Prevent Central-Line Bloodstream Infections

7/31/2019 Prevent Central-Line Bloodstream Infections

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Running head: PREVENT CENTRAL LINE BLOODSTREAM INFECTIONS 1

Prevent Central Line Bloodstream Infections

Christina (Ngu) Phoo

Molloy College


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PREVENT CENTRAL LINE BLOODSTREAM INFECTIONS 2

Prevent Central Line Bloodstream Infections

Central line bloodstream infections are most common type of health care-acquired

infections (HAIs) which accounts for considerable high morbidity and mortality rates in all

patient care settings. According to Centers for Disease Control and Prevention (CDC) in 2002,

the estimated number of HAIs in U. S hospitals was 1.7 million; moreover, the bloodstream

infection is a second leading cause of death, rating to be 31% among other types of infection

from different sites. This increase has tremendous impact on the cost of health care (Segreti et

al., 2009). The Intravascular catheters inserted in the vena cava are called central lines or central

vascular catheters (CVCs), and peripherally inserted central catheters are also known as PICCs;

and both have greater chances for bloodstream infections. National JCAHO addresses standard

goals to help promote quality and safety for patients in reducing risk of HAIs, assure safe

practice in the area, and to minimize the cost of health care.

Nurses are the primary professionals who are accountable in reducing such HAIs,

ensuring patient safety, and to promote quality practice in the area of care. Therefore, a nurse

must to have the essential knowledge with the safety measures which are mandated throughout

the hospital. Central lines are most susceptible place for bloodstream infections. In fact, it occurs

mainly due to improper handling and poor practice by nurses. The most important thing in

prevention is through good hand hygiene, though, it is still remain poor by the nurses (Gorski,

2009). Other areas that need improvement are, aseptic technique with infusion, hub/needleless

connector cleansing, clearing of catheters occlusions, and catheter securement (Gorski, 2009).

Most nurses are unaware of the prevention process, and set of complications beyond the

infection itself. The procedure of central catheter insertion and appropriate removal techniques

are very essential in reducing infection rates (Gorski, 2009).


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The steps for improvement in central line insertion must maintain accordingly to reduce

risk of infections. Such steps involve before, during, and after catheter insertion. For example,

before the initial insertion of central line, it is important to educate professional staff on risk of

central line-associated bloodstream infections (CLABSIs). Then, assess the competency of

professional staff on methods to prevent or reduce CLABSIs, and consider implementation of

intravenous therapy teams. Thirdly, select the appropriate antimicrobial agents to control

CLABSIs due to potential risk factors (Segreti et al., 2009).

It is important to educate the patient and family members regarding central catheters and

CLABSIs. Ongoing process should be made in evaluating new device or technology to determine

its effect on the rates of catheter-related infections (Segreti et al., 2009). In order to minimize the

risk of transmission of pathogens from hospital environment, it is best to establish programs for

education and assessment of inpatient environmental services (Segreti et al., 2009). Different

types of catheters may also lead to risk of CLABSI, therefore, ensure a process to determine

appropriate vascular access devices (Segreti et al., 2009).

During central line insertion, it is best to avoid the femoral vein due to higher chances of

infection from that area (Segreti et al., 2009). The most preferred placement is through a

subclavian vein, however, each patient should be assessed individually by knowing the risks and

common complications from the site. These risks include vascular hemorrhage, vascular spasm,

and arterial puncture, as well as, a peripheral nerve injury and brachial nerve plexus (Hertzog &

Waybill, 2008). PICCs have common complications as CVCs which include cardiac tamponade,

air embolism, pneumothorax, hemothorax, hydrothorax, and thoracic duct injury (Hertzog &

Waybill, 2008). The use of ultrasound technology during catheter placement is found to be faster

and the most effective way in reducing these kinds of complications (Segreti et al., 2009).


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After the central line insertion, it is important to maintain the quality of site and to

establish proper handling to reduce common CLABSIs. It is an essential nursing knowledge, care

and management, also as per institution protocols and guidelines for patient safety. The standard

components of care include proper dressing change techniques, administration set changes, and

methods of catheter stabilization, in addition, catheters should be assessed daily (Segreti et al.,

2009). Moreover, practice of good hand hygiene, appropriate barrier precautions with clean

gloves, and disinfection of the catheter hub must to take seriously by nurses in further prevention

of CLABSIs (Segreti et al., 2009).

