Preventing occlusion and restoring patency to central venous catheters

Bolton, Deborah

doi:10.12968/bjcn.2013.18.11.539

Cited by 10 publications

(3 citation statements)

References 21 publications

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“…The occlusion rate varies depending on the setting, purpose of use, patient characteristics, and can range from 0% to >30%. 7,[10][11][12][13][14] Fibrin sheath formation can occur within 1 week of catheter placement as a result of the body's physiological response to vein injury and to presence of a foreign body, resulting in possible catheter obstruction. 8,15 In addition, pressure changes within the catheter due to body movements, muscle flexing, respiration, coughing, vomiting, crying, clamping, unclamping, syringe plunger rebound, and syringe connection/disconnection can pull blood into the catheter tip and promote thrombus formation within a lumen.…”

Section: Introductionmentioning

confidence: 99%

Needle-free connectors to prevent central venous catheter occlusion at a tertiary cardiac center: A prospective before and after intervention study

et al. 2021

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Objectives: To evaluate the effectiveness of needle-free connectors to maintain Central Venous Catheter—CVC patency. Background: Loss of patency is a common complication associated with CVC. For patients, this can be stressful and painful, and can result in a delay in infusion therapy. Pressure-activated anti-reflux needle-free connectors are one of the most modern devices; however, no studies have compared this connector with the open-system three-way stopcock in terms of the incidence of CVC occlusion. Methods: This study is a prospective before and after intervention study. From March to August 2018, an observation phase was conducted with the three-way stopcock as the standard central venous catheter hub and closure system (phase 1). After implementation of needle-free connectors (phase 2), post-intervention observations were made from September 2019 to January 2020 (phase 3). Results: Of 199 CVCs analyzed, 41.2% (40/97) occluded in at least one lumen in the first phase, and 13.7% (14/102) occluded after introducing the technological device, absolute risk reduction 27.5% (95% confidence interval 15.6%–39.4%). The lumens supported by needle-free connectors showed a higher probability of maintaining patency compared with three-way stopcocks. No differences were observed in the rate of infection. Conclusions: Pressure-activated anti-reflux needle-free connectors are effective and safe devices suitable for the management of vascular access in cardiac patient care. Staff training, even on apparently simple devices, is essential to avoid the risk of infection.

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Section: Introductionmentioning

confidence: 99%

Needle-free connectors to prevent central venous catheter occlusion at a tertiary cardiac center: A prospective before and after intervention study

et al. 2021

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“…[1][2][3][4] Embora as vantagens do CVC sejam bem reconhecidas, a incidência e o potencial de complicações associadas não devem ser minimizadas, entre as quais a obstrução do cateter. 5 Existem várias razões para o desenvolvimento da oclusão, como causas mecânicas, precipitação de medicamentos e infusões de soluções densas, além da frequência de realização e do tipo de solução para flushing. 1,5 No entanto, a obstrução de gênese trombótica é a mais comum, 5,6 o que implica para o paciente na interrupção terapêutica e no aumento de riscos associados à nova cateterização, além de acréscimo de custos hospitalares.…”

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“…5 Existem várias razões para o desenvolvimento da oclusão, como causas mecânicas, precipitação de medicamentos e infusões de soluções densas, além da frequência de realização e do tipo de solução para flushing. 1,5 No entanto, a obstrução de gênese trombótica é a mais comum, 5,6 o que implica para o paciente na interrupção terapêutica e no aumento de riscos associados à nova cateterização, além de acréscimo de custos hospitalares. 7 O uso da solução de heparina tem sido o método mais utilizado desde os anos 1970 6 para garantir a função e uso do CVC, pois se acredita que a heparina previne a coagulação no dispositivo.…”

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Solução salina versus heparina para permeabilidade do acesso venoso central de curta permanência: revisão integrativa / Saline solution versus Heparin for permeability of short-stay central venous access: an integrative review

Silva¹,

Machado²,

Leonhardt³

et al. 2021

Braz. J. Hea. Rev.

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RESUMOObjetivo: analisar as publicações sobre uso de heparina comparada a solução salina para manter permeabilidade e prevenir oclusão do Cateteres Venosos Centrais (CVC) de curta permanência em pacientes adultos. Métodos: revisão integrativa realizada através das bases MEDLINE/PubMed, CINAHL, Web of Science, Scopus e BVS, de artigos publicados entre 2011 e 2020, com os descritores controlados e operadores booleanos: heparin AND sodium chloride OR saline solution AND central venous catheters AND permeability OR catheter obstruction. Resultados: foram encontrados 1731 artigos na busca, sendo que 6 compuseram a amostra final, todos estrangeiros. Houve maior prevalência de estudo com nível de evidência I (4 publicações). Todos os estudos recomendaram o uso da solução salina devido a pouca ou baixa qualidade da evidência acerca do uso da heparina. Conclusão: parece não haver diferença entre o uso de heparina ou solução salina no que diz respeito a manutenção da permeabilidade do CVC de curta permanência em pacientes adultos. Implicações para a prática: sugere-se o uso da solução salina para manutenção da permeabilidade do CVC de curta permanência, a fim de reduzir a exposição à heparina e suas potenciais complicações, além do que é uma solução mais viável economicamente.

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Lean Six Sigma for Intravenous Therapy Optimization: A Hospital Use of Lean Thinking to Improve Occlusion Management

Steere

Rousseau

Durland

2018

Journal of the Association for Vascular Access

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Background: Continual improvement is a necessary part of hospital culture. This occurs by identifying opportunities for improvement that influence efficiency while saving money. Methodology: An investigation of intravenous device-related practices was performed by the nurses of the intravenous access team, pharmacy, and hospital operations at Hartford Hospital using Lean Six Sigma methodology. Central venous access device occlusion and tissue plasminogen activator variability was identified. Using observation, measurement of performance, and root cause analysis, the hospital's practices, policies, and equipment were evaluated for the process of occlusion management. The team utilized a Six Sigma strategy employing the elements define, measure, analyze, improve, and control, which is a disciplined, data-driven methodology that focuses on eliminating defects (waste). Interventions initiated based on the assessment performed by the team using the define, measure, analyze, improve, and control approach included replacement of negative displacement needleless connectors with antireflux needleless connectors and specialty team assessment before tissue plasminogen activator use. Results: Over the course of the 26-month study, Hartford Hospital experienced a 69% total reduction in tissue plasminogen activator use representing a total 26-month savings of $107,315. Other cost savings were reflected in areas of flushing, flushing disposables, and in a decrease in needleless connector consumption. Central line-associated bloodstream rates fell 36% following the intervention as an unexpected secondary gain, resulting in further savings related to treating this nonreimbursable hospital-acquired condition. Conclusions: This study examined the influence of using Lean Thinking and Six Sigma methodology as a tool in saving hospital money, resulting in better patient outcomes.

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Preventing occlusion and restoring patency to central venous catheters

Cited by 10 publications

References 21 publications

Needle-free connectors to prevent central venous catheter occlusion at a tertiary cardiac center: A prospective before and after intervention study

Needle-free connectors to prevent central venous catheter occlusion at a tertiary cardiac center: A prospective before and after intervention study

Solução salina versus heparina para permeabilidade do acesso venoso central de curta permanência: revisão integrativa / Saline solution versus Heparin for permeability of short-stay central venous access: an integrative review

Lean Six Sigma for Intravenous Therapy Optimization: A Hospital Use of Lean Thinking to Improve Occlusion Management

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