Central Venous Catheter Infection Problem - Literature review Example

?CVC Infection Problem: Literature Review Introduction This research paper is focused on the problem of CVC infection problem discussion. This chapter will present a literature overview of the theme related to the challenges of CVC infection problem and correlate it with the problem of nursing practices. Such issues, as CVC insertion, hygiene, compliance with general norms, regulations and recommendations are considered. Literature Review Researches and studies in the field of central venous catheter (CVC) related infection, post-insertion care and CDC guidelines have been lately crucially important for the medical staff and nurses. The study presents a literature search using several databases, including Cinahl Plus, ProQuest, PsyclNFO, and MEDLINE Ovid, and a variety of professional websites such as Google Scholar. In relation to CVC-related infection, many search results emerged. They were subsequently selected by the following criteria: English articles, articles written within the last 10 years and relevancy to the topic. Many different search terms were used to find suitable articles and other relevant research material to support this thesis. Terms used in database searches were “central venous catheter”, “central venous catheter-related infection”, “intravascular catheter-related sepsis”, “CDC guidelines”, and “catheter dressing”. Much of the literature reviewed and many of the most recent studies focus on the following topics: managing central venous catheters, the role of nurses working in critical care environments in the prevention of intravascular catheter-related bloodstream infection, and new guidelines to reduce central venous infection. Central venous catheters provide many benefits for the patient and they are considered life-sustaining devices; however, their use can result in various complications for the patient, such as thrombosis and infection, which increase incidences of morbidity and mortality (Rello et al, 2000; Dimick et al, 2001). In the abovementioned sources, there is an evident tendency to focus on an important role of a nurse, taking care of a patient with CVC-related infections, such as the insertion site, skin antisepsis, dressings, administration of set replacement and hand hygiene. 1. What is central venous catheter? CVC "is any catheter with its tip inserted into a large central vein such as the superior or inferior vena cava, the femoral iliac, subclavian, or jugular veins” (Collingnon 1994, p….). A large central vein is used to insert a central venous catheter, which is the vascular infusion site used for CVC, blood aspiration, massive fluid infusion, renal replacement therapy, medication administration, nutrition, and right heart catheterization (Himilton & Bodenham, 2009, and Shapy et al, 2008). There are the following options of CVC insertion: tunneled (inserted via two small incisions on a chest: one is a few inches above a nipple and another is under a collarbone, peripherally inserted (the end of the catheter lies in a large vein near your hear) or implanted ports (are surgically placed under the skin, usually on the upper chest, and the catheter is threaded into the venous system). The common insertion sites are femoral, subclavian, and internal jugular veins. 2. Epidemiology: The central venous catheter is connected with risk for infection that can increase morbidity and mortality and the cost of care (Labeau et al, 2008; Rickard etal,2004). In England, approximately 6,000 patients per year may acquire a catheter-related blood stream infection and the estimated cost to treat these infections exceeds 6,000 pounds per infection (Waghorn, 1994; National Audit Office, 2004). Similarly, in the United States, the estimate is up to 16,000 ICU patients per year with treatment costs per infection estimated to range from $3,700 to $29,000. Annually, 500 to 4,000 patients die of central venous catheter-related bloodstream infections (Mermal, 2000). In Europe, almost 12% of healthcare-associated infections are bloodstream infections (National Audit Office, 2004). An 18 month prospective, nested case-control study for 55 patients with bloodstream infection (BSI) and 55 without BSI shows an increased length of stay in ICU for patients with central venous catheter–associated BSI. The consequences include increased healthcare costs and a higher attributable mortality (Higuera et al, 2007). On other hand, there are two studies, which did not find association between CVC-RBSI and ICU mortality with control severity of illness (Digiovine et al, 1999; Soufir et al, 1999). Also, two prospective studies suggest 35% increase in mortality rate( Collignon,1994; Pittet, Tarara& 1994), that is evident nowadays after more than a decade has already passed. Three studies undertaken done in Pediatric Intensive Care Unit (PICU) examined about costs of CVC infections. The studies compared nosocomial infection primary BSI for patients with nosocomial primary BSI infection with patients without nosocomial primary BSI infection. The patients each had similar underlying diseases and periods of ventilator days. The findings shows that costs of caring for patients with nosocomial primary BSI are far higher than costs for patients those who are not diagnosed with nosocomial infection primary BSI (Elward et al , 2005, SoLonim et al, 2001). Moreover, catheter-related bloodstream infections account for 10-20% of all nosocomial infections. The rates of CR-BSI are high; however, Harbart, Sax and Gastemier (2003) consider at least 20% in their review of studies done between January 1990 and October 2002, while Berenholtz et al (2004) in his prospective cohort study claims that almost all CVC-RBSI can be decreased. Similarly, Pronovost et al (2006) report fall in catheter-related bloodstream infection rate by 66% after using evidence- based strategies, such as “bundle research strategy”, which is focused more on practice with a strong theoretical background). Therefore, there is an evident correlation between these two studies, claiming about CVC-RBSI gradual elimination. Although physicians are responsible for CVC requests and insertions, post-insertion catheter care is primarily a nursing responsibility. This means that nursing care plays a major role in catheter-infection prevention. As a result, there are many practices now implemented in hospitals to decrease levels of infection in any procedure involving intravenous administration set or site of catheter insertion. (Rickard et al, 2004). 3. Catheter-related infections prevention In order to prevent catheter-related infections, a nurse can take care about the catheter surface. Usually, the microorganisms originate from the patients’ own skin flora. This route is the most common one and it occurs either at the time of insertion or later. Secondly, a nurse should remember of a catheter hub, where microorganism colonies grow. Siteges-Serra et al (1985) recognized that the most common source of catheter-related infection was the catheter hub. Thirdly, a nurse should remember about microorganisms spread via the bloodstream. Finally, contamination may occur because of fluid infusate (Elliot & Mermal, 2000, Mermal et al, 2001, and Herman, Hamilton & Bodenham, 2009). However, Herman added another possible source or entry route, which was manipulation of the venous line, with the resulting migration of organisms along the internal lumen of the catheter. 4. Types of intravascular catheter-related infection: There are two categories for intravascular catheter-related infection: localized or systemic. A localized infection occurs when microorganisms colonize in the exit site of the catheter. Patients who have a localized central venous catheter-related infection are fortunate in that, in this type of infection, erythema, oedema, and purulent exudates may be present at the insertion site. It is easy to detect this type of infection early with regular observation of the insertion site, as recommended in post-catheter insertion care. In contrast, systemic infection associated with intravascular catheterization may be only suspected if patients have low-grade fevers ( Read More