scholarly journals Managing central venous access during a health care crisis

2020 ◽  
Vol 72 (4) ◽  
pp. 1184-1195.e3
Author(s):  
Tristen T. Chun ◽  
Dejah R. Judelson ◽  
David Rigberg ◽  
Peter F. Lawrence ◽  
Robert Cuff ◽  
...  
Keyword(s):  
Health Care ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Health Care Crisis

Evidence-based Practice: Improving Outcomes for Patients with a Central Venous Access Device

2011 ◽  
Vol 16 (2) ◽  
pp. 64-72 ◽  
Author(s):  
Dorothy Mathers
Keyword(s):  
Health Care ◽  
Continuing Education ◽  
Best Practice ◽  
Evidence Based Practice ◽  
Central Venous Access ◽  
Relevant Literature ◽  
Venous Access ◽  
Positive Pressure ◽  
Evidence Based ◽  
Central Venous

AbstractPurpose: To apply evidence-based practice when flushing central venous access devices (CVADs).Background/Introduction: There is a lack of standardized flushing protocols for CVADs among health care institutions. Identifying best practice and assuring skillful implementation of evidence-based practice protocols is essential to maintaining catheter patency.Review of Relevant Literature: Evidence supports the use of nonheparinized saline flush, positive-pressure valve caps, and proper flushing technique to maintain CVAD patency (Bowers, Speroni, Jones, & Atherton, 2008; Hadaway, 2006; & Jasinsky & Wurster, 2009). Reinforcement of proper flushing techniques has demonstrated improved patency rates of CVADs (Feehery, Allen, & Bey, 2003).Methods: Corporate and individual in-services were conducted to improve nurses' skill and knowledge of evidence-based practice related to flushing CVADs. Outcomes were measured by comparing baseline data with data collected in the same manner post-education. Data was obtained by means of a questionnaire and direct observation of nurses' flushing technique.Outcomes: The evidence-based practice project demonstrated a significant improvement (p <0.05) in both the nurses' knowledge and skill in flushing CVADs.Conclusion: Continuing education and reinforcement of proper flushing technique is an appropriate strategy to increase knowledge of and compliance with evidence-based practice protocols.Implications for practice: Providing continuing education and periodic reinforcement of nursing skills can lead to improved patient outcomes. These strategies, along with changing flushing protocols to non-heparinized saline, can also reduce health care costs. Future studies are needed to determine the appropriate frequency of in-service education.

Successful Long-Term Central Venous Access

1998 ◽  
Vol 2 (1) ◽  
pp. 38-40
Author(s):  
Franco Tesio ◽  
Hamurabi De Baz ◽  
Giacomo Panarello
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Central Venous

Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

1996 ◽  
Vol 75 (02) ◽  
pp. 251-253 ◽  
Author(s):  
Manuel Monreal ◽  
Antoni Alastrue ◽  
Miquel Rull ◽  
Xavier Mira ◽  
Jordi Muxart ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Upper Extremity ◽  
Statistical Significance ◽  
Central Venous Access ◽  
Venous Access ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
Central Venous ◽  
True Incidence ◽  
Venous Access Devices

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

Evaluation of Different Turbulence Models for the Characterization of Shear Stresses in the Central Venous Access for Hemodialysis

2020 ◽  
Author(s):  
Saulo Gonçalves ◽  
Matheus Costa ◽  
Thabata Lucas ◽  
Jonathas Haniel ◽  
Mário Silva ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Turbulence Models ◽  
Venous Access ◽  
Shear Stresses ◽  
Central Venous

Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

2019 ◽  
Vol 14 (1) ◽  
pp. 47-49
Author(s):  
Basant K. Puri ◽  
Anne Derham ◽  
Jean A. Monro
Keyword(s):  
Bloodstream Infection ◽  
Antibiotic Treatment ◽  
Central Venous Access ◽  
Case Series ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Host Cells ◽  
Central Venous ◽  
Intravenous Antibiotic ◽  
Venous Access Devices

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.

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