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)

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

The Journal of Vascular Access ◽

10.1177/11297298211039653 ◽

2021 ◽

pp. 112972982110396

Author(s):

Andrea Sansalone ◽

Raffaello Vicari ◽

Fabio Orlando ◽

Alessandro Dell’Avo ◽

Silvia Giuffrida ◽

...

Keyword(s):

Central Venous Catheter ◽

Intervention Study ◽

Absolute Risk ◽

Phase 1 ◽

Venous Catheter ◽

Care Staff ◽

Infusion Therapy ◽

Central Venous ◽

Post Intervention ◽

Before And After

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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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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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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