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Best Practices in the Management of Central Vascular Access Devices: An Observational Study in Areas With a High Prevalence of Trained Nurses. JOURNAL OF INFUSION NURSING 2018; 41:319-325. [PMID: 30188454 DOI: 10.1097/nan.0000000000000297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since 2009, the Department of Continuing Education at the Orthopedic and Trauma Center Hospital in Turin, Italy, has provided a training course for nurses in the management of central vascular access devices (CVADs). The course focuses on dressing and flushing procedures, as well as compliance with other CVAD guidelines. An observational study was conducted among nurses to determine the level of best practices in areas with a high prevalence of nurses trained in the management of CVADs. A correlation was observed between best practices and having attended the course, but other variables also influenced best practices.
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Complications of intravascular catheters in ICU: definitions, incidence and severity. A randomized controlled trial comparing usual transparent dressings versus new-generation dressings (the ADVANCED study). Intensive Care Med 2016; 42:1753-1765. [PMID: 27734108 DOI: 10.1007/s00134-016-4582-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe all post-insertion complications involving most used intravascular access, and to determine whether the use of a new-generation transparent dressing (3M™ IV Advanced) might reduce their number and impact on ICU patient outcomes. METHODS Patients older than 18, with an expected length of stay ≥48 h and requiring at least one central venous catheter (CVC), arterial catheter (AC), haemodialysis catheter (HDC), pulmonary arterial catheters (PAC) or peripheral venous catheter (PVC) were randomized into two groups: a new-generation transparent dressing, or the hospital's classical transparent dressing, and were followed daily for any infectious and non-infectious complications. Complications were graduated for severity by an independent international multicentre multidisciplinary panel of practitioners using a Delphi process. RESULTS We included 628 patients, 2214 catheters (873 PVCs, 630 CVCs, 512 ACs and 199 HDCs and PACs) and 4836 dressings. Overall incidence rate was of 60.9/1000 catheter-days. The most common complication was dysfunction (34.6/1000 catheter-days), mainly for PVCs (16/1000 catheter-days) and ACs (12.9/1000 catheter-days). Infectious complications incidence rate in CVCs and ACs was of 14.5/1000, mostly due to colonization (14.2/1000 catheter-days). Thrombosis incidence was of 3.8/1000 catheter-days with severe and very severe complications in 16 cases (1.8/1000 catheter-days) and one thrombosis-related death. 3M™ IV Advanced dressing did not decrease the rate of catheters with at least a minor complication [57.37/1000 vs. 57.52/1000 catheter-days, HR 1.03, CI (0.84-1.27), p = 0.81]. Incidence rates for each single complication remained equivalent: infectious [HR 0.93 (0.62-1.40), p = 0.72], deep thrombosis [HR 0.90 (0.39-2.06), p = 0.80], extravasation and phlebitis [HR 1.40 (0.69-2.82), p = 0.35], accidental removal [1.07 (0.56-2.04), p = 0.84] and dysfunction [HR 1.04 (0.80-1.35), p = 0.79]. CONCLUSION The ADVANCED study showed the overall risk of complications to intravascular catheters in ICU patients being dysfunction, infection and thrombosis. The 3M™ IV Advanced dressing did not decrease complication rates as compared to standard dressings.
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Chen S, Yao J, Chen J, Liu L, Miu A, Jiang Y, Zhu J, Tang S, Chen Y. Knowledge of “Guidelines for the prevention of intravascular catheter-related infections (2011)”: A survey of intensive care unit nursing staffs in China. Int J Nurs Sci 2015. [DOI: 10.1016/j.ijnss.2015.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Montero JG, Lerma FÁ, Galleymore PR, Martínez MP, Rocha LÁ, Gaite FB, Rodríguez JÁ, González MC, Moreno IF, Baño JR, Campos J, Andrés JMA, Varela YA, Gay CR, García MS. Combatting resistance in intensive care: the multimodal approach of the Spanish ICU "Zero Resistance" program. Crit Care 2015; 19:114. [PMID: 25880421 PMCID: PMC4361202 DOI: 10.1186/s13054-015-0800-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - José Campos
- Centro Nacional de Microbiología, Majadahonda, Madrid, Spain.
