Central Venous Catheter Access: The Registered Nurse's Role in Preventing Catheter Related Blood Stream Infections

Wednesday, July 13, 2011: 2:05 PM

William G. Warrington Jr., PhD, RN
Center for Nursing Research, Orlando Health, Orlando, FL
Mary Lou Sole, PhD, RN, CCNS, FAAN, FCCM
College of Nursing, University of Central Florida, Olando, FL

Learning Objective 1: The learner will be able to describe the nurse’s role in preventing catheter related blood stream infections.

Learning Objective 2: The learner will be able to identify two areas that nurses can improve to decrease catheter related blood stream infections.

Purpose:  Central venous catheters (CVC) are inserted to provide intravenous access for a variety of conditions.  CVC use increases the risk for catheter related bloodstream infection (CRBSI). CRBSI can be prevented through proper hand hygiene and aseptic technique during catheter access or manipulation. The purpose of this study was to describe current registered nurses (RN) practices related to CVC access and to identify opportunities for improvement.

Methods:  A prospective observational study was conducted following IRB approval and waiver of consent.  Trained observers used a checklist to evaluate the CVC access procedure on 11 pediatric and adult critical care units within a multi-hospital system; 483 observations were recorded.  Observations included hand hygiene and procedures for cleaning the access port.  Data were analyzed with descriptive statistics and chi-square analysis.       

Results:  The primary reason for accessing the port was to administer medications (71.2%).  Correct hand hygiene was observed 69.8% of the time, and clean gloves were worn in 85.3% of observations.  The correct antiseptic to cleanse the access port was applied 80.3% of the time, but the appropriate length of scrub time was only 40.0%, and drying time 21.5%.  No significant differences in practices were noted between weekends and weekdays or between day and night shifts.  RNs on the pediatric units had a higher hand hygiene compliance (85.2% versus 62.0%, p<0.001).  However, pediatric nurses were less likely to cleanse the port with alcohol (72.2% versus 84.4%), and used chlorhexidine and povidone iodine more often for cleansing (p=.001).  

Conclusion:  Many opportunities for improving hand hygiene and antiseptic use when accessing CVCs exist to prevent CRBSI.  RNs in the pediatric setting were more compliant in the hand hygiene procedure for proper CVC access.  Participation in a national initiative led by the pediatric clinical nurse specialist may be one reason for the higher compliance.