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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Volume 1, Issue 1

Garrett Kitt, BSN, RNCentral Line Follow-Up

Garrett Kitt, BSN, RN

Over the past few months, Children’s Hospital’s administrative and clinical leadership, educators, physicians, and research personnel have been working diligently on the Central Venous Catheter (CVC) Management policy. This policy was built by the Central Venous Line (CVL) Policy Team, utilizing supporting evidence from national professional associations that are considered to be the largest pediatric physician-nurse evidenced based collaboratives in the nation. Our patients and staff benefit from these collaborative investigation efforts through a partnership with the National Association of Children’s Hospitals and Related Institutions (NACHRI). This national organization is the primary engine for reducing pediatric catheter-associated bloodstream infections (CA-BSI) in the U.S. This year, our Pediatric Intensive Care Unit (PICU) formally joined the NACHRI Quality and Research Project aimed at eliminating CA-BSI.

Recently our PICU CA-BSI team went to Dallas, Texas, for an update on the NACHRI CA-BSI Project. This is the second event our unit members have participated in this year. As a result, we have been able to represent our Hospital and share our evidenced-based CA-BSI prevention strategies, “CVC Care Bundles.” During these events our team participates with other children’s hospitals across the nation in large-scale, nurse-physician education and presentation efforts, which guide us in using the latest research to decrease CA-BSIs. This national project began in 2004 with 29 facilities and is now in its second phase expanding to 51 facilities, with a goal to include over 300 facilities. Many of the Phase One facilities have successfully achieved and sustained a rate of zero through implementation of the care bundles.

Nursing Excellence IconAs many of you may already know, one of the significant changes as a result of the new CVC policy and the NACHRI learning collaborative is the incorporation of insertion and maintenance bundles. “CVC Care Bundles”, designed with evidenced-based criteria to improve patient outcomes, are available in our open shelving areas. The concept of using pre-packaged items to complete a patient intervention is not new; but one of many ways (identified by clinicians) to simplify and standardize care with regard to venous access devices. The pre-packaged items were originally extracted from guidelines in the Centers for Disease Control (CDC) Patient Safety Protocol component of their National Healthcare Safety Network. This information, along with expert opinion considerations from NACHRI faculty and collaborative members, is being used nationally to set-up bundles that include tools for CVC site care of PICC lines and mediports, CVC blood draws, admin set/cap changes, and catheter insertion (1). Bundle education rollouts have been started and are being implemented via our Clinical Education Department. As referenced in the new CVC policy, the bundles contain equipment that we are familiar with and provide a one-stop-shop method for gathering necessary supplies to complete a task – all the while practicing with evidenced-based guidelines right at your fingertips (2). Having the availability of these pre-packaged items will streamline efforts.

Current NACHRI data shows that CA-BSIs are dramatically reduced with improved compliance of these bundles. It is no secret that standardized routines promote safer and more effective care (3, 4, 5). As we continue to standardize key areas in our practice, such as our CVC policy, we will be able to minimize margins of error and overcome related barriers in the future. By continuing to pursue these and other evidenced-based guidelines in practice, our patients will have improved outcomes. The collaborative’s baseline goal is to provide the insertion and maintenance bundle contents to at least 90% and 70% of all patients respectively with central lines (4). Our goal is to include utilization of this new practice with at least 95% of all patients with central venous catheters. The new CVC policy promotes the evidenced-based care necessary to deliver safer and more effective management of central line access. This is another example of how we further embrace our culture of safety. I am proud to be on your team – stay Magnetized. For more information on NACHRI, please visit their website.


References

1. Campbell, D., & Ridling, D. (ppt.) (2008). Proceedings from Phase 2 PICU Collaborative on Eradicating CA-BSI’s: Maintenance Bundle. Cincinnati,
OH.

2. Children’s Hospital Central California. (2008). Patient Care Guideline 2.3076:Central Venous Catheter (CVC) Management. Madera, CA.: Author.

3. Earing, K. A., Hobson, D. B., & White, K. M. (2005). Best practice protocols:preventing central line infection. Nursing Management, 36(10), 18-24.

4. Miller, M. R. (ppt.) (2008). Proceedings from Phase 2 PICU Collaborative on Eradicating CA-BSI’s: Welcome and a Shared Vision. Cincinnati, OH.

5. Pronovost, P., Needham, D., Berenholtz, S., et al. (2006). An Intervention to Decrease Catheter Related Bloodstream Infections in the ICU. New  England Journal of Medicine, 356(26), 2725-2732.


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