scholarly journals NURSES' KNOWLEDGE OF INTENSIVE CARE UNIT ON CENTRAL VENOUS CATHETER DRESSING

Author(s):  
Fabiana Rezer ◽  
Wladimir Rodrigues Faustino

Objective: to describe the knowledge of the nurses of an Intensive Care Unit on the dressing of Central Venous Catheter. Method: descriptive, exploratory research with quantitative approach, performed with nurses in an Intensive Care Unit. A closed questionnaire was used with questions about Central Venous Catheter dressing and for documentary analysis of the patients submitted to the procedure. Data collection took place in the period from February to April 2016. The study follows all ethical and legal precepts, being approved with nº53479016.4.0000.5541. Results: Participants (100%) were right regarding hand hygiene and protection barriers; while 50% were correct in relation to the puncture site and the first dressing with gauze and micropore; 50% were correct regarding the clear membrane dressing. Conclusion: nurses have satisfactory knowledge about the dressing of central venous catheter, however, there is a need for capacity building and greater adherence in relation to nursing prescriptions.

2021 ◽  
Author(s):  
JingMei Li ◽  
JiaFei Zhang ◽  
Bo Feng ◽  
ChunHui Wang ◽  
MeiLing Wang

Abstract Background: The objective of this study was to evaluate incidence and influencing factors of complications related to central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Xi'an Children's Hospital.Methods: We analyzed the complications of all children that had CVCs and were hospitalized between June 2020 to February 2021. A total of 334 CVCs were inserted in 310 children.Results: We noted 102 (30.54%) CVCs-related complications. Complications related to CVCs insertion were infection of catheter (13.17%) and malposition of catheter (8.38%), occlusion of CVCs (2.99%), accidental removal (0.6%), puncture site exudate (4.79%), central venous thrombosis (0.6%). Infection mainly due to Staphylococcus epidermidis. 88 cases (24.55%) of CVCs were extubated due to complications. Analysis of the frequency of maintenance-related complications except for center vein thrombosis showed no differences between the jugular, femoral and subclavian vein access (P > 0.05). It was found that the duration of the catheterization use was critical for the occurrence of CVCs-related infections, puncture site exudate, occlusion (P < 0.05). Suture-off, bleeding of insertion site, and the maximum channels of intravenous infusion in patients were dominant risk factors of catheter-related complications. Conclusion: The risk factors of complications during catheter indwelling are suture-off, bleeding of insertion site and the maximum channels of intravenous infusion in patients. Therefore, strict aseptic operation in various operations, control of the infusion channel, effective fixation of the central venous catheter, reduce the malposition and pull of the catheter, and reduce the infiltration of blood at the puncture point, are particularly important to prevent the complications related to the central venous catheter.


Author(s):  
Sheetal Pearl Charan ◽  
Sister John Mary

Background : A central venous catheter, also called a central line, is a long, thin, flexible tube used to give medicines, fluids, nutrients, or blood products over a long period of time, usually several weeks or more, and is one of the important method of treatment. If central venous catheters are not cared for it can result for serious bloodstream infections. These complications worsen patient’s health, prolong hospital stay and increase the cost of care. In practice it has been found that, although hospitals have guide lines for care of central venous catheters, it is not been followed. Operational Definitions:-1. Effect:- According to Oxford dictionary effect means as a change produced by an action or cause. In the study effect refers to the change in the nursing practice of Intensive care unit nurses with relation to central venous site care. 2. Education program:-According to Oxford dictionary education means providing knowledge; instructive or informative. Program means a planned series of future events or actions. In the study education program refers to lecture cum demonstration methods that was used to educate nurses about central venous site care. 3. Central venous site care:-According to medical dictionary a central venous device also known as a central venous catheter, is a catheter placed into a large vein in the neck (internal jugular vein), chest (subclavian vein or axillary vein) or groin (femoral vein). Site is the entry point. Care is the serious attention or consideration applied to doing something correctly or to avoid damage or risk. In the study central venous site care refers to aseptic measures taken to prevent infection of the central venous site. 4. Intensive care unit (ICU):- According to Oxford dictionary :-Intensive care unit is a specialized department of hospital which provides medical treatment with constant attention for a seriously ill patient. In the study it refers to Intensive care unit where critical patients are taken care of. 5. Intensive care unit (ICU) nurse:-According to Oxford dictionary nurse is a person trained to care for the sick or infirm, especially in a hospital.In the study it refers to the nurses working in the Intensive care unit in selected hospital with an experience of 6 months and above. Objective:1. The aim of the study was to assess the practices of ICU nurses with relation to Central venous site care before and after the education programme 2. To associate the practice score of ICU nurses with selected demographic variables. Methods: The study was an experimental pre-test post- test design done on 60 ICU nurses. The tools used for the study were demographic information and observational checklist of 63 items divided in pre-performance, performance and post performance phase. An observation before implementing the education programme was made. After education programme four observations were made. Results: Most of the samples i.e. 48 (80%) of the ICU nurses were in the age group of 23-27 years, 8 (13.3%) were in the age group of 18-22 years and the remaining i.e. 4 (6.7) were in the age group of 28-32 years. Majority of the samples i.e. 31 (51.7%) of the ICU nurses were BSc qualified, 24 (40%) were GNM qualified and remaining 5 (8.3%) were Pb.Bsc qualified. Most of the samples, 26 (43.3%) of ICU nurses had an experience of 0-2years, 27 (45%) had an experience of 2-4 years and the remaining 7 (11.7%) had an experience of 4-6 years. Majority of samples i.e. 41 (68.3%) of ICU nurses had attended doctor's class for Central venous site care, 16 (26.7%) of them had knowledge regarding Central venous site care from seminar, 2(3.3%) of them had attended workshop and 1 (1.7%) of them did not receive any training regarding Central venous site care. In terms of other sources of information 26 (43.3%) of ICU nurses had knowledge from doctors, 17 (28.3%) of them had knowledge from internet, 16 (26.7%) of them had knowledge from senior staff and 1 (1.7%) of them had information from books. After the education programme in pre- performance phase 2 nurses removed ring and ornament, 34 of them removed only wrist watch and 24 of them did not remove ring and ornaments from their hands, 13 nurses had short nails, In performance phase, 44 nurses wore face mask, majority of nurses didn’t wear sterile gloves, before site care 48 nurses performed hand hygiene using soap and water and remaining 12 with water only, 6 nurses followed few steps of hand hygiene and 54 did not follow any steps. All nurses were found to perform hand hygiene for less than 1 minute. For site cleaning it was observed that 56 nurses cleaned 2 inches in diameter around the site with isopropyl alcohol and povidone iodine. In post - performance phase 58 nurses used soap and water for washing hands. Those who did not wash hands with soap and water applied sterilium, 10 nurses followed few steps of hand hygiene and 50 did not follow any steps. All of the nurses performed hand hygiene for less than 1 minute and none of the nurses documented the procedure.


