Construction of a nursing care instrument for patients with central venous catheters

Objective: to build a nursing care instrument for patients with short-term central venous catheters in an Intensive Care Unit. Methods: a multi-method study in three stages: structuring of the instrument; pre-testing of the instrument; agreement analyses among nurses and final composition of the instrument. Results: the instrument, in its first version, presented three domains related to the moment of insertion (five items), maintenance (15 items) and catheter removal (ten items). Most of the 30 items were assessed as relevant (23/77%) and presented a satisfactory Content Validity Index (28/93%). Ten items were reformulated, 32 new items were included, and three items were deleted. Conclusion: the instrument was constructed, which presented response validity for the care of nurses to patients with central venous catheters in Intensive Care Units, consisting of three domains and 59 items evaluated by nurses and considered appropriate for the moments of insertion, maintenance and removal of the catheter.

Vascular Access in Pediatric Oncology and Hematology: State of the Art

Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without painful and repeated venipuncture. For these reasons, central venous catheters are currently an important component in pediatric onco-hematological care, with a direct influence on outcome. Indeed, there are peculiar issues (techniques of insertion, management, complications etc.) which must be well-known in order to improve the outcome and the quality of life of children with cancer.

Presample Volume Necessary to Obtain Accurate Laboratory Parameters from Central Venous Catheters in Dogs

ABSTRACT We compared laboratory parameters from central venous catheters using multiple presample volumes (PSVs) to venipuncture values. Blood was obtained from dogs for a venous blood gas, packed red blood cell volume (PCV), total solids (TS), and a coagulation panel. Blood was drawn both by venipuncture and from the catheter (using PSVs 300%, 600%, and 1200% of the dead space volume). Twenty dogs were enrolled. Venipuncture values were significantly higher than those obtained from the catheter for PCV (300% [P = .007], 600% [P = .005], and 1200% [P = .02]), TS (300% [P = .006] and 600% [P = .04]), and lactate (600% [P = .04] and 1200% [P = .01]). Venipuncture values were significantly lower than those obtained from a catheter for pH (1200% [P = .008]) and chloride (300% [P = .04], 600% [P = .003], and 1200% [P = .03]). An increase was found in prothrombin time in samples drawn with 600% PSV compared with 1200% (P = .008). The PCV and TS are diluted when smaller PSVs are used. A 1200% PSV best approximated the PCV and TS obtained by venipuncture. A 300% PSV may be adequate to evaluate coagulation and venous blood gas values.

Mechanical complications of central venous catheters in children: A cohort study

Background: Despite the numerous advantages of central venous catheters (CVCs), they have been associated with a variety of complications. Surveillance for mechanical complications of CVCs is not routine, so the true incidence and impact of this adverse patient outcome remains unclear. Setting and methods: Prospectively collected CVC data on mechanical complications were reviewed from a centralized database for all in-hospital patient days at our tertiary-care hospital from January 2001 to June 2016 in patients aged <19 years. Patient demographics, CVC characteristics, and rates of mechanical complications per 1,000 days of catheter use were described. Results: In total, 8,747 CVCs were placed in 5,743 patients during the study period, which captured 780,448 catheter days. The overall mechanical complication rate was 6.1 per 1,000 catheter days (95% confidence interval [CI], 5.9–6.3). The highest complication rates were in nontunneled lines; this was consistent throughout the 15-year study period. Also, 521 CVCs (∼6%) were removed due to mechanical complications before therapy termination. Catheters with tip location in the superior vena cava or right atrium had the fewest complications. Conclusions: Mechanical complications of CVCs are a common and significant event in the pediatric population. We propose that CVC-associated mechanical complications become a routinely reported patient safety outcome.

Low Consciousness in a Patient with Venous Air Embolism Introduced via Peripheral Vascular Cannulation

Introduction: Venous air embolism is rarely seen, can be fatal and is associated mostly with large central venous catheters and mechanical ventilation. Some cases due to peripheral intravenous access have also been reported. Case Description: We present a case of intracranial venous air embolism most likely secondary to peripheral cannulation. On admission, the patient was drowsy with a suddenly deteriorating Glasgow coma scale score. This case emphasizes cautious cannula insertion and close monitoring of the patient in the event of complications. Conclusion: Intravenous cannulation is common but care should be taken to avoid catastrophic complications. Consider air embolism as the differential diagnosis if a patient has a low level of consciousness after an intravenous cannula is inserted.

Safety of Bedside Placement of Tunneled Hemodialysis Catheters in the Intensive Care Unit: Translating from the COVID-19 Experience

Background: Critically ill patients with coronavirus disease 2019 (COVID-19) and kidney dysfunction often require tunneled hemodialysis catheter (TDC) placement for kidney replacement therapy, typically under fluoroscopic guidance to minimize catheter-related complications. This entails transportation of patients outside the intensive care unit to a fluoroscopy suite, which may potentially expose many healthcare providers to COVID-19. One potential strategy to mitigate the risk of viral transmission is to insert TDCs at the bedside, using ultrasound and anatomic landmarks only, without fluoroscopic guidance. Methods: We reviewed all COVID-19 patients in the intensive care unit who underwent right internal jugular TDC insertion at the bedside between April and December 2020. Outcomes included catheter placement-related complications such as post-procedural bleeding, air embolism, dysrhythmias, pneumothorax/hemothorax, and catheter tip malposition. TDC insertion was considered successful if the catheter was able to achieve blood flow sufficient to perform either a single intermittent or 24 h of continuous hemodialysis treatment. Results: We report a retrospective, single-center case series of 25 patients with COVID-19 who had right internal jugular TDCs placed at the bedside, 10 of whom underwent simultaneous insertion of small-bore right internal jugular tunneled central venous catheters for infusion. Continuous veno-venous hemodialysis was utilized for kidney replacement therapy in all patients, and a median catheter blood flow rate of 200 mL/min (IQR: 200–200) was achieved without any deviation from the dialysis prescription. No catheter insertion-related complications were observed, and none of the catheter tips were malpositioned. Conclusions: Bedside right internal jugular TDC placement in COVID-19 patients, using ultrasound and anatomic landmarks without fluoroscopic guidance, may potentially reduce the risk of COVID-19 transmission among healthcare workers without compromising patient safety or catheter function. Concomitant insertion of tunneled central venous catheters in the right internal jugular vein for infusion may also be safely accomplished and further help limit personnel exposure to COVID-19.

To Study Effect of Education Programme on Central Venous Site Care Among ICU Nurses in Selected Hospital

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.

Unusual complications of the central venous catheterization in trauma patients

Central venous catheters (CVCs) are commonly used in patients with trauma. The placement and removal of the CVCs can result in various complications regardless of the skill of the professionals. Herein, two cases of rare complications are presented— an inadvertent subclavian artery catheterization and a cerebral air embolism after a CVC removal. Moreover, practical solutions for each complication are provided in detail.