While much focus has been on CLABSI or BSI in data collection , gaining an understanding of overall device performance should be an ongoing part of a collaborative infection prevention and vascular access quality improvement program .
• to extend the complication free , functional dwell of all vascular access catheters . Reviewing practices regarding flushing ( volume , frequency and pattern ), needleless connector disinfection ( device requirements regarding clamp sequence to minimize blood reflux , plus organizational policies regarding hub hygiene with or without the use of alcohol impregnated caps ), site assessment ( frequency based on device type , infusate and patient characteristics ), dressing maintenance ( assessment of dressing for integrity , and presence of moisture of blood beneath the dressing ), consideration of the use of chlorhexidine dressings as well as maintenance of administration sets with an understanding of practices for continuous and intermittent infusions and specific medication requirements . Frameworks exist for evaluating current practices against evidence-based recommendations for improvement ( Ferrari and Taylor , 2020 ; Mathew et al ., 2020 ).
Removal
With the key exception of intraosseous ( IO ) devices and any device placed under emergent / non-aseptic conditions , there are no time-based requirements for removal of central or peripheral catheters . Reviewing organizational policies for alignment with these recommendations can enhance vessel health and preservation by reducing arbitrary , time-based restarts of devices ( Rickard and Wallis , 2012 ). For peripheral IVs , a framework such as I-DECIDED combines focused assessment and care with decisions about removal ( Ray-Barruel , Cooke , Chopra , Mitchell , and Rickard , 2020 ; G . Ray-Barruel , Cooke , Mitchell , Chopra , and Rickard , 2018 ). All devices require careful evaluation at specified intervals as noted in maintenance with clear plans for appropriate action and indications that require prompt removal and evaluation for potential need for reinsertion . Occlusion that cannot be resolved , lack of blood return prior to vesicant administration , painful insertion sites or tracts are several examples of common findings that would warrant removal . For all devices , there must be clear interdisciplinary involvement to identify the need for continued access and plans to provide continuity of therapy prior to removing functioning catheters while balancing the need for careful identification of idle catheters for prioritized removal if no longer clinically indicated .
Data Collection
While much focus has been on CLABSI or BSI in data collection , gaining an understanding of overall device performance should be an ongoing part of a collaborative infection prevention and vascular access quality improvement program . Identifying factors contributing to premature failure and increased completion of therapy will help reduce complications and improve outcomes . Various methods of obtaining this data and aggregating it exist to assist in streamlining the burden and maximizing the impact on improved processes ( DeVries , 2020 ; Girgenti and Moureau ,
2013 ) and there is an ongoing call to develop global registries for benchmarking and development of evidence based interventions ( Schults et al ., 2020 ). Taking the time to review strategies for clinical audits when undertaking individually rather than a consortium can help bolster the validity and clinical impact of the findings ( Ray-Barruel , Ullman , Rickard and Cooke , 2018 ; Ullman , Ray-Barruel , Rickard and Cooke , 2018 ).
Conclusion
Vascular access remains a key therapeutic necessity for hospitalized patients . Understanding organizational procedures regarding insertion , care , maintenance and removal of all vascular access devices as well as measuring outcomes and compliance with insertion and care bundles remains the cornerstone of preventing infections in patients with indwelling catheters .
Michelle DeVries , MPH , CIC , VA-BC , serves as the senior infection control officer at Methodist Hospitals in Gary , Ind . and as an adjunct research fellow with Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Griffith University , Brisbane , Australia .
Disclosures : DeVries serves as a consultant or on the speakers ’ bureaus with Becton Dickinson , Eloquest , Ethicon , Smiths Medical , Teleflex and Velano Vascular and has received investigator initiated grant funding from Johnson and Johnson .
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