Standardizing central venous catheter care: hospital to home The guideline for Standardizing central venous catheter care: hospital to home was obtained from the National Guideline Clearinghouse. This guideline standardizes care of the central line to ensure continuity of care and decrease complications. Central line infection and thrombosis cause thousands of deaths each year and increases medical costs (CDC). Proper care of the central line utilizing antibacterial dressings, passive disinfection caps and pulsatile flushing can decrease infection. Properly obtaining blood specimens can result in faster identification of bacteria and proper intravenous (I.V.) antibiotic administration. Thrombosis can be decreased with proper flushing and monitoring. Patients transitioned to home from the hospital with a central line need to understand their role in self-care and reporting of complications.
Theoretical Foundation Dorothy Orem’s theory of self-care speaks to a person’s knowledge of potential health concerns (Petiprin, 2016). One of the major assumptions of the theory is people should be self-reliant and responsible for their care. Patients transitioned to home with central line catheters are often over whelmed and anxious with caring for the catheter. Utilizing Orem’s theory, the nurse understands there are universal self-care requisites. A home care nurse will assess the home situation to ensure I.V. therapy care can be performed in the home. The home is evaluated for safety and that the patient has access to necessities. Referrals are often made to community resources to further assist the patient. When a patient becomes ill, according to Orem’s theory, health deviation self-care requisites develop (Petiprin, 2016). Education becomes crucial. Home care patients need to understand how to contact the nurse, doctor and to utilize the 911 system for emergencies. Patients need to understand complications of I.V therapy and CVAD complications. The nurse will teach proper handwashing, care of the central line, flushing of the lumens, medication administration and trouble shooting. Signs and symptoms of infection and thrombosis are also taught. Utilizing a guideline allows proper procedure and continuity of care among nurses. Orem has identified five ways methods of helping patients. These methods are evident when caring for patients with Central lines. The five methods of helping are (a) acting for and doing for others, (b) guiding others, (c) Supporting others, (d) providing an environment promoting personal development in relation to meet future demands and (e) teaching another (Petiprin, 2016). Nurses help patients by changing the central line dressing and assessing for complications. Patients can be guided at this time with education and emotional support. Consideration must be made that central lines can cause body image disturbances, especially for younger patients. Ensuring patients’ needs are being met and being nonjudgmental will provide a trusting relationship. Review of Literature Prevention of central line infection is crucial to decrease mortality. Central line dressings are a barrier against unwanted organisms entering the catheter insertion site. Properly maintaining the site will decrease complications. A longitudinal prospective cohort s study was conducted by Mark Loewenthal, et al. in 2016. This study indicates a concentration of 2% chlorhexidine (CHG) is associated with a higher rate of skin reactions than either 0.5% or 1% CHG. Interestingly, higher CHG concentrations did not decrease the number of central-line-associated bloodstream infections (CLABSIs). Skin reactions observed included inflammation, itching, and /or burning. The study utilized two types of polyurethane films dressing with a polyacrylate adhesive. The guideline recommends chlorhexidine solution for skin antisepsis as part of …show more content…
However, current research indicates more thought needs to be given when drawing specimens. The following laboratory tests: glycemia, azotemia, alkaline, Phosphatase, SGPT, bilirubin, amylase, GGT, chlorine, troponin I, CK-MB and platelets showed no value changes when drawn from the central line with different waste volumes or drawn peripherally. Also, the values did not change if the catheter was flushed with 5ml or 10 ml of NSS prior to obtaining the specimens. Alternatively, drawing specimens for LDH, calcium, potassium and white blood count showed significant discrepancy between a central line draw and obtaining peripherally (Cicolini). Further research would be necessary to determine if larger waste volumes had an effect on laboratory values. The study also does not indicate if the patient was receiving continuous infusion via the Central
Theoretical Foundation Dorothy Orem’s theory of self-care speaks to a person’s knowledge of potential health concerns (Petiprin, 2016). One of the major assumptions of the theory is people should be self-reliant and responsible for their care. Patients transitioned to home with central line catheters are often over whelmed and anxious with caring for the catheter. Utilizing Orem’s theory, the nurse understands there are universal self-care requisites. A home care nurse will assess the home situation to ensure I.V. therapy care can be performed in the home. The home is evaluated for safety and that the patient has access to necessities. Referrals are often made to community resources to further assist the patient. When a patient becomes ill, according to Orem’s theory, health deviation self-care requisites develop (Petiprin, 2016). Education becomes crucial. Home care patients need to understand how to contact the nurse, doctor and to utilize the 911 system for emergencies. Patients need to understand complications of I.V therapy and CVAD complications. The nurse will teach proper handwashing, care of the central line, flushing of the lumens, medication administration and trouble shooting. Signs and symptoms of infection and thrombosis are also taught. Utilizing a guideline allows proper procedure and continuity of care among nurses. Orem has identified five ways methods of helping patients. These methods are evident when caring for patients with Central lines. The five methods of helping are (a) acting for and doing for others, (b) guiding others, (c) Supporting others, (d) providing an environment promoting personal development in relation to meet future demands and (e) teaching another (Petiprin, 2016). Nurses help patients by changing the central line dressing and assessing for complications. Patients can be guided at this time with education and emotional support. Consideration must be made that central lines can cause body image disturbances, especially for younger patients. Ensuring patients’ needs are being met and being nonjudgmental will provide a trusting relationship. Review of Literature Prevention of central line infection is crucial to decrease mortality. Central line dressings are a barrier against unwanted organisms entering the catheter insertion site. Properly maintaining the site will decrease complications. A longitudinal prospective cohort s study was conducted by Mark Loewenthal, et al. in 2016. This study indicates a concentration of 2% chlorhexidine (CHG) is associated with a higher rate of skin reactions than either 0.5% or 1% CHG. Interestingly, higher CHG concentrations did not decrease the number of central-line-associated bloodstream infections (CLABSIs). Skin reactions observed included inflammation, itching, and /or burning. The study utilized two types of polyurethane films dressing with a polyacrylate adhesive. The guideline recommends chlorhexidine solution for skin antisepsis as part of …show more content…
However, current research indicates more thought needs to be given when drawing specimens. The following laboratory tests: glycemia, azotemia, alkaline, Phosphatase, SGPT, bilirubin, amylase, GGT, chlorine, troponin I, CK-MB and platelets showed no value changes when drawn from the central line with different waste volumes or drawn peripherally. Also, the values did not change if the catheter was flushed with 5ml or 10 ml of NSS prior to obtaining the specimens. Alternatively, drawing specimens for LDH, calcium, potassium and white blood count showed significant discrepancy between a central line draw and obtaining peripherally (Cicolini). Further research would be necessary to determine if larger waste volumes had an effect on laboratory values. The study also does not indicate if the patient was receiving continuous infusion via the Central