Central venous dialysis : an Australian survey

Aim: To explore the current central venous dialysis catheter (CVDC) nursing care practices in Australia. Method: A survey of dialysis units in Australia. Results: 66% return rate (48/73) Internal jugular is the main insertion site (75%) and the majority are tunneled (85%). Insertion was performed most commonly by radiologists (34%) followed by intensivists (24%) with one center reporting insertion by nursing staff. CVDCs were most commonly inserted in radiology (54%), followed by theatre (33%). Dressings were attended weekly (55%) or on dialysis days (45%). Chlorhexidine was the antiseptic solution of choice (54%) followed by povidine-iodine (37%). In 21% of centres Mupirocin was routinely applied in addition to the antiseptic solution. Transparent dressings were overwhelmingly favoured however most centres recommended alternatives related to patient need. 21% of units reported enrolled nurses undertaking dressings. All units reported the use of sterile gloves and sterile dressing packs. 10% reported different routine care for tunneled and non-tunneled. 40% of the units collected data on infection rates per catheter days. General opinion (39%) was identified as the reason to base CVDC protocols while descriptive studies (25%), RCTs (23%) and guidelines (18%) were also reported. Conclusion: There are significant variations in the Australian nursing practice related to the care of CVDCs. Although there is still practice based on general opinion there is evidence that changes in practice in the past 8 years may be associated with knowledge derived from research.

Effectiveness of a care bundle to reduce central line-associated bloodstream infections

OBJECTIVE: To determine the effectiveness of a care bundle, with a novel line maintenance procedure, in reducing the rate of central line-associated bloodstream infection (CLABSI) in the intensive care unit (ICU).

DESIGN, PARTICIPANTS AND SETTING: Before-and-after study using CLABSI data reported to the Victorian Healthcare Associated Infection Surveillance System (VICNISS), in adult patients admitted to a tertiary adult ICU in regional Victoria between 1 July 2006 and 30 June 2014. VICNISS-reported CLABSI cases were reviewed for verification. An intervention was implemented in 2009.

INTERVENTION: The care bundle introduced in 2009 included a previously established line insertion procedure and a novel line maintenance procedure comprising Biopatch, daily 2% chlorhexidine body wash, daily ICU central line review, and liaison nurse follow-up of central lines.

MAIN OUTCOME MEASURES: CLABSI rate (cases per 1000 central line days). RESULTS: The average CLABSI rate fell from 2.2/1000 central line days (peak of 5.2/1000 central line days in quarter 4, 2008) during the pre-intervention period to 0.5/1000 central line days (0/1000 central line days from July 2012 to July 2014) during the post-intervention period.

CONCLUSION: Our study suggests that this care bundle, using a novel maintenance procedure, can effectively reduce the CLABSI rate and maintain it at zero out to 2 years.