Evidence based Practice: Central Venous Catheters

Evidence-Based Practice
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Introduction
The application of Central Venous Catheters (CVCs) provides one of the crucial elements that help address hospitalized patients' treatment. In this case, those suffering from critical medical conditions. By definition, a CVC refers to a tube inserted into the large veins around the neck, chest, groin area, or arm applicable in the performance of medical procedures or somewhat distribution of various fluids alongside patient medications. In most instances, such devices are deemed necessary when it comes to the aspect that entails saving adult patient's lives. Despite such importance attached to the device, there is a greater risk on the patient's side concerning contracting a bloodstream infection in the process of treatment. Statistics reveal that an estimated 500,000 Catheter Line Bloodstream Infections (CLABSI) occurs in the United States alone annually, with a higher probability of the infection resulting in mortality (Haddadin et al., 2020). According to Haddadin et al. (2020), CLABSI presents one of the leading causes of death in the U.S., therefore, associated with an increase in patient healthcare cost, morbidity as well as mortality globally.
Such a trend has led to a growing concern over the patient's level of exposure to such infections; therefore, dire need to improve the level of care about the implantation alongside the maintenance of CVCs. The various healthcare organizations, such as CDC, have developed guidelines focusing on preventing CLABSI amongst other healthcare infections (Centers for Disease Control and Prevention, 2017). For instance, the "CL bundle" application is considered one of the profound guidelines that concern catheter insertion and maintenance. Healthcare organizations worldwide maintain that CLABSI is preventable if there are strict implementation and following of the evidence-based guidelines.
There has been the elaborate implementation of the existing guidelines globally, which is very successful. Despite the evidence of successful intervention programs, the problem persists and devastates a significant adult population percentage. In such a case, the question remains: why does such a trend continue to occur? And will the CL bundle be effective in reducing CLABSI if all the elements of the bundle follow effective implementation?
This study elaborates through illustration on the effectiveness of such a procedure (CL bundle) in the event that all the elements of the bundle are fully applicable in the prevention of CLABSI. The support from the research on this guideline would demand proper education and professionalism from the nurses. This would help them understand the importance of compliance to all CL Bundle care elements that effectively reduce the rate of occurrence of CLABSI. This study identifies the clinical problem and how it can result in positive patient outcomes by providing evidence-based solutions alongside nursing intervention measures (Rupp & Majorant, 2016).
The nursing care problem, in this case, is Central Line-Associated Blood Stream Infections (CLABSI), which is a primary laboratory-confirmed bloodstream infection that usually occurs in patients with a central line at the time of (or within 48-hours before) the onset of symptoms and the infection does not relate to an infection from another site. Notably, the outcome of the Central line-associated bloodstream infections (CLABSIs) are thousands of deaths annually and additional medical costs to the healthcare system. However, there is a belief that such infections present one of the preventable types of conditions associated with the health care system (CDC, 2016).
PICOT statement
Would adult patients within the cardiovascular ICU experience a decrease in the incidence of CLABSI in the case where medical professionals utilize the CLABSI bundle. The CLABSI bundle entails; hand hygiene, barrier precautions, application of chlorohexidine, optimal site selection, avoidance of femoral sites, alongside daily supervision of line necessity protocols as opposed to nurses dealing with central lines without a protocol during the duration of the ICU stay?
P – The group comprises adult patients in the cardiovascular ICU
I – the intervention considered is the application of the CLABSI bundle protocol.
C – No protocol, individual
O – Significant decrease in the rate of CLABSIs
T – during ICU stay
It is unfortunate that CLABSI is still prevalent in the acute care setting and most commonly in ICU despite the use of preventive measures. CLABSI seems an interesting topic due to encountering a lot of infection and application of prevention measures towards such a condition. In this case, one can hope that there is a possibility of reducing the prevalence of CLABSI to zero in the future with extensive work.
Methodology
The study conducted a systematic review that establishes the research question through the application of the PICO strategy. There are the identification and selection of appropriate studies; this entails critical data assessment, data collection, data analysis, and presentation and ultimately result from interpretation. The PICO process results in questions such as; what are some of the preventive measures related to CLABSI implemented amongst adult patients in the ICU at the hospital? The research was conducted on adults with central lines, with the study having a baseline where standard scrub was applicable, use of cap on central lines and reinstitution of standard disinfection (Wright et al., 2013).
The search took place between February 10th and March 3rd, 2021, within the international databases that entails Web of Science, Pubmed/Medline, Scopus, Cochrane, Cinahl alongside the Coordination of improvement of higher Level Personnel (CAPES) platform. The various terms applicable in the search were a selection from MeSH (Medical Subject Headings) terms alongside All Fields, also from DeCS (Health Sciences Descriptors) as terms that relate to descriptors and keywords. The various Boolean operators AND as well as OR were applicable.
Importantly, the search process entailed studies that answered the identified research question. The studies were related to the topic and cover the interventions as regards the care alongside the maintenance of catheters. The inclusion criteria considered various original research studies published between 2015 and 2021 written in English. The inclusion also considered adult patients in ICUs, short-term CVCs, and also tittles that considered the subject of study. Further, the exclusion criteria considered articles that addressed the pediatric population. Articles that did not originate from the research, with shallow information on the inserted central catheter (PICC), were excluded. This includes articles with inadequate information on hemodialysis as well as articles that did not address existing preventive measures that could be applicable in addressing the prevention of central line-associated bloodstream infections.
From the results of the methodology, the search strategy generated 1600 references, out of which 120 were duplicates, therefore, excluded from the study. The strategy was possible with the help of Mendeley software. In this case, there were a total of 1,400 studies selected; however, 1,300 were excluded after their titles and abstracts failed to match the study's objective. In this case, only 100 articles remained. Afterwards, the research assistants scrutinized the full texts of the 100 articles reaching a consensus on the content applicable. This resulted in 70 studies being excluded for not attaining the inclusion criteria standards; therefore, only 30 studies were found legible for this review. The remaining 30 studies were taken through thorough synthesis and analysis. In this case, the Microsoft word analysis tool was applicable where references, method, care, result, and level of evidence were included. The data assessment was done according to the level of evidence as per the Joanna Briggs Institute.
Results
This study is a presentation of findings with the highest level of evidence that concerns various measures taken to prevent CLABSI amongst adult patients within ICUs. Th...