Needle-free connectors to prevent central venous catheter occlusion at a tertiary cardiac center: A prospective before and after intervention study

Objectives: To evaluate the effectiveness of needle-free connectors to maintain Central Venous Catheter—CVC patency. Background: Loss of patency is a common complication associated with CVC. For patients, this can be stressful and painful, and can result in a delay in infusion therapy. Pressure-activated anti-reflux needle-free connectors are one of the most modern devices; however, no studies have compared this connector with the open-system three-way stopcock in terms of the incidence of CVC occlusion. Methods: This study is a prospective before and after intervention study. From March to August 2018, an observation phase was conducted with the three-way stopcock as the standard central venous catheter hub and closure system (phase 1). After implementation of needle-free connectors (phase 2), post-intervention observations were made from September 2019 to January 2020 (phase 3). Results: Of 199 CVCs analyzed, 41.2% (40/97) occluded in at least one lumen in the first phase, and 13.7% (14/102) occluded after introducing the technological device, absolute risk reduction 27.5% (95% confidence interval 15.6%–39.4%). The lumens supported by needle-free connectors showed a higher probability of maintaining patency compared with three-way stopcocks. No differences were observed in the rate of infection. Conclusions: Pressure-activated anti-reflux needle-free connectors are effective and safe devices suitable for the management of vascular access in cardiac patient care. Staff training, even on apparently simple devices, is essential to avoid the risk of infection.

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Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion

BMJ Open Quality ◽

10.1136/bmjoq-2020-001222 ◽

2021 ◽

Vol 10 (4) ◽

pp. e001222

Author(s):

Enyo A Ablordeppey ◽

Byron Powell ◽

Virginia McKay ◽

Shannon Keating ◽

Aimee James ◽

...

Keyword(s):

Central Venous Catheter ◽

Acute Care ◽

Imaging Modality ◽

Phase 1 ◽

Venous Catheter ◽

Point Of Care Ultrasound ◽

Central Venous ◽

X Ray ◽

Chest X Ray ◽

Routine Chest

IntroductionAvoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention.MethodsThe intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion.With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments.Ethics and disseminationApproval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.Trial registration numberClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.

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A new technique for measuring fistula flow using venous blood gas oxygen saturation in patients with a central venous catheter

Clinical Kidney Journal ◽

10.1093/ckj/sfz064 ◽

2019 ◽

Vol 13 (2) ◽

pp. 184-187

Author(s):

Silverio Rotondi ◽

Lida Tartaglione ◽

Maria Luisa Muci ◽

Marzia Pasquali ◽

Nicola Pirozzi ◽

...

Keyword(s):

Central Venous Catheter ◽

Oxygen Saturation ◽

Venous Blood ◽

Venous Catheter ◽

Gas Analysis ◽

Surgical Revision ◽

Blood Gas ◽

Manual Compression ◽

Central Venous ◽

Before And After

Abstract Background Doppler ultrasound (DU) monitoring early after arteriovenous fistula (AVF) creation allows the identification of low blood flow (Qa) requiring prompt revision, but it is costly (needs skilled operators and technical instruments) and is not available in all dialysis units. Therefore alternative first-line methods to measure Qa would be welcomed. We reasoned that once an AVF is created, an increment in central venous oxygen saturation (ScvO2) is predictable and proportional to Qa. Methods Accordingly, in patients receiving dialysis through a central venous catheter (CVC) in whom an AVF was created, we measured, by means of blood gas analysis, the ScvO2 increment before and after manual compression of the arteriovenous shunt and verified its correlation with DU-measured Qa. Results We sampled blood gas in 18 patients with CVC and AVF before and after 30 s manual compression of the AVF. ScvO2 averaged 70.5 ± 3% before and 65.2 ± 3% after AVF closure, with an average drop of 5.1 ± 3% (range 1–12). AVF Qa, which was measured within 24 h by means of DU, averaged 635 ± 349 mL/min (range 50–1300) and was strictly and positively correlated with ΔScvO2 (r = 0.954, P < 0.0001). Conclusions Therefore we suggest that in patients with CVC and a newly created AVF, it is possible to monitor AVF Qa without DU by simply measuring blood gas and ΔScvO2. This technique is simple, cheap, repeatable, non-invasive and operator independent and represents a new useful screening test to detect delayed AVF access maturation deserving prompt DU measurement and surgical revision. It helps to quickly identify patients in urgent need of DU verification and possible surgical revision. Regrettably, it is applicable only in patients with CVC.

