Preventing Infection While Inserting Central
The most common infection is the central line associated blood stream infection (CLABSI). The risk is greater when the central intravenous line is in place for a longer period of time, especially when the catheter is not maintained appropriately or when there is a leakage of IV fluid into the tissues. Inserting a central intravenous line is a sterile procedure so it is a nurse’s responsibility to minimize the risk of infections. Health care-associated infections increase the length of hospitalization, hospital cost, patient discomfort, and morbidity and mortality rates (O’Grady & Pearson, 2002).
Thus, it is important for health care professional and nurses to be responsible for knowing their roles and how to use maximum sterile barriers while placing central venous catheters. According to the Agency for Healthcare and Research Quality (AHRQ), there are many practices healthcare professionals should follow to prevent CLABSI (Marschall, 2008). Maximum sterile barriers are one of the essential practices when inserting central venous catheters to prevent catheter-related bloodstream infections, which are observed in a patient care scenario that occurred in the neonatal intensive care unit.
Jenkins is a former 30 weeks-premature male infant born with respiratory distress and placed on a ventilator. He later developed bowel distention and could not tolerate formula. He was started on a course of antibiotics and was given nothing by mouth (NPO). Infant was then started on total parenteral nutrition (TPN) and intralipids (IL) via peripheral intravenous line. Upper gastrointestinal X-rays were done and showed bowel perforation, so a pediatric surgeon was consulted for bowel surgery.
It was found that the infant had exploratory laparotomy and bowel resection. Thus, the infant remained on NPO and total parenteral nutrition and intralipids continued to be administered. Due to long term needs of intravenous fluids (IVF), it was difficult to maintain the intravenous site, so the infant needed a CVC. Initially, a peripheral inserted central catheter line was unsuccessfully attempted three times by a nurse practitioner. The pediatric surgeon was consulted for the second time to surgically place a CVC for long term IVF fluids replacement.
Before the patient went for the procedure, all health care personnel were responsible in following the recommended AHRQ guidelines to prevent an infection from occurring. This would include the monitoring of central line insertion before and after central line management with ongoing maintenance care (Marschall, 2008). Before Insertion: All nurses would be educated on the risk factors of CLABSI and proper maintenance of the central line, such as administration of medication, IV tubing changes, and dressing changes, according to their hospital’s policies and protocols.
Nurses’ competencies would be reviewed on an annual basis, and nurses would verify that consulting surgeons or the trained staff is competent to do surgical central line insertions to make sure preventative measures are taken to bypass potential infections (Marschall, 2008). Parents would also be educated on risk factors before the CVC is inserted to learn how certain sterile techniques, such as cleaning hands with alcohol-based rub or soap and water, prevent infections. At Insertion: A catheter checklist is utilized to make sure all measures are taken to prevent infection when the CVC is inserted.
Proper sterile barriers are implemented: a mask prevents infection from any talking and coughing that may occur; a hat prevents hair from falling; and sterile gown and gloves keep any microorganisms that may be on your hands and clothes from crossing the sterile barrier (Raad, Hanna, & Maki, 2007). A sterile drape should cover the patient to provide additional protection against possible infection. Traffic is reduced around the sterile field, and a designated nurse observes that aseptic techniques are maintained during the procedure, reporting any changes in the aseptic technique.
Gloves are used only after hands are washed with alcohol-based rub. Chlorhexidine is used on patients older than 32 weeks of age because further research is needed on the alternative effects on the skin. Povidine-iodine is used for patients under the age of 32 weeks. (Miller-Hoover & Small, 2009). After Insertion: The catheter needs to be reevaluated on a daily basis to prevent infection. Nurse must use sterile maximum barriers when administering medication through the catheter injection port, changing IV tubing, and change dressing.
Central venous catheters are usually cared and maintained by nurses, so nurses are accountable for following all the sterile technique measures when administering medications, changing IV tubing, and changing dressing (Sharpe, 2009). Nurses must assess the needs of the catheter on a routine basis to prevent CLABSI. Without proper care, a catheter can cause the development of sepsis, which leads to a spike in the mortality rate. Nurses are accountable for proper documentation of the central line site for skin integrity.
In addition, nurses and other health care professionals must have good sanitary hygiene and create a sterile environment when interacting with patients. Preventing CLABSI all starts with proper care by healthcare professionals, but it also occurs as nurses educate the patients, their families, and their fellow peers on how to avoid infection. In conclusion, central venous catheters are one of the leading causes of infection in hospitals. The AHRQ has published guidelines and regulations to help nurses in their responsibilities to treat patients.
These guidelines include the use of a catheter checklist, sufficient training of the nursing staff, and most importantly, and the creation of a maximum sterile barrier for the patient. Using the correct antiseptic based on age of the infant and proper hygiene by health professionals can make a large difference in hospitals where patients are prone to infections. Overall, it is the nurse’s responsibility to prevent infection by maintaining a sterile environment with a mask, cap, patient drape, and other barriers. With proper care and diligence, patient safety becomes an utmost priority.