The central venous access device or CVAD plays an important role in the recovery of critical patient in the health care settings. However, study has indicated that high risk of bloodstream infection and occlusion is associated with CVAD (Ullman et al. 2015). The purpose of the essay is to provide brief discussion about the prevention of CVAD associated bloodstream infection and occlusion. In this regards the following paper will provide the plan of care for prevention of bloodstream infection and both the prevention and treatment of occlusion.
Central venous access device is a small, flexible tube that is placed in the large veins for some patients that require access to the bloodstream frequently. The CVAD is mainly placed in the large vein of neck or chest and in some cases in the groin as well (Moureau et al. 2013). As found in the case of Joseph, CVAD plays an important role in nursing care. There are many benefits of using CVAD, for example, it helps to administer drugs, medication and other intravenous fluids and nutritional components, helps to transfuse different blood products and helps to draw blood for diagnosis. In addition, the risk of blood clot, inflammation and scaring due to the use of needles and anxiety is less in CVAD. Thus, in order to manage critical patients in ICU most of the health professional prefer to use CVAD (Madenci et al. 2014).
Beside such advantages of using CVAD, several studies have identified the risk of bloodstream infection due to the use of CVAD. A central line infection of bloodstream is most common in ICU. Such infection leads to the increase morbidity, health care cost and death as well. Due to such reason, CVAD associated bloodstream infection has become one of the major concern for health care system (Chopra et al. 2013). However, it is important to use CVAD in order to manage critical patients. Thus, some prevention measures have been introduced in order to reduce the risk of infection and use the CVAD in an effective manner.
The insertion site of the CVAD is mostly related to the bloodstream infection. Thus, it is important to insert the catheter properly. In order to reduce the risk of infection it is important to select proper type of catheter and insert it according to the purpose and duration. Using midline catheter instead of short line catheter could reduce the risk of infection (Deshmukh and Shinde 2014). In case of central venous catheter it is required to avoid the insertion through femoral vein. Using an ultrasound guidance during the placement of CAVD could help to reduce the mechanical complications and the number of attempts of cannulation, thus could reduce the risk of infection effectively (Palomar et al. 2013). Maintaining hand hygiene and adequate aseptic techniques before and after the insertion of CVAD is important to reduce the risk of infection. In order to ensure safety cleaning of the skin with alcoholic chlorhexidine solution is required. It would help to clean the germs in the skin and facilitate the insertion process (Gahlot et al. 2014). Risk of infection increases with the duration of using CVAD, thus it is important to monitor the CVAD in a daily basis in order to prevent the infection. Study has identified that the most common source of bloodstream infection is the hubs of the CVAD. It serves as the pathway of entry for microorganisms. Such microorganisms may be dispersed into the bloodstream through the hubs and lumen and could cause severe infection. Thus, it is important to disinfect the surface of the hubs before accessing those (Shah et al. 2013). It is important to change the administration sets timely, because prolong use of one administration set could lead to the consequence of infection. Finally, after removal of the CVAD proper dressing is important in order to prevent infection (Deshmukh and Shinde 2014). Such process would help to reduce the risk of infection and foster the recovery.
Another potential risk for Joseph associated with CVAD is occlusion. It has been found that within 14 to 36% patient complication related to occlusion occur (Jeroudi et al. 2014). Different types of occlusion has been identified such as chemical, mechanical and thrombotic. Chemical occlusion occur due to the precipitation of drugs or medication. Mechanical occlusion is associated with internal or external complications. It may occur due to improper management, improper placement, tubing kinks, dislodgement and clogged filters (Meier et al. 2014). 58% occlusion occur due to thrombotic occlusion (Jeroudi et al. 2014). It may occurs due to formation of thrombus within the CVAD. Types of thrombus included intraluminal thrombus, mural thrombus or fibrin sheath or tail (Meier et al. 2014). In some cases it has been found that positioning of the patient leads to the consequence of occlusion. For example, if a patient positioned in a way that the position of the catheter get affected, the condition may cause occluded CVAD (Sukhu et al. 2014). Such occlusion could lead to severe health condition, thus it is important to introduce prevention measures and diagnose properly to provide adequate treatment.
It has been found that in major cases occlusion occur due to reflux of blood. Thus, it is important to maintain the patency of the catheter in order to minimize the risk of occlusion. In this regards the neutron catheter patency is effective (Shah and Shah 2014). Assessment of catheter patency is important in order to identify the types of occlusion and potential complications in the early stage and provide proper treatment to manage the occlusion. In addition, the patient could be educated regarding the management of CVAD and how to move during the administration of CVAD, so that their positioning could not affect the position of the catheter, thus, occlusion due to patient positioning could be prevented (Bastable and Bastable 2017).