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The Effects of Introducing a Mobile Application-Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study (Preprint)

10.2196/preprints.35199 ◽

2021 ◽

Author(s):

Robert Tamblyn ◽

Jorge L Brieva ◽

Madeleine Cain ◽

F Eduardo Martinez

Keyword(s):

Central Venous Catheter ◽

Mobile Application ◽

Venous Catheter ◽

Mobile App ◽

Central Venous ◽

Adult Intensive Care Unit ◽

Accreditation Program ◽

Before And After ◽

Electronic Logbook ◽

First Time

BACKGROUND To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs utilising a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile application (App) could provide the ideal platform for trainees in an adult intensive care unit (ICU). OBJECTIVE To compare trainee compliance with completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an App-based logbook. METHODS A retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a two-year period in the adult ICU of the John Hunter Hospital (JHH), Newcastle, NSW, Australia, participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in patients’ electronic medical records (EMR) appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor’s signature for the before and after periods. We also analysed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions. RESULTS Of 2,987 CVC insertions documented in the EMR between April 7, 2019, and April 6, 2021, 2,161 (72%) were included and separated into cohorts before and after the app’s introduction. Following the introduction of the App-based logbook the percentage of CVC insertions appearing as logbook entries increased from 3.6% to 20.5% (P<.001). There was no difference in the proportion of supervisor approved entries containing a supervisor’s signature before and after the introduction of the app, with 76.3% and 83.2% respectively (P=.31). Following the introduction of the App there was an increase in the percentage of active logbook users from 15.1% to 62.4% (P<.001). Adherence to one’s logbook was similar in both groups with 75% of first-time users in the before group and 79.5% in the after group going on to log at least 3 or more CVCs during their time working in ICU. CONCLUSIONS The addition of an electronic, mobile, app-based logbook to a pre-existing paper-based logbook, was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in ICU.

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Tetrasodium EDTA as a Novel Central Venous Catheter Lock Solution Against Biofilm

Infection Control and Hospital Epidemiology ◽

10.1086/502577 ◽

2005 ◽

Vol 26 (6) ◽

pp. 515-519 ◽

Cited By ~ 107

Author(s):

Steven L. Percival ◽

Peter Kite ◽

Kerrie Eastwood ◽

Ricardo Murga ◽

Janice Carr ◽

...

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infections ◽

Venous Catheter ◽

Viable Cell ◽

Infusion Therapy ◽

Central Venous ◽

Home Infusion Therapy ◽

Cell Counts ◽

Lock Solution ◽

Catheter Lock

AbstractBackground:Central venous catheter (CVC)-related bloodstream infections (BSIs) are known to increase rates of morbidity and mortality in both inpatients and outpatients, including hematology-oncology patients and those undergoing hemodialysis or home infusion therapy. Biofilm-associated organisms on the lumens of these catheters have reduced susceptibility to antimicrobial chemotherapy. This study tested the efficacy of tetrasodium EDTA as a catheter lock solution on biofilms of several clinically relevant microorganisms.Methods:Biofilms ofStaphylococcus epidermidis, methicillin-resistantS. aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, andCandida albicanswere grown to levels of approximately 1 × 105colony-forming units (CFU)/cm−1on CVC segments in a model system, then subjected to the tetrasodium EDTA lock treatment.Results:Comparisons of biofilms before and after exposure to the 40-mg/mL−1tetrasodium EDTA lock for 21 hours showed that the biofilm viable cell counts of all organisms tested were significantly reduced (P< .05) after exposure to the treatment.Conclusion:Antimicrobial lock treatment using 40 mg/mL−1of tetrasodium EDTA for at least 21 hours could significantly reduce or potentially eradicate CVC-associated bio-films of clinically relevant microorganisms (Infect Control Hosp Epidemiol2005;26:515-519).

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Incidence of Central Venous Catheter-Related Bloodstream Infections: Evaluation of Bundle Prevention in Two Intensive Care Units in Central Brazil

The Scientific World JOURNAL ◽

10.1155/2019/1025032 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Thais Yoshida ◽

Ana Elisa Bauer de Camargo Silva ◽

Luciana Leite Pineli Simões ◽

Rafael Alves Guimarães

Keyword(s):

