Vascular Access

It has been more than 10 years since The New England Journal of Medicine published the Keystone project’s ground breaking work on reducing ICU CLABSIs using a central line insertion bundle. Since that time, this has become the absolute standard throughout healthcare settings in the United States. When it comes to completing the central line insertions checklist, many of us only accept “yes” and “yes with prompting” as possible responses. Our accrediting agencies expect this as a standard of practice.

In this new series for 2017, we offer insights from experts in industry and in healthcare delivery regarding smart evaluation and purchasing of infection prevention and control-related products. In this installment, we address IV and catheter-related products.

Australian researchers have found a new way to make one of the most common medical procedures in the world - placing drips or intravenous (IV) lines - safer, less painful and potentially more cost effective. The researchers, who were funded by the Emergency Medicine Foundation of Australia (EMF), found that using medical skin glue to hold hospital drips in place significantly reduced the need to replace them due to infection, pain, blockage or falling out.

As infection preventionists (IPs), the Centers for Disease Control and Prevention (CDC)’s Guidelines for the Prevention of Intravascular Device Associated Infections have long served as the cornerstone of much of our policy development. When the SHEA/IDSA Compendium documents were released those too served as a source of guidance.  What sometimes has been overlooked have been the Infusion Nurses Society standards which were updated most recently earlier this year and currently reflect the latest evidence based recommendations for all aspects of infusion therapy across all disciplines involved. To keep moving the needle beyond the status quo we need to expand our involvement beyond just hand and skin antisepsis (an over simplification of our role!) and help with all aspects of vascular access and infusion therapy to impact the overall quality of care for these prevalent devices.

Earlier this year, one of the most widely used resources guiding clinical practice for the infusion specialty received a major upgrade. The Infusion Nurses Society (INS) issued a revised Infusion Therapy Standards of Practice, incorporating five years’ worth of new data to establish the most current, evidence-based best practices in vascular access.

Central venous catheters (CVCs) play an integral role in healthcare, however studies have shown that they are among the most frequent cause of healthcare-associated infections (HAIs). Their use is associated with a risk of bloodstream infection caused by microorganisms colonizing the external surface of the device or the fluid pathway when the device is inserted or in the course of its use. The Joint Commission’s CLABSI Toolkit notes that “Employing relatively simple evidence-based practices to reduce, if not eliminate, CLABSIs appears to be within the reach of even resource-limited settings. Within this framework, HAIs-and CLABSIs in particular-are more and more being viewed as ‘preventable’ events.”

Every day, patients around the country get IV devices placed in their arms, to make it easier to receive medicines or have blood drawn over the course of days or weeks. But these PICC lines also raise the risk of potentially dangerous blood clots. Now, a University of Michigan Medical School team has shown how serious that clot risk really is for hospitalized patients, and what factors put patients at highest risk.