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Alkubati SA, Ahmed NT, Mohamed ONE, Fayed AM, Asfour HI. Health care workers' knowledge and practices regarding the prevention of central venous catheter-related infection. Am J Infect Control 2015; 43:26-30. [PMID: 25448304 DOI: 10.1016/j.ajic.2014.09.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Central venous catheter-related infection (CVC-RI) is considered a common cause of increased morbidity, mortality, and medical care costs in intensive care units (ICUs). The objective in this descriptive study was to assess the knowledge of health care workers in ICUs about guidelines for the prevention of CVC-RI and their adherence to these guidelines in practices. METHODS Health care workers were assessed for their actual practices during central venous catheter (CVC) insertion and care. Then a questionnaire was distributed to the health care workers to assess their knowledge regarding the prevention of CVC-RI. RESULTS All the health care workers (N = 100; 40 physicians, 60 nurses) in the ICUs (levels I and III and triage) of Alexandria Main University Hospital participated in the present study. The response rate was 100%. The total percentage of correct answers of the health care workers about the guidelines for the prevention of CVC-RI was low. There was no significant difference between physicians' and nurses' knowledge regarding the total score on the questionnaire (P = .134). However, physicians had a significantly higher knowledge about the pathophysiology of CVC-RI and skin antisepsis items than nurses. There were no significant differences between the knowledge of physicians and nurses in other items except for CVC care, where nurses showed significantly higher knowledge than physicians (P = .001). CONCLUSION The results of the present study revealed health care worker's low knowledge regarding the prevention of CVC-RI and low compliance with the standard guidelines of CVC care. Therefore, health care workers should be periodically evaluated for their knowledge and practices regarding guidelines for the prevention of CVC-RI.
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Affiliation(s)
- Sameer A Alkubati
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen.
| | - Nadia T Ahmed
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Osama N E Mohamed
- Department of Microbiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Akram M Fayed
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hayam I Asfour
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Ullman AJ, Long DA, Rickard CM. Prevention of central venous catheter infections: a survey of paediatric ICU nurses' knowledge and practice. NURSE EDUCATION TODAY 2014; 34:202-207. [PMID: 24070818 DOI: 10.1016/j.nedt.2013.09.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 08/17/2013] [Accepted: 09/01/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Central venous catheters are important in the management of paediatric intensive care unit patients, but can have serious complications which worsen the patients' health, prolong hospital stays and increase the cost of care. Evidence-based recommendations for preventing catheter-related bloodstream infections are available, but it is unknown how widely these are known or practiced in the paediatric intensive care environment. OBJECTIVES To assess nursing knowledge of evidence based guidelines to prevent catheter-related bloodstream infections; the extent to which Australia and New Zealand paediatric intensive cares have adopted prevention practices; and to identify the factors that encouraged their adoption and improve nursing knowledge. DESIGN Cross-sectional surveys using convenience sampling. SETTINGS Tertiary level paediatric intensive care units in Australia and New Zealand. PARTICIPANTS Paediatric intensive care nursing staff and nurse managers. METHODS Between 2010 and 2011, the 'Paediatric Intensive Care Nurses' Knowledge of Evidence-Based Catheter-Related Bloodstream Infection Prevention Questionnaire' was distributed to paediatric intensive care nursing staff and the 'Catheter-Related Bloodstream Infection Prevention Practices Survey' was distributed to nurse managers to measure knowledge, practices and culture. RESULTS The questionnaires were completed by 253 paediatric intensive care nurses (response rate: 34%). The mean total knowledge score was 5.5 (SD=1.4) out of a possible ten, with significant variation of total scores between paediatric intensive care sites (p=0.01). Other demographic characteristics were not significantly associated with variation in total knowledge scores. All nursing managers from Australian and New Zealand paediatric intensive care units participated in the survey (n=8; response rate: 100%). Wide practice variation was reported, with inconsistent adherence to recommendations. Safety culture was not significantly associated with mean knowledge scores per site. CONCLUSIONS This study has identified that there is variation in the infection prevention approach and nurses' knowledge about catheter-related bloodstream infection prevention. The presence of an improved safety culture, years of paediatric intensive care experience and higher qualifications did not influence the nurses' uptake of recommendations, therefore further factors need to be explored in order to improve understanding and implementation of best practice.
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Affiliation(s)
- Amanda J Ullman
- NH&MRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Centre for Health Practice Innovation Griffith Health Institute, Griffith University, Nathan, QLD, Australia; Paediatric Intensive Care Unit, Royal Children's Hospital, Herston, QLD, Australia.
