Abstract

Background: The 2011 Centers for Disease Control and Prevention guidelines provide evidence-based recommendations for preventing central line-associated bloodstream infection (CLABSI). Educating and training health care personnel—incorporating bundled strategies for maximizing patient safety throughout the course of intravenous therapy—is the major area of interest. Despite a low number of reported CLABSIs—below national benchmarks—our large regional medical center has the goal of 0 CLABSI.

Purpose: The purpose of our project was to develop an educational intervention guided by the Healthcare and Technology Synergy Framework to improve registered nurses' (RNs) knowledge of evidence-based practice guidelines to decrease the incidence of CLABSI.

Methodology: A pretest/posttest format was used to evaluate an educational session on the nursing management of central lines (CLs). Participants in the study were RNs employed at a large regional medical center who worked 50% or more per week providing direct patient care in the hospital's intensive care units. An educational session on nursing management of CLs was presented. A 16-question survey (7 demographic and 9 knowledge questions) to assess RNs' knowledge of care and maintenance of CLs was used as the pretest and posttest.

Conclusions: RNs' knowledge of care and maintenance of CLs improved significantly after the intervention (pretest mean score = 4.6 and posttest mean score = 8.4; P = .0001).

Implications for Practice: An educational intervention can increase RNs' knowledge of care of CLs. As a result of this project, an annual evidence-based practice educational intervention was adopted for RNs at our large regional medical center.

Abstract

Background: Vascular access is continually evolving in areas of clinical practice and new technology. Our vascular access team (VAT), like many others, has moved away from chest radiograph after peripherally inserted central catheter (PICC) insertion to a catheter tip positioning system or tip locating device (TLD). Our VAT collected data over a 3-year period to assess any changes that resulted from the TLD implementation. The intent was to drill down into the PICC data over the 3 years and quantify any changes gained or lost from the previous practice of post-PICC insertion chest radiograph.

Methods: A share point database system that was already in place was updated to also incorporate key elements of the TLD. Initial time studies were also collected to validate average cycle time. The VAT was educated and validated on the TLD technology before implementation. Key stakeholders (ie, members of the radiology department, administration, hospitalist physicians, and the medical director) were communicated with and signed off on the project.

Results: Retrospective analysis from 2012–2014 revealed that 1079 PICCs had been inserted. Of those, 781 PICCs were placed successfully with the TLD with an accompanying reduction of 781 chest radiographs. Precycle time averaged 114 minutes compared with post-TLD, which averaged 37 minutes. No changes in deep vein thrombosis rate were identified.

Conclusions: Implementing the dual vector biosensor TLD improved our insertion cycle time by a mean of 77 minutes. The new cycle time provided increased procedure capacity for the VAT. Chest radiograph reduction of 72% was also realized with the TLD over the 3-year period.

Abstract

Central venous catheters and peripherally inserted central catheters are fundamental in the delivery of pharmacologic and nutrition therapies to patient populations, including individuals with cancer. Malposition and migration of these catheters outside of the superior or inferior vena cava can contribute to delays in therapy as individuals await repositioning, and in some cases replacement of the catheter. Traditional repositioning using overwire or interventional radiology techniques can be costly and may delay care. The placement and management of these catheters has increasingly become the domain of specially trained vascular access nurses. A team of specially trained vascular access nurses, in collaboration with interventional radiologists at a National Cancer Institute-designated comprehensive cancer center developed a procedure for catheter repositioning using a simultaneous rapid saline flush technique (SRSFT). We present this procedure, along with implications for cost and clinical outcomes. Clinical outcomes suggest that 68% of catheters have been successfully repositioned using this technique with no adverse events associated with the procedure noted to date. In addition, the use of the SRSFT represents a cost savings of up to 90% compared with traditional repositioning procedures. The SRSFT is identified as safe, timely, cost-conscious, and therapeutically effective, although further research is needed to formally evaluate the efficacy of repositioning using this technique compared with overwire and interventional-radiology-guided repositioning, including complications and quality outcomes.

Abstract

Today's patients are more complex in terms of comorbidities and other conditions requiring multiple, long-lasting therapies such as chemotherapy, total parenteral nutrition, blood transfusion or blood component infusions, and frequent blood sampling. The use of central venous catheters represents an important aspect of care for many patients. It is essential to inform health care workers of the risks associated with central venous catheters such as systemic and infectious complications, mechanical complications, and/or thrombotic complications. To maintain monitoring of our peripherally inserted central catheter team's activity, we developed and adopted a database in which all the data regarding each catheter are recorded. By doing that, we have improved catheter management, clinical efficiency, as well as achieved a cost reduction. We implanted 1416 vascular access devices in 1341 patients of both sexes (632 male and 709 female) for a total of 135,778 vascular access device-implant days between March 2010 and December 2013 for several indications. We have followed-up total complications and we correlated them with the need for catheter removal. The results were that open-tipped catheters resulted in both more complications and a greater need for removal.

Abstract

Introduction: Establishing an effective midline program involves more than simply learning an insertion technique for a new product. Midline catheters provide a reliable vascular access option for those patients with difficult venous access who would otherwise require multiple venipunctures or the use of higher-risk central lines to maintain access. An effective midline program establishes a protocol for device selection and includes standing orders to facilitate speed to placement.

Methods: Our retrospective descriptive review evaluated the successful integration of midline programs into existing vascular access bedside insertion programs in 2 acute care hospitals. The investigator reviewed a convenience sample of hospital patients. Participants in the study included vascular access team managers and team members from the sample sites.

Results: The results of this 2-hospital study demonstrate successful integration of a midline program into a bedside insertion program with 0 midline-related infections since initiation. Documentation of overall central line-associated bloodstream infection rates for hospital 1 changed from 1.7/1000 catheter-days to 0.2/1000 catheter-days, reflecting a 78% reduction in infections and a projected cost avoidance of $531,570 annually. Both hospitals demonstrated reduced rates of infection following implementation of a midline program.

Conclusions: Midlines have a history of lower risk for both infection and thrombosis compared with central venous devices. Although more research is needed on the more recently developed midline catheters, available evidence suggests that midlines provide a safe and reliable form of vascular access, reducing costs and the risk of infection associated with central venous catheters, especially those placed solely for patients with difficult venous access.