Intravenous Catheter Replacement 1639
Peripheral intravenous catheterisation is an invasive procedure involving the insertion of a cannula into a patient’s vein to allow direct access into the venous system (Intensive Care Coordination & Monitoring Unit, 2013). It is essential that evidence based practice regarding changes and replacement of cannulas should be executed to prevent any complications such as phlebitis and sepsis (Clinical Excellence Commission, 2013).
Routine vs. Clinically Indicated Replacement
The NSW Ministry of Health Protocol of Peripheral Intravenous Cannula (PIVC) Insertion and Post Insertion Care in Adult Patients indicates that peripheral intravenous cannulas should not remain in situ for longer than 72 hours (Clinical Excellence Commission, 2013). Recently, there has been much discussion on whether routine replacement (72-96 hours) or clinically indicated replacement (when signs of infection, blockage, cannula tissuing etc.) yield better results. A search of electronic databases was conducted, including CINAHL, Medline/PubMed, Science Direct and BMJ was conducted using search terms drawn from natural language of the topic as well as controlled language specific to the different databases. 7 primary research articles were selected based on publication date, sample size, with a focus on research articles and study trial results.
Baker, Anderson and Macfie (2004) established conflicting results to these findings. Baker et al. (2004) executed a randomised control trial located at a single centre using 47 patients. 26 patients in the study were in the control group where catheters were only removed as clinically indicated by pain at site, dislodgement or signs of peripheral venous thrombophlebitis. In the st...
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... of the risks associated with peripheral intravenous catheters. American Journal Of Epidemiology, 118(6), 839-851.
Van Donk, P., Rickard, C., McGrail, M., & Doolan, G. (2009). Routine replacement versus clinical monitoring of peripheral intravenous catheters in a regional hospital in the home program: A randomized control trial. Infection Control and Hospital Epidemiology, 30(9), 915-917
Webster, J., Clarke, S., Paterson, D., Hutton, A., van Dyk, S., Gale, C., & Hopkins, T. (2008). Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomized control trial. BMJ, 337:a339 doi: 10.1136/bmj.a339
Webster, J., Osborne, S., Rickard, C., & New, K. (2013). Clinically-indicated replacement versus routine replacement of peripheral venous catheters (Review). Cochrane Database of Systematic Reviews, 2013(4), 1-40. doi: 10.1002/14651858
Transcatheter aortic valve replacement or TAVR is the latest technology used principally for the treatment of aortic stenosis, a condition in which one of the major valves of the heart, the aortic valve, becomes tight and stiff, usually as a result of aging (3). Since many patients who need aortic valve replacement for aortic stenosis are too sick to undergo major valve replacement surgery, they are unable to get the treatment they need. With the transcatheter aortic valve, this issue is bypassed because this valve can be implanted in the heart by accessing the patient’s heart through an artery in the groin. The valve can be inserted through a wire that can be pushed to the heart and the old valve is simply pushed to the side when the new valve is implanted. This technology has been in use in the US with Edwards’ Sapiens valve since 2011 and has saved the lives of many patients with aortic stenosis (4). Medtronic’s CoreValve uses similar technology and has won patent fights in Europe and has been in use internationally. However, within U.S., Medtronic has not been...
According to an article by Timsit, J., et al. an estimated 5 million central venous catheters are inserted in patients each year. CBIs, most of which are associated with central venous catheters, account for more than 11% of all health-care associated infections. Additionally, more than 250,000 central-line associated blood stream infections also occur annually, with an estimated mortality rate of 12-25%. For patients within the intensive care unit, the numbers were even higher. Each episode significantly increases the patient’s hospital stay, as well as increasing costs from $4,000 to $56,000 per episode.
Then after threading a catheter through the needle, the anesthesiologist will withdraw the needle and leave the catheter i...
Transcatheter aortic valve replacement (TAVR) introduction to the clinical practice revolutionized the interventional cardiology ,it is a valuable option for a non –operable patient with sever aortic stenosis or high risk population however ,TAVR is associated with a risk of cerebral embolization and ischemic vascular events and possible neurological impairment the estimate of these complication is vary but it have been reported early and late after the procedure moreover the reported incidence of bleeding associated with TAVI is relatively high .with this given incident of complication required adequate antithrombotic therapy during and following procedure ,however despite the current guidelines recommendation the optimal antithrombotic is not very well established .
2013). Inappropriate use of urinary catheter in patients as stated by the CDC includes patients with incontinence, obtaining urine for culture, or other diagnostic tests when the patient can voluntarily void, and prolonged use after surgery without proper indications. Strategies used focused on initiating restrictions on catheter placement. Development of protocols that restrict catheter placement can serve as a constant reminder for providers about the correct use of catheters and provide alternatives to indwelling catheter use (Meddings et al. 2013). Alternatives to indwelling catheter includes condom catheter, or intermittent straight catheterization. One of the protocols used in this study are urinary retention protocols. This protocol integrates the use of a portable bladder ultrasound to verify urinary retention prior to catheterization. In addition, it recommends using intermittent catheterization to solve temporary issues rather than using indwelling catheters. Indwelling catheters are usually in for a longer period. As a result of that, patients are more at risk of developing infections. Use of portable bladder ultrasound will help to prevent unnecessary use of indwelling catheters; therefore, preventing
Different studies had different result numbers or different percentage reduction rates which was primarily based on their indifferences in regards to study design utilized and sample size. As evidenced by research results (Magers, June 2013) and (Welden, 2013), these showed a reduction of urinary catheter days resulted in reduced CAUTI rates. Though different outcome results between the different research studies, they all strongly significantly supported the notion that a nurse-driven protocol to assess and evaluate the appropriateness and use of urethral catheter compared with a no protocol is essential to help in the reduction of CAUTIs. Interpreting these results, (Meddings et al., 2013) showed a drop greater than 52% in CAUTIs and a decrease in catheterization by 37%. The study results from the six scholarly research study articles showed nearly similar or corresponding outcomes. The results were significant enough to support the PICO question. In general, though the difference in sample size, the results still strongly supported excellent outcomes when a nurse-driven protocol is used to evaluate the necessity of continued urethral catheter use. (Chen et al., 2013, para.
