4010 Scholarly Paper
LeTanya V. Cintron
Huron School of Nursing
There are a variety of intravascular devices used for vascular access and they are becoming more common in today’s healthcare system, mainly due to their convenience. Whether it’s a short-term triple lumen central venous catheter or an arterial catheter for hemodynamic monitoring or long term venous access for inpatient or outpatient use for fluids, TPN, chemo, home antibiotics or hemodyalisis; central venous catheters are here to stay. Their convenience and ease of access makes them almost a necessity in patient care, but at what cost? Regardless of their purpose and ease of use, it is up to us as nurses and healthcare workers to recognize when patients are at risks for infection due to venous catheter use. In this paper, I will identify guidelines to prevent blood infections from central lines.
The Joint Commission has identified the prevention of central line-associated bloodstream infections as one of its safety goals. They hold importance to educating all staff and workers that are involved in managing and caring for central lines. They emphasize in infection prevention. Patient and family education is also key; especially for individuals with long term lines at home. The Joint Commission also promotes the use of a catheter checklist and a standardized protocol for central venous catheter insertion with emphasis on hand hygiene prior to catheter insertion or manipulation, use of a central line bundle, and the “use [of] a standardized protocol for sterile barrier precautions during central venous catheter insertion” (TJC, 2009). A peer reviewed article written by Maki, Kluger and Crnich, shows that higher blood stream infection rates for intra vascular devices used 100 days or less were found in surgically implanted cuffed and tunneled all-purpose CVCs, and cuffed and tunneled hemodialysis catheters (2010). Lower blood stream infection rates were found in temporary non-cuffed hemodialysis catheters, non-cuffed but tunneled CVCs, non-cuffed and non-tunneled CVCs, peripheral subcutaneous central venous ports, central venous ports, outpatient PICCs, intra-aortic balloon pumps, chlorohexidine-silver-sulfadiazine-impregnated CVCs, inpatient PICCs, arterial catheters, midline catheters, and peripheral IV catheters to name a few (Maki, Kluger & Crnich, 2010).
These results differed when studying IVD’s that were used up to 1000 days. These results shower higher blood stream infections in peripheral IV catheters placed by surgical cut down, peripheral steel needles, intra-aortic balloon pumps, short-term non-cuffed hemodialysis catheters, and silver-impregnated Lower rates were now shown with non-cuffed, non-tunneled multi-lumen CVCs, inpatient PICC, arterial catheters, chlorhexidine-silver-sulfadiazine-impregnated CVCs, cuffed and tunneled all-purpose Hickman-like CVCs, long-term cuffed and tunneled hemodialysis CVCs, outpatient PICC, peripheral IV catheters, peripheral central venous subcutaneous ports, and central venous ports (Maki, Kluger & Crnich, 2010).
The article states that the rates of nosocomial blood stream infections are directly dependent on their clinical surveillance. “We believe that clinical surveillance data in general overestimate the true risk of catheter-related BSI with CVCs while underestimating the actual risk of IVD-related BSI with other types of IVDs because each device in use in the hospital during the surveillance period is not routinely scrutinized” (Maki, Kluger & Crnich, 2010). This theory is based on their finding that hospitals report all health care associated blood stream infections as being caused by central venous catheters if they cannot find a link to a local infection which therefore leads to an overestimation of CVC related infections. However, does this mean we disregard the possibility of a CVC...