2016 ◽  
Vol 29 (6) ◽  
pp. 373
Author(s):  
Jorge Rodrigues ◽  
Andrea Dias ◽  
Guiomar Oliveira ◽  
José Farela Neves

<p><strong>Introduction:</strong> To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate.<br /><strong>Material and Methods:</strong> A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 <em>versus</em> group 2).<br /><strong>Results:</strong> Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter.<br /><strong>Discussion:</strong> After multidimensional strategy implementation there was no reported central-line associated bloodstream infection<br /><strong>Conclusions:</strong> Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.</p>


2021 ◽  
pp. 0310057X2110242
Author(s):  
Adrian D Haimovich ◽  
Ruoyi Jiang ◽  
Richard A Taylor ◽  
Justin B Belsky

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.


Perinatology ◽  
2019 ◽  
Vol 30 (2) ◽  
pp. 60 ◽  
Author(s):  
Young Duck Kim ◽  
Na Mi Lee ◽  
Su Yeong Kim ◽  
Dae Yong Yi ◽  
Sin Weon Yun ◽  
...  

2020 ◽  
Vol 10 (2) ◽  
pp. 115-119
Author(s):  
Debasish Kumar Saha ◽  
Suraiya Nazneen ◽  
ASM Areef Ahsan ◽  
Madhurima Saha ◽  
Kaniz Fatema ◽  
...  

Background: Central venous catheter (CVC) insertion is very common in intensive care unit (ICU). CVC is usually inserted in subclavian, internal jugular and femoral veins. However, CVC insertion may lead to significant mechanical complications. Our aim was to detect the occurrence of CVC related mechanical complications according to different insertion site. Methods: This prospective observational study was carried out during the period of May 2016 to July 2019 in Department of Critical Care Medicine, BIRDEM General Hospital, Dhaka, enrolling 349 adult patients requiring new CVC insertion in ICU. Results: Among 349 study subjects, 167 CVC were inserted through subclavian vein, 88 through internal jugular and 94 through femoral vein. There was no significant difference among three groups (subclavian / internal jugular / femoral) in terms of age, gender distribution, presence of co-morbid illness.Total mechanical complicationsin study population was 43 (12.3 %) including pneumothorax (14, 4.0%), arterial puncture (10, 2.9%), hemorrhage (11, 3.2%), catheter tip malposition (6, 1.7%), hemothorax (1, 0.3%) and lost guidewire (1, 0.3%). Pneumothorax was more with internal jugular (9.1%) than subclavian (3.6 %) route, which was statistically significant (p=0.007). Although hemorrhage and arterial puncture events were higher with femoral site than subclavian or internal jugular, which were not significant. Catheter tip malposition occurred in 4 (2.4%) patients with subclavian insertion and 2 (2.3%) patients with internal jugular site, no such event in femoral site. Hemothorax and lost guidewire occurred in only 1 patient with subclavian and internal jugular site respectively. Site-wise total mechanical complications were higher in internal jugular (17.0%) followed bysubclavian (10.8%) site and femoral site (10.6%). Conclusion: In this study, though not statistically significant, CVC related mechanical complications occurred more in subclavian site than in internal jugular or femoral insertion site. Birdem Med J 2020; 10(2): 115-119


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