The patient is a fifty-two-year-old male of Irish American descent with initials A.B. who presents to the clinic for a follow-up visit to discuss key risk factors following an admission to the hospital where he underwent cardiac catheterization and the placement of a stent.
Several skills are beneficial to the nurse and paramedic, but perhaps one of the most important skills is the ability to place an intravenous catheter into a vein. This procedure is most commonly referred to as “starting an IV”. In today’s medical community, intravenous cannulation is necessary for the administration of many antibiotics and other therapeutic drugs. Listed below are the procedures and guidelines for starting a successful IV. Following these instructions will provide a positive experience for the patient and clinician.
The topic chosen is blood transfusion. Blood transfusion is one of the most common procedures that are performed in the hospital setting to save lives and help improve one’s health. People who have serious injuries may need blood transfusions to replace the lost of blood. Some of the injuries are more critical than others and require an enormous amount of blood. In addition, many people have illnesses that prevent their body from making blood properly. Blood circulates in the body providing oxygen and nutrients and collects waste so it can be eliminated by the body; therefore, it is an important factor for everyone’s lives (Lewis Medical surgical nursing). Blood should be carefully transfused. Although it is a lifesaver, nurses should follow the proper procedure and strict guidelines to safely transfuse the blood. One sample error during transfusion can cause someone life.These situations can lead to death, especially in serious cases. So nurses must have knowledge and understand the purpose of blood transfusion.
Essential IV information management and application of patient care technology is an essential that I consider most important to my practice. My nursing skill and technology is challenged every day while working. The new technology, change in procedures, and new equipment are essential to working in the Cardiac Catheterization Lab. One must adapt and change daily in order to keep up and stay educated. New physicians join and we must learn their technique styles and equipment needs while still maintaining exceptional patient care.
Central lines (CL) are used frequently in hospitals throughout the world. They are placed by trained health care providers, many times nurses, using sterile technique but nosocomial central line catheter associated blood stream infections (CLABSI) have been a dangerous issue. This is a problem that nurses need to pay particular attention to, and is a quality assurance issue, because CLABSI’s “are associated with increased morbidity, mortality, and health care costs” (The Joint Commission, 2012). There have been numerous studies conducted, with the objective to determine steps to take to decrease CLABSI infection rate, and research continues to be ongoing today. The problem is prevalent on many nursing units, with some patients at great risk than others, but some studies have shown if health care providers follow the current literature, or evidence based guidelines, CLABSIs can be prevented (The Joint Commission, 2012). The purpose of this paper is to summarize current findings related to this topic, and establish a quality assurance (QA) change plan nurses can implement for CL placement and maintenance, leading to decreased risk of nosocomial CLABSIs.
Lindley, P., Pestano, C. R., & Gargiulo, K. (2009). Comparison of postoperative pain management using two patient-controlled analgesia methods: Nursing perspective. Journal of Advanced Nursing, 65(7), 1370-1380. doi: 10.1111/j.1365-2648.2009.04991.x
There have been an incidents of prolonged hospital stay due to central line infections putting patients at risk for mortality, morbidity, and increase in medical cost. When central lines are placed at bedside or in interventional radiology, the inserter is required to document the steps and sterile procedure that took place in the electronic health record. Furthermore, with weekly and as needed dressing changes, nurses are required to use central line bundles and document what was used (ex: Chloraprep, biopatch, tegaderm, etc.) to track how the dressing was done. From these documented records, staff can gather data and measure the compliance of sterile procedure. Additionally, if a patient with a central line develops a fever without an unknown cause physician will order blood culture from the central line if catheter-related infection is suspected. If the test comes back positive, the team will initiate antibiotics immediately. By integrating electronic health records it can assist in CLABSI prevention strategies, raise the standard for best practices, and essentially reduce central line infections. With the quarterly results of CLABSI in our unit, CVC committee have re-educated the staff on appropriate dressing changes using sterile technique, transitioned to a different end
One day, this writer happened to see another nurse changing a Peripherally Inserted Central Catheter Line dressing. As a nurse leader, this writer asked the nurse why she is changing the dressing. The caregiver explained dressing changes can prevent infection to the site and there are lot of patients readmitted because of central line infections and subsequent complications. This nurse demonstrated good kn...
Today I also gained experience performing technical skills, that I had yet to complete in the clinical setting. With nurse supervision I successfully removed my patient’s NG-tube and peripheral IV, as well as changed her ostomy appliance. It was exciting to see how the education I have received in the laboratory setting has quipped me with the knowledge needed to implement safe practice techniques. I demonstrated a safe practice throughout implementation of the specific technical interventions, and taught my patient about the purpose of my actions in a way that was appropriate for her level of understanding.