| | - Debbie A Long
- NH&MRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Centre for Health Practice Innovation Griffith Health Institute, Griffith University, Nathan, QLD, Australia; Paediatric Intensive Care Unit, Royal Children's Hospital, Herston, QLD, Australia
| | - Claire M Rickard
- NH&MRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Centre for Health Practice Innovation Griffith Health Institute, Griffith University, Nathan, QLD, Australia; Research and Development Unit, Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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Vandijck DM, Labeau SO, Vogelaers DP, Blot SI. Prevention of nosocomial infections in intensive care patients. Nurs Crit Care 2010; 15:251-6. [PMID: 20712670 DOI: 10.1111/j.1478-5153.2010.00409.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Changes in patient profile, and in the health care environment, altering socioeconomic conditions and advances in science and information technology challenge the nursing profession, in particular intensive care nursing. All these changes will undoubtedly affect the way we will practice in the (near) future. A comprehensive understanding of these factors is therefore essential if nursing is to meet the challenges presented by tomorrow's critical care environment. Precisely because of the often expensive high-tech evolutions that have occurred at a rapid pace and are to be further expected, a continued focus on the basics of nursing, the core role of care, as well as maintaining confidence in the capacity to deliver safe, high-quality, and evidence-based patient care will increasingly be a challenge to critical care nurses. In particular, basic nursing skills and knowledge remain a key prerequisite in the prevention of nosocomial infections, which is a continuing major complication and threat to intensive care unit patients. However, critical care nurses' knowledge about the evidence-based consensus recommendations for infection prevention and control has been found to be rather poor. It has nevertheless been demonstrated that a meticulous implementation of such preventive bundles may result in significantly better patient and process outcomes. Moreover, many preventive strategies are considered to be easy to implement and inexpensive. As such, a first and critical step should be to increase critical care nurses' adherence to the recommendations of the Centers for Disease Control and Prevention. AIM In this article, an up-to-date assessment of evidence-based recommendations for the prevention of nosocomial infections, with special focus on catheter-related bloodstream infections and strategies relevant for nurses working in critical care environments, will be provided. Additionally, we will detail on a number of approaches advocated to translate the internationally accepted consensus recommendations to the needs and expectations of critical care nurses, and to consequently enhance the likelihood of successful implementation and adherence. These steps will help critical care nurses in their striving towards excellence in their profession. SUMMARY Intensive care nurses can make a significant contribution in preventing nosocomial infections by assuming full responsibility for quality improvement measures such as evidence-based infection prevention and control protocols. However, as general knowledge of the preventive measures has been shown to be rather poor, nurses' education should include supplementary support from evidence-based recommendations.
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Affiliation(s)
- Dominique M Vandijck
- Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgium.
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Moreno-Millán E, Villegas-Del Ojo J, Prieto-Valderrey F, Nieto-Galeano J. [Adverse effects, intercommunication, management of knowledge and care strategies in intensive nursing]. Med Intensiva 2010; 35:3-5. [PMID: 21130536 DOI: 10.1016/j.medin.2010.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 09/19/2010] [Indexed: 11/25/2022]
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Ferrete-Morales C, Vázquez-Pérez MA, Sánchez-Berna M, Gilabert-Cerro I, Corzo-Delgado JE, Pineda-Vergara JA, Vergara-López S, Gómez-Mateos J. [Incidence of phlebitis due to peripherally inserted venous catheters: impact of a catheter management protocol]. ENFERMERIA CLINICA 2010; 20:3-9. [PMID: 20106690 DOI: 10.1016/j.enfcli.2009.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 06/30/2009] [Accepted: 10/21/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the impact on the incidence of PPIVC by implementing a catheter management protocol and to determine risk factors for PPIVC development in hospitalized patients. METHOD A total of 3978 episodes of venous catheterization were prospectively included from September 2002 to December 2007. A catheter management protocol was implemented during this period of time. The incidence and variables associated to the occurrence of PPIVC were determined. RESULTS The incidence of PPIVC from 2002 to 2007 was 4.8%, 4.3%, 3.6%, 2.5%, 1.3% and 1.8% (p<0.001). Perfusion of amiodarone [adjusted OR (AOR) 25.97; 95% CI=7.29-92.55, p=0.0001] and cefotaxime (AOR 2.90; 95% CI=1.29-6.52, p=0.01) and the shift when the catheters were placed (AOR for morning vs. night shift 0.60; 95% CI=0.35-1.02, p=0.063) were independently associated to the development of PPIVC. A history of phlebitis was the only factor independently associated to phlebitis due to peripherally inserted central venous catheters (AOR 3.24; CI at 95% CI= 1.05-9.98, p=0.04). CONCLUSIONS A catheter management protocol decreases the incidence of PPIVC in hospitalized patients. The risk of PPIVC increases for peripherally inserted central venous catheters when the patients have a history of phlebitis and for peripheral venous catheters when amiodarone or cefotaxime are infused. Catheterization of peripheral veins performed during morning shifts is associated with a lower incidence of PPIVC when compared with night shift catheterizations.
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Affiliation(s)
- C Ferrete-Morales
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, España.
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Labeau S, Vandijck D, Blot S. Strategies for Implementation of Evidence-based Guidelines for Prevention of Healthcare-associated Infection. Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Helder OK, Latour JM. Reduction of catheter related bloodstream infections in intensive care: one for all, all for one? Nurs Crit Care 2009; 14:107-8. [PMID: 19366406 DOI: 10.1111/j.1478-5153.2009.00340.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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