Intensive Care ◽

Central Venous Catheter ◽

Intensive Care Units ◽

Bloodstream Infections ◽

Venous Catheter ◽

Incidence Density ◽

P Value ◽

Central Venous ◽

Central Brazil ◽

Before And After

Background. Central venous catheter-associated bloodstream infections (CVC-BSIs) have been associated with increased length of hospital stay, mortality, and healthcare costs, especially in intensive care units (ICUs). The aim of this study was to evaluate the incidence density of CVC-BSIs before and after implementation of the bundle in a hospital of infectious and dermatological diseases in Central Brazil. Methods. A retrospective cohort study was conducted in two ICUs (adult and pediatric) between 2012 and 2015. Two periods were compared to assess the effect of the intervention in incidence density of CVC-BSIs: before and after intervention, related to the stages before and after the implementation of the bundle, respectively. Results. No significant reduction was observed in the incidence density of CVC-BSIs in adult ICU (incidence rate ratio [IRR]: 0.754; 95.0% CI: 0.349 to 1.621; p-value = 0.469), despite the high bundle application rate in the postintervention period. Similarly, significant reduction in the incidence density in pediatric ICU has not been verified after implementation of the bundle (IRR: 1.148; 95.0% CI: 0.314 to 4.193; p-value = 0.834). Conclusion. Not significant reduction in the incidence density of CVC-BSIs was observed after bundle implementation in ICUs, suggesting the need to review the use of process, as well as continuing education for staffs in compliance and correct application of the bundle. Further studies are needed to evaluate the effect of bundle in the reduction of incidence density of CVC-BSIs in Brazil.

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Reducing Central Venous Catheter Infection Rates Amongst Hematology Patients: Real-Life Implementation Of a ‘Matching Michigan’ Approach In This Patient Population

Blood ◽

10.1182/blood.v122.21.1716.1716 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1716-1716

Author(s):

Mari Kilner ◽

Jennifer Collins ◽

Ashley Price ◽

Annette Richardson ◽

Julie Samuel ◽

...

Keyword(s):

Central Venous Catheter ◽

Best Practice ◽

Conflicts Of Interest ◽

Average Rate ◽

Real Life ◽

Venous Catheter ◽

High Dose ◽

Infection Rates ◽

Central Venous ◽

Post Intervention

Abstract Background Central venous catheter bloodstream infections (CVC BSIs) cause substantial morbidity and are extremely costly. The Michigan Keystone Intensive Care Unit (ICU) project in 2004-5 demonstrated that interventions designed to reduce the incidence of CVC BSIs significantly reduced infection rates in US ICU patients (NEJM 2006;355:2725-32). The ‘Matching Michigan’ initiative in England between 2009-11 ascertained that the adoption of these interventions also led to a reduction of CVC BSIs in patients managed in English ICUs (BMJ Qual Saf 2013;22:110-23). This strong evidence base and involvement in local National Health Service Commissioning for Quality and Innovation (CQUIN) schemes, designed to incentivise hospitals to meet quality targets, led us to collect data on CVC BSIs in hematology patients within our hospital trust. Information was collected before and after the implementation of best practice guidance regarding the insertion and maintenance of CVCs, using complex strategies similar to those employed by the Keystone ICU project. Methods Data was collected prospectively from all patients managed in the cancer unit at Newcastle upon Tyne Hospitals, UK. Our unit undertakes approximately 80 allografts and 80-100 autografts annually and is a regional centre for high dose chemotherapy for acute leukemia and lymphoma. Over a 23 month period, between July 2011-May 2013, we collected data on CVC patient days and CVC BSIs. Clinical and microbiological data were correlated monthly. Using these data, a clinical team determined whether infections were unrelated to the CVC, CVC associated (CABSI) or CVC related (CRBSI). Standardised definitions and a standardised decision tree were used as per the ‘Matching Michigan’ methods. In April 2012, interventions aimed at minimising CVC BSIs were introduced and developed over several months. These technical and non-technical interventions were based on national best practice guidance. They included observation and standardisation of nursing and medical catheter care and catheter insertion, focused staff and patient education and monthly feedback of outcomes at ward level. From April 2012, reduction of CVC BSIs became a CQUIN quality target for our unit. Results There were 2530 mean CVC patient days per month between July 2011-May 2013. More than 95% of those days related to long-term rather than short-term catheters. During this period there were 254 CVC BSIs. Pre-intervention the average rate of infection (CRBSI and CABSI) per 1000 CVC days over a quarterly period was 6.2. Post-intervention, there was a significant reduction in the rate of infection during a quarterly period to 3.56 per 1000 CVC days (p=<0.05). Conclusions Implementation of best practice guidance, measurement of infection rates and real-time feedback to staff, led to a significant reduction in CVC BSIs in hematology patients. Our findings support the evidence that targeting specific practices significantly reduces the rate of CVC BSIs. They also demonstrate, for the first time, that these methods can be translated from an ICU setting to hematology patients. Disclosures: No relevant conflicts of interest to declare.

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