In case if occlusion occur, it is important to diagnose it properly to introduce interventions according to the type of occlusion. In case of mechanical occlusion treatment include, reposition of the CVAD, removal of additional device such as connectors, placement of the catheter properly, identify the tip malposition and stop the infusion of intravenous fluid. Such process would help to manage the mechanical occlusion effectively (Rossetti et al. 2015). Clearance of catheter is important to improve patency and manage chemical occlusion. In case of low pH precipitation HCl is used for make it soluble and in case of high pH precipitation sodium bicarbonate or sodium hydroxide is used to make it soluble (Shah and Shah 2014). If occlusion is caused due to the formation of thrombus it is important to administer thrombotic agents in order to restore the CVAD. 0.9% sterile NaCl solution to each lumen and aspirate the blood from the lumens. Heparinised saline is also used to flush the lumens (Patel, et al. 2013). Alteplase could be used as catalyst to resolve the blood clots. It has been found that 2mg of Alteplase is most effective in order to treat thrombotic occlusion (Jeroudi et al. 2014). In order to investigate about the severity different tests are performed such as venography, chest x-ray and echocardiography and fibrinolytic lock is used before the investigation. In some severe cases thrombectomy need to be performed in order treat the thrombotic occlusion (Patel, et al. 2013).
Conclusion:
From the above discussion it can be said that, using CVAD is important in order to manage critical patients in ICU as it helps to administer medication and other intravenous fluids transfuse different blood products and draw blood for diagnosis with minimum risk of inflammation. However, it has been found that several risks are associated with CVAD, for example, occlusion and bloodstream infection. It has been found that bloodstream infection is most common within the ICU patients and approx. 36% patients suffer from occlusion of CVAD. Thus, it is important to introduce effective prevention and treatment in order to manage the risks, facilitate the treatment and ensure patient safety. The prevention and treatment process discussed in the paper could help to manage occlusion and bloodstream infection in an effective manner.
References:
Bastable, S.B. and Bastable, S.B., 2017. Essentials of patient education. Jones & Bartlett Learning.
Chopra, V., O’horo, J.C., Rogers, M.A., Maki, D.G. and Safdar, N., 2013. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infection Control & Hospital Epidemiology, 34(9), pp.908-918.
Deshmukh, M. and Shinde, M., 2014. Impact of structured education on knowledge and practice regarding venous access device care among nurses. Int J Sci Res, 3(1), pp.895-901.
Gahlot, R., Nigam, C., Kumar, V., Yadav, G. and Anupurba, S., 2014. Catheter-related bloodstream infections. International journal of critical illness and injury science, 4(2), p.162.
Jeroudi, O.M., Alomar, M.E., Michael, T.T., Sabbagh, A.E., Patel, V.G., Mogabgab, O., Fuh, E., Sherbet, D., Lo, N., Roesle, M. and Rangan, B.V., 2014. Prevalence and management of coronary chronic total occlusions in a tertiary Veterans Affairs hospital. Catheterization and Cardiovascular Interventions, 84(4), pp.637-643.
Madenci, A.L., Solis, C.V. and de Moya, M.A., 2014. Central venous access by trainees: a systematic review and meta-analysis of the use of simulation to improve success rate on patients. Simulation in Healthcare, 9(1), pp.7-14.
Meier, B., Blaauw, Y., Khattab, A.A., Lewalter, T., Sievert, H., Tondo, C., Glikson, M., Document Reviewers, Lip, G.Y., Lopez-Minguez, J. and Roffi, M., 2014. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion. Europace, 16(10), pp.1397-1416.
Moureau, N., Lamperti, M., Kelly, L.J., Dawson, R., Elbarbary, M., Van Boxtel, A.J.H. and Pittiruti, M., 2013. Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. British journal of anaesthesia, 110(3), pp.347-356.
Patel, V.G., Brayton, K.M., Tamayo, A., Mogabgab, O., Michael, T.T., Lo, N., Alomar, M., Shorrock, D., Cipher, D., Abdullah, S. and Banerjee, S., 2013. Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. JACC: Cardiovascular Interventions, 6(2), pp.128-136.
Palomar, M., Álvarez-Lerma, F., Riera, A., Díaz, M.T., Torres, F., Agra, Y., Larizgoitia, I., Goeschel, C.A. and Pronovost, P.J., 2013. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience. Critical care medicine, 41(10), pp.2364-2372.
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Shah, H., Bosch, W., Thompson, K.M. and Hellinger, W.C., 2013. Intravascular catheter-related bloodstream infection. The Neurohospitalist, 3(3), pp.144-151.
Shah, P.S. and Shah, N., 2014. Heparin?bonded catheters for prolonging the patency of central venous catheters in children. Cochrane database of systematic reviews, (2).
Sukhu, T. and Krupski, T.L., 2014. Patient positioning and prevention of injuries in patients undergoing laparoscopic and robot-assisted urologic procedures. Current urology reports, 15(4), p.398.
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