Objective: Complications following central venous catheter removal (CVC) have been associated with potentially serious and life-threatening conditions as a result of venous air embolism. Following a minor complication post central line removal, our staff reviewed the literature for direction to best practice.
Design: The investigation included synthesis of evidence, including, but not limited to, input of advanced practice nurses and physicians from throughout the United States and, the Centers for Disease Control and Association of Critical Care Nurses websites.
Population: Evidence revealed two main goals to prevent air embolism for all patients: increased intrathoracic pressure and, provision of a mechanical barrier.
Concepts: The case studies discovered in the evidence and input from multiple experts prompted us to revise current practice.
Methods: Utilizing gathered evidence, the procedural steps to discontinue a CVC were revised. The procedure then underwent the standard institutional approval process. Multiple strategies were utilized to educate current staff and the skill was added as an orientation competency.
Findings: Recent presentation of this effort at a national nursing conference elicited positive feedback. Review of the evidence, most notably the case studies of complications, produced an "AH-HA" moment by our staff, in that the procedure is common, yet not benign.
Conclusions: Nurses need to question current practice. Steps within each critical procedure must be identified and re-evaluated at timed intervals to ensure support by critical thinking and research.
Implications: Using evidence to change practice de-emphacizes ritualistic clinical experiences. This investigation stimulated staff nurses to continue the process of utilizing evidence to examine practice.
Back to The Demise of "Sacred Cows" in Nursing Practice: A Magnet Hospital Uses the Evidence
Back to International Evidence-Based Practice Preconference
Sigma Theta Tau International
9 July 2003