Home infusion pharmacy quality improvement for central venous access devices using anti-reflux needleless connectors to reduce occlusions, emergency room visits, and alteplase costs (original) (raw)
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Central Venous Catheters in Home Infusion Care: Outcomes Analysis in 50,470 Patients
Journal of Vascular and Interventional Radiology, 2002
PURPOSE: Outpatient home infusion therapy is increasing; however, little data exist on the outcomes of patients receiving care. The purpose of this study was to document the natural history of central venous catheters (CVCs) used in home infusion care to determine the rate and type of catheter complications.
Journal of hospital medicine, 2014
Central venous catheter (CVC) occlusion is common, affecting 30% of all CVCs. To compare length of stay (LOS), costs, and readmissions associated with the use of alteplase to clear catheter blockage to outcomes associated with catheter replacement. Retrospective observational study utilizing a large hospital database. Hospitalized patients treated for catheter occlusion from January 2006 to December 2011. Univariate analyses of patient characteristics and treatment patterns and multivariable regression analyses of postocclusion hospital costs, LOS, and 30- and 90-day readmissions were conducted. We included 34,579 patients treated for a CVC occlusion by replacement (N=1028) or by alteplase (2 mg) administration (N=33,551). Patients receiving alteplase were somewhat younger than those having catheter replacement (60 ± 19 vs 62 ± 20 years old, P=0.0002). After adjusting for patient and hospital factors via regression modeling, average daily postocclusion costs were $317 lower for alte...
Journal of Parenteral and Enteral Nutrition, 2006
Background: Intraluminal occlusion is common in children with central venous catheters (CVCs). Although multiple factors predispose CVCs to occlusion, reflux of blood is frequently implicated. We hypothesized that use of either a single-valve or positive-pressure-valve needleless connector device would reduce CVC occlusion rates in comparison to a standard device. We further hypothesized that saline would be as effective as heparinized saline flush in preventing occlusion and infection. Methods: CVC lumens were prospectively capped with 1 of 3 needleless connector devices in a 4-group design. Group 1 lumens were capped with a standard device, group 2 with a single-valve device, group 3 with a positive-pressure-valve device flushed with heparinized saline, and group 4 with a positive-pressure-valve device flushed with saline. Data were obtained regarding occlusion and infection rates and user satisfaction. Results: Three hundred sixty children with 599 CVC lumens completed the study. Complete occlusion occurred in 19/150 (12.7%) lumens in group 1 in comparison to 2/150 (1.3%) in group 2, 5/149 (3.4%) in group 3, and 6/150 (4%) in group 4 (p Ͻ .05). There was a trend toward a 2-fold greater infection rate in group 4. User satisfaction was higher in groups 2, 3, and 4 than group 1 (p Ͻ .05). Conclusions: CVCs capped with a single-valve or positive-pressure-valve needleless connector device have lower complete catheter occlusion rates than those capped with a standard device. Heparinized saline flush affords no advantages over saline in reducing occlusion rate; however, there was a trend toward lower infection rate with the use of heparinized saline. ( Journal of Parenteral and Enteral Nutrition 30:85-90, 2006) Central venous catheters have become essential in the management of adults and children with acute and chronic diseases. Though these devices are clearly beneficial, they are not without risks. One of the most frequent complications associated with the use of these devices is occlusion, which occurs in up to 25% of central venous catheters. 1,2 Historical prospective data at Cincinnati Children's Hospital Medical Center (CCHMC) revealed a 12% catheter occlusion rate (internal data). Catheter occlusion can lead to restricted catheter use and delay or discontinuation of patient therapy, thus compromising the quality of care. In addition, the resulting inability to obtain blood samples through these malfunctioning devices can result in the need for peripheral venipuncture that is often difficult and traumatic in children. Characteristics that contribute to catheter occlusion include catheter composition, catheter size, various patient factors, infusate composition, local catheter use protocols, and the use of connector devices. 3-5 A variety of needleless connector devices has been marketed, with claims that they can decrease central venous catheter occlusion and infection rates by preventing reflux of blood through the catheter tip. Needleless connector devices are currently available with 4 basic designs: standard (no valve), single valve, dual valve, and positive pressure valve. Theoretically, needleless connector devices with an internal valve prevent retrograde movement of fluid and associated complications, including catheter occlusion and infection. A positive-pressure-valve needleless connector device was recently shown to be effective in significantly reducing total catheter occlusion rate in comparison to a standard connector device. 6,7 There is, however, little additional published evidence supporting the use of one valve connector device design over another in the prevention of central venous catheter occlusion, infection, or other complications. We hypothesized that the use of either a single-valve or positivepressure-valve needleless connector device would reduce central venous catheter occlusion rates in comparison to the use of a standard device in children with indwelling central venous catheters. In addition, we hypothesized that the use of saline-only flush would be as effective as heparinized saline flush in preventing occlusion and infection.
