School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Queensland, Australia; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Sunshine Coast Health Institute, Queensland, Australia.
Intensive Care Unit, Gold Coast University Hospital, Queensland Health, Queensland, Australia.
Intensive Crit Care Nurs. 2022 Jun;70:103217. doi: 10.1016/j.iccn.2022.103217. Epub 2022 Feb 17.
Central venous catheters are often used in managing critically ill patients. Clinical practice guidelines and care bundles exist to prevent central line associated blood stream infections; however, detailed adherence to these guidelines and care bundles is unclear.
This study was aimed to describe clinicians' adherence to recommended practices in central venous catheter insertion and management.
A cross-sectional prospective observational study was conducted in the intensive care unit of an Australian tertiary hospital over a four-month period. We observed a total of 50 nurses during post insertion management, and 10 physicians during central venous catheter insertion using purposely designed observation tools.
Our audit identified 90% adherence to recommended practices in central venous catheter insertion and 60% to post insertion management. However, there were areas where participants' practices were not congruent with evidence-based recommendations, including choice of central venous catheter insertion site, type of central venous catheters, dressing choice, aseptic technique, and documentation.
Our audit showed a detailed picture of clinician's adherence to recommended practices in central venous catheter insertion and management. A clearer understanding of the barriers and facilitators of issues identified is needed to inform the design of future interventions to reduce central line related blood stream infections in the unit.
中心静脉导管常用于治疗重症患者。为预防中心静脉相关血流感染，存在临床实践指南和护理捆绑包；然而，对这些指南和护理捆绑包的详细遵守情况尚不清楚。
本研究旨在描述临床医生在中心静脉导管插入和管理方面对推荐实践的依从性。
在澳大利亚一家三级医院的重症监护病房进行了一项为期四个月的横断面前瞻性观察研究。我们使用专门设计的观察工具，在插入后管理期间共观察了 50 名护士，在中心静脉导管插入期间观察了 10 名医生。
我们的审核发现，中心静脉导管插入和置管后管理的推荐实践的依从率分别为 90%和 60%。然而，参与者的实践与循证建议并不一致，包括中心静脉导管插入部位的选择、中心静脉导管的类型、敷料的选择、无菌技术和记录。
我们的审核详细展示了临床医生在中心静脉导管插入和管理方面对推荐实践的依从性。需要更清楚地了解确定问题的障碍和促进因素，以便为未来旨在减少该单位中心静脉相关血流感染的干预措施提供信息。
