Abstract

Intestinal failure and the subsequent reliance on parentral nutrition through central venous catheters increases the likelihood of a central line-associated bloodstream infection. Antimicrobial lock solutions such as ethanol lock therapy are providing promising evidence of the ability to reduce central line-associated bloodstream infection. This case study reviews the use of ethanol lock therapy for a pediatric patient who experienced 0 central line-associated bloodstream infections during the 2-year time period covered by this report.

Abstract

Background: Our aim was to adapt recommendations from high-quality, evidence-based clinical practice guidelines (CPGs) for central vascular access device (CVAD) insertion, management, and removal in King Saud University Medical City. Currently, the hospital has a policy and procedure for CVAD insertion; however, the methodology of creating the policy document was not evidence-based, and the clinical content was not up to date. A new CPG will guide the revision of CVAD policies and procedures and eliminate variation in clinician practices.

Methods: The King Saud University Medical City CPG Committee introduced the modified ADAPTE process methodology for adaptation and implementation of CPGs originally developed by the ADAPTE Collaboration.

Results: The final decision of the panel after full assessment of 2 selected source CPGs was to adopt all Centers for Disease Control and Prevention CPG recommendations and some essential sections from the Infusion Nurses Society CPG recommendations. In addition, the team developed new implementation tools.

Conclusions: The ADAPTE process is an excellent scientific and rigorous process for CPG adaptation and clinical performance improvement. It can be further adapted according to the local context and resources to promote a sense of ownership of the adapted CPG. Furthermore, new CPGs will have a positive effect on hospital-wide accreditation processes and local benchmarking of health care quality outcomes.

Abstract

Background: Vascular access is a critical component of care for patients in neonatal intensive care units (NICUs). Our NICU had only a small number of nurses cross-trained to perform peripherally inserted central catheter (PICC) insertions and was not able to provide coverage 24 hours a day, 7 days a week. We combined the vascular access team (VAT) and NICU PICC team to improve the timeliness of NICU PICC insertions, standardize care, and use ultrasound for all PICC placements.

Methods: A paper guide tool was developed to prioritize PICC placements as emergent, same-day, or nonemergent. NICU nurses were trained to insert PICCs using ultrasound. Catheter insertion and care processes were standardized for the new centralized PICC team. NICU and VAT staff worked together to improve daily communication, hand-offs, and referrals. Criteria were developed to determine the appropriate hospital location for PICC insertions. Charge nurses began capturing information about patients with PICCs on daily planning sheets.

Results: Following implementation of the new combined VAT, the average wait time for emergent and same-day insertions decreased 10%. No adverse events were reported due to a delay in PICC placement or the PICC referral process.

Conclusions: Combining the NICU PICC insertion nurses and the VAT into a new centralized PICC team provided an opportunity for growth in both areas. NICU PICCs are now placed efficiently based on patient acuity and referral prioritization throughout the hospital. NICU and VAT physicians and nurses have developed a strong partnership for the provision of PICC services for NICU patients.

Abstract

Background: The peripherally inserted central catheter implantation and maintenance process was optimized at Shanghai Fu Dan University Cancer Center using lean-based methodology. Problems addressed were coping with capacity limitations and streamlining the process of patient care to reduce potential complications associated with delays in catheter administration. These clinical processes were evaluated with regard to pretreatment areas—such as booking, waiting, and patient education—and solutions were recommended to the problems that were identified.

Methods: Lean methodology was used under actual clinical settings to improve the clinical process, using observations, patient surveys, interviews, data analysis, and a kaizen workshop. Three tools were applied from lean methodology: value stream mapping, bottleneck calculation, and fishbone root cause analysis. The philosophy of kaizen was used to enhance teamwork, boost morale, and encourage all members of the frontline nursing team and administration leaders to contribute ideas and suggestions for improvement.

Results: A value stream map and a redesigned future value stream map were plotted at the workshop to identify problems related to inefficiency and waste and to aid in proposing solutions. Implementation of these solutions resulted in smooth and steady patient distributions on days with the largest patient volume during a typical week and an increase of 30% in the number of patients that could be seen in a week.

Conclusions: The economic methodology of lean manufacturing, especially value stream mapping, can be a powerful tool for visualizing and better understanding processes to reduce waste and reengineer a standardized workstream in settings where peripheral intravenous central catheters are placed.

Abstract

Peripheral intravenous (PIV) catheters are the most commonly used catheters in hospitals, with up to 70% of patients requiring a peripheral venous line during their hospital stay. This represents 200 million PIV catheters used per year in acute-care hospitals in the United States alone. These medical devices are also used in other health care settings, such as long-term care facilities and nursing homes, and common indications include the administration of medications, nutrients, and fluids. These catheters require proper maintenance and care to avoid complications such as phlebitis, infiltration, occlusion, local infection, and bloodstream infection. Recently it has been suggested that PIV catheter use may lead to a higher rate of complications than previously thought. This is important because some studies have claimed that the rate of bloodstream infections due to PIV catheters is actually comparable to the rates observed with central venous catheters, rather than much lower as previously thought. Moreover, catheter-related infections are now seen as largely preventable. Our goal was to review the current literature and provide an overview of the various approaches used to manage PIV catheter sites as well as review current recommendations.