Reflection Clinical Incident Hiv

Topics: Randomized controlled trial, Central venous catheter, Clinical trial Pages: 12 (3895 words) Published: August 16, 2011

Central Venous Catheter Blood stream infections (CVCBSIs) is a major cause of morbidity and mortality in patients with end- stage renal disease treated with chronic haemodialysis (Jaber 2005).The purpose of this review is to determine whether the use of Biopatch on the exit site of central venous catheter (CVC) can help prevent infection. Before any research was undertaken, a focused question was formulated and a search strategy was then developed to compare the available evidence. A PICO (Sackett et al 1997) was undertaken using the terms Central Venous Catheter, Chlorhexidine, Biopatch and Infection. A Facet analysis (Ranganathan 1967, cited by Spiteri 1998) was performed and a literature search was conducted using four electronic databases. This databases searches, contains both nursing and medical research and reviews. The databases used were Medline (1982-2011), CINAHL (1996-2011), Embase (1982-2011) and BNI (1982-2011) Mckibbon and Mark (1998) states that CINAHL and Medline databases are the most appropriate methodological to identify studies that report high quality research which can be used for clinical application. Most of the search result, produced articles that were Control Randomised Trails (RCT). Torgerson and Torgerson (2008), states that RCT is the gold standard for research method and for addressing the what? question in ‘evidence-informed’ policy making and practice. The literature search in CINAHL generated 145 article and limited to 2 articles which did not answer the question directly, however before the limits were applied two articles were found to relate to the question but one article answer the question and was a crossover intervention trail. The searches in BNI yielded 14 results and were limited to 1 article which did not relate to the question. Further searches in Medline and Embase, produced 19 and 21 results consecutively and none of this search answered the question.

BACKGROUND The purpose of this research is to analysed published researched article on the effectiveness of Biopatch for the prevention of central venous catheter. Working in an area where CVC is being used, prompted the need to look for the best evidence available for the prevention of CVC line infection. There has been a steady rise of CVC infection in the past months and this has raised concern for both patients and staffs, as some of those patients affected had to have their lines removed, and even ITU admissions. In view of this problem, the need to look for preventive method prompted the question of the efficacy of Biopatch for the prevention of CVC. The life line of haemodialysis (HDX) patients, remain their vascular access. People with end stage renal disease (ESRD), requires a reliable access for their circulatory system to receive life sustaining HDX. The ideal access would be long lasting, free of complication and permits adequate flow rates to deliver effective treatments (Schwab 1997). 25% of hospital admissions for HDX patients are for access problems and access failure is a major cause of morbidity (Levy et al 2005).

Central Venous Catheter (CVC) is an important aspect in HDX vascular access with 46% to 70% of patients commencing HDX through CVC; however it is a known risk factor for staphylococcus aureus infection and bacteraemia, ( sattler et al). Catheter related bacteraemia (CRB) include exit site infection, tunnel line infection and bacteraemia. CRB are the most common and important infection associated with CVC use and may be cause by a wide variety of gram positive and gram negative organism (Jaber 2005). There has been several preventive measures introduced to try and reduce the rate of CRB at the catheter insertion site or lines, this include the use of prophylactic topical antimicrobial ointments at the catheter exit site, the use of prophylactic catheter locking solution for prevention of CRB, strategies for...

Citations: Carmis BC, MD, MSCR,. Richmond M, RN, MHS, CIC,. Dyer KL, MPH. Zimmerman HN, MPH,. Coyne DW, MD. Rothstein M, MD. Fraser VJ, MD. ; Infection Control and Hospital Epidemiology, Vol. 31, No 11 (November 2010), pp. 1118-1123.
Levy J, Morgan J, Brown E. 2005) A practical guide todialysis and how to manage end stage renal failure. Oxford handbook of dialysis (2nd edn) New York: Oxford University Press.
Levy MD. ;A new register for clinical trials information. Can Med Assoc J. 2000; 162-970-971.
Gray J. (1997) Doing the right things in Evidence Base health-care. Churchhill Livingstone, New York ch2, P17.
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