through peripherally inserted central catheters (PICCs) using a standard hospital infusion pump.

Background: Two questions asked with the use of PICCs and flow rates are (1) can a PICC be used to give nonemergent fluid boluses, and (2) can standard hospital infusion pumps develop enough pressure to rupture a catheter?

Methods: New PICCs of different brands and gauges were gathered. Six standard hospital infusion pumps and tubing of the same brand and model were used. The pressure sensor was set at 600 mm Hg. The pumps were connected through the access ports of each intravenous tube in a series fashion. The PICC end was submerged under 5 cm of water. All equipment and fluids were at 70° F. PICCs were trimmed to 45 cm. Fluids were run starting with the first pump at 999 mL/hour and then additional pumps were added until the pump's 600 mm Hg limit stopped the infusion or catheter rupture. Tests with the same PICC were repeated and recorded.

Results: Flow rates varied with the type, size, gauge, and brand of PICC catheter. Flows were achieved from 2,100 mL/hour to >6,000 mL/hour. None of the PICCs ruptured.

Conclusions: Maximum flow rates through PICCs were limited by the maximum pressure allowed by the standard hospital infusion pump. A standard hospital infusion pump cannot generate enough pressure to rupture a new-out-of-the-package catheter.

Implication for Practice: Nonemergent fluid boluses can be given through PICCs and standard infusion pumps will not rupture a PICC.

Abstract

Background/Purpose: Although annual rates of catheter-related bloodstream infections (CR-BSI) in a comprehensive cancer center were below the national average, further reductions were sought. Research indicates that contamination of a catheter's intraluminal pathway is a major cause of CR-BSI. Connectors are the gateway to the intraluminal pathway and studies link positive displacement, negative displacement, and split septum connectors to CR-BSI.

Project Description: The infusion therapy team piloted a zero fluid displacement (ZFD) connector based on the design of the ZFD, which appeared uniquely suited to CR-BSI prevention. A product trial was performed in intensive care units to compare the CR-BSI rates associated with the current split septum connector to the ZFD connector. The design was quantitative and quasiexperimental.

Results: During the trial, CR-BSI rates decreased from 4.2 (2,331 catheter days) with the split septum connector, to 0.4 (2,477 catheter days) with the ZFD connector. Six months after institutional implementation of the ZFD connector there were zero CR-BSI in the intensive care units across 4,424 catheter days, despite the complexity and acuity of a largely immunocompromised oncology patient population. The previous 6 months with the split septum the CR-BSI rate was 2.24 across 4,920 catheter days.

Conclusions: Our institution's success suggests that protecting the intraluminal pathway with a properly designed connector may be more crucial to the prevention bundle than is widely understood or practiced. Other hospitals may achieve comparable results by implementing a similar device.