Throughout the process, CDC recommends to change the gauze dressing every 48 hours

or less, when it becomes soiled to minimize risk of infections. The recommended time for

transparent dressing is 5 to 7 days or less. Chlorhexidine is the most recommended and

commonly used antiseptic for skin preparation (Segreti et al., 2009). A recent study showed that

the use of chlorhexidine-containing sponge dressings reduced the rate of catheter related

infections; indeed, it is one of SHEA strategies in minimizing complications (Segreti et al.,

2009). The recommendation for administration set is to change at intervals, not more than 96

hours for tubing that is used for blood products, or lipids (Segreti et al., 2009). On the other

hand, the primary and secondary continuous administration sets, exclude blood products or lipids

are to change no more than 72 hours. The intermittent primary sets are change every 24 hours,

and for any contaminated sets, should changed immediately (Segreti et al., 2009).

It is important to ensure catheter patency, especially because any movement at the

insertion can increase the chances of catheter related complications and the risk of infections

(Segreti et al., 2009). Some data suggests that repeated manipulation of central lines for routine

procedures such as blood sampling may increase the risk of catheter hub colonization and


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subsequent systemic infection (Segreti et al., 2009, p. 130). Accidental complications may also

take place. For example, dislodgment or catheter migration may lead to infiltration and

extravasations (Hertzog & Waybill, 2008). In some cases, the catheter may be damaged by

needle puncture, stretching, or wear and tear on the tubing connections (Hertzog & Waybill,

2008). Excessive delivery pressure can rupture the PICC. Compression and motion points can

cause a pinch-off syndrome leading to catheter fracture. If complete, the tip can embolize to the

heart and lung (Hertzog & Waybill, 2008, p. 160).

Thrombotic occlusions are frequent causes of catheter colonization and sepsis, along with

losing catheter patency. It occurs in 2% to 8% of PICC insertion (Hertzog & Waybill, 2008, p.

160). Components of a c atheter patency care . . . include catheter flush with normal saline

and/or heparin, use of antireflux devices, and standing orders . . . Methods of flushing and flush

solutions will vary based on the type of catheter used as well as with the use of antireflux devices

. . . or positive/neutral pressure needleless connectors (Segreti et al., 2009, p. 131). Use of

heparin to avoid clots in central vascular catheters, thereby reducing the risk of infection, has

long been a common practice in healthcare institutions (Meyer, 2009, p. 82). The antibiotic-

lock combination of minocycline and ethylenediaminetetraacetic acid (EDTA) has been

demonstrated . . . to prevent the likelihood of clotting, as well as acting as a bacterial agent,

decreasing the presence of biofilm on catheter surfaces (Meyer, 2009, p. 83).

There are issues with central catheter dressings in relation to increased colonization and

moisture retention with these dressings producing the bacteria. Chlorhexidine impregnated

patches are becoming more commonly used in conjunction with transparent semipermeable

polyurethane dressings as a method of decreasing central catheter-associated bloodstream

infections (Meyer, 2009, p. 81). Transparent dressing s reliably secure the device, permit


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continuous visual inspection of the catheter site, permit patient to bathe and shower without

saturating the dressing, and require less frequent changes than do standard gauze and tape

dressing (Meyer, 2009, p. 81).

Nurses are responsible for providing IV therapy. Their k nowledge and skill can

minimize infusion related complications and affect patient safety, satisfaction, healthcare costs,

and length of hospital stay (Dychter, Gold, Carson, & Haller, 2012, p. 89). Therefore, nurses

must to be aware of such complications regarding the extent of hospital infections especially for

central lines, follow proper guidelines from own hospital since every hospital is different in

protocol, and maintain quality care and management to improve patient safety and satisfaction.

Finally, the Certified Registered Nurse Infusion (CRNI) credential is the only nationally

accredited certification for infusion nursing, indeed, it requires of passing a national certification

examination (Dychter, Gold, Carson, & Haller, 2012).


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References

Dychter, S., Gold, D., Carson, D., & Haller, M. (2012). A review of complications and economic

considerations of peripheral access. Journal of Infusion Nursing , 35(2), 84-91.

doi:10.1097/NAN.0b013e31824237ce

Gorski, L. (2009). Speaking standards . . . Journal of Infusion Nursing , 32(6), 311-312.

doi:10.1097/NAN.0b013e3181be0760

Hertzog, D., & Waybill, P. (2008). Complications and controversies associated with peripherally

inserted central catheters. Journal of Infusion Nursing , 31(3), 159-163.

doi:10.1097/01.NAN.0000317702.66395.f1

Meyer, J. (2009). A broad-spectrum look at catheter-related bloodstream infections: many

aspects, many populations. Journal of Infusion Nursing , 32(2), 80-86.

doi:10.1097/NAN.0b013e318198d30c

Segreti, J., Garcia, S., Gorski, L., Moureau, N., Shomo, J., Zack, J., . . . Moody, M. (2009).

Consensus conference on prevention of central line-associated bloodstream infections:

2009. Journal of Infusion Nursing , 34(2), 126-133. doi:10.1097/NAN.0b013e31820b8a3e


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Prevent Central-Line Bloodstream Infections