Safer patient care through better Peripheral Intravenous Catheter management
International Journal of Infection Control, 2012
a surveillance project was undertaken in 3 medical wards of a teaching hospital in Malta, with the aim of introducing standardised peripheral venous catheter (PVC) care and to reduce risk of infections. Data on 285 patients' with peripheral catheters left in situ for more than 12 hours was collected from october 2010 to February 2011 in two separate surveillance periods; pre and post intervention. In the pre-intervention phase 132 observations of PVC were carried out whereas 153 catheters were observed in the post-intervention phase. each catheter was assessed for documentation of insertion date, quality of dressing, duration of catheter and Visual Infusion Phlebitis (VIP) score. The intervention consisted of introducing the VIP score document for daily cannula assessments and their duration not exceeding 72 hours. Medical doctors and nurses were offered regular training on the new procedure and the post-insertion care of PVC lines. other measures included daily assessment of PVC line, weekly audit with feedback to nursing and medical staff. The phlebitis rate fell from 22.7% in the pre-intervention to 6.5% in the post-intervention phase. There was also significant improvement in dressing quality and reduction of PVC duration days. The risk of developing phlebitis was 3.47 times higher in the pre-intervention phase than in the post-intervention (95CI: 1.77-6.84) p=0.0001. The results suggest that a significant reduction in the incidence of inflammation associated with peripheral intravenous catheters may be achieved by performing daily cannula assessments and replacing the catheters after 72 hours.
Central venous catheter practices: Results of a survey
American Journal of Infection Control, 1995
Background: The incidence of nosocomial bloodstream infections has increased twofold to threefold in the past decade, and central venous catheter infections account for about 90% of catheter-related nosocomial bloodstream infections. Many studies of risk factors for central venous catheter complications have been conducted, resulting in recommendations for preventive strategies, but few data are available regarding the frequency with which such strategies are employed in clinical practice. Methods: A survey was conducted of persons attending a meeting of the National Association of Vascular Access Networks in New Orleans on September 25, 1992. The survey contained 15 questions related to central venous catheters regarding infection control measures, measures to maintain patency, and use of the catheter for obtaining blood specimens for diagnostic tests. Results: Ninety-two persons from 24 states completed the questionnaire as representatives of 23 teaching hospitals, 21 nonteaching hospitals, and 48 home health agencies. Transparent dressings were used more frequently (88%) than cotton gauze (27%). Alcohol and povidone-iodine solutions were the most frequently used antiseptics. Antimicrobial ointment was used by fewer than half; of these, 86% used povidone-iodine and 26% used polymyxin-neomycin-bacitracin. Heparin flushes were still being used by 97% to maintain patency. Most (82%) used central venous catheters to draw blood cultures; of these, 68% drew only qualitative cultures and 32% drew quantitative cultures in addition to or instead of qualitative cultures. Conclusions: Significant diversity of practice was documented among the health care organizations represented in this survey. Some of the practices documented in this survey have been associated with higher rates of bloodstream infection; this may partially explain the observed increase during the past decade in the incidence of nosocomial bloodstream infections. (AJIC AM J INFECT CONTROL 1995;23:5-12) Approximately 5 million central venous catheters (CVCs) of various types are sold in the United States each year. 1 Many of these catheters are inserted in hospitalized patients on a short-term basis for hemodynamic monitoring or administration of drugs, parenteral nutrition, fluid therapy, and blood products. Long-term, tunneled CVCs and implantable ports are inserted for ease of venous access in patients with malignancy or other serious diseases requiring prolonged