McClay Rebecca, Garner Orlando, Pyle Ashley, Catalasan Gerardo, Mileski Michael
School of Science, Technology, Engineering, and Math, American Public University System, 111 W. Congress St., Charles Town, West Virginia 25414, USA.
Critical Care, Midland Memorial Hospital, 400 Rosalind Redfern Grover Parkway, Midland, Texas 79701, USA.
Crit Care Res Pract. 2025 Jul 28;2025:3224037. doi: 10.1155/ccrp/3224037. eCollection 2025.
This manuscript examines the use of respiratory therapists (RTs) to perform central venous and arterial line placements to address the lack of available staff to perform these procedures. To address these concerns, researchers implemented a program to provide further education to RTs to advance their skills to perform these procedures. Our facility sought to create a train-the-trainer formatted vascular access program utilizing RTs to relieve procedure burdens for critical care providers and maintain safe patient care with CLABSI rates better than the National Database of Nursing Quality Indicators (NDNQI) 95th percentile. A quality improvement project using the IOWA model was performed at the mixed ICU/CCU at a West Texas tertiary care hospital. All patients admitted from May 2017 through December 2023 to the mixed ICU/CCU for arterial catheters (ACs) and all inpatient units for central venous catheters (CVCs) were included. A training program using formal evidence-based protocols was created by the critical care medical director, who implemented the program and provided the original training with the goal of educating facility RTs on proper insertion of venous and ACs. Simple descriptive statistics were used to analyze the results of the program. Over the 5-year retrospective review of RTs placing vascular access lines, only two negative events occurred. Our RTs performed 3878 ACs with zero complications. They also performed 6471 CVCs with only two complications (both pneumothoraces). Overall, the RT team had a success rate of 94.45% There was a minimal complication rate of 0.03%. We found the integration of RTs to the vascular access role to be highly successful in meeting both facility and patient needs.
本手稿探讨了利用呼吸治疗师(RTs)进行中心静脉和动脉置管,以解决执行这些操作的可用人员短缺问题。为解决这些问题,研究人员实施了一项计划,为RTs提供进一步教育,以提升他们执行这些操作的技能。我们的机构试图创建一个培训培训师形式的血管通路计划,利用RTs减轻重症护理人员的操作负担,并以优于国家护理质量指标数据库(NDNQI)第95百分位的中心静脉导管相关血流感染(CLABSI)发生率维持安全的患者护理。在西德克萨斯三级护理医院的混合重症监护病房/冠心病监护病房进行了一项使用爱荷华模型的质量改进项目。纳入了2017年5月至2023年12月期间入住混合重症监护病房/冠心病监护病房接受动脉导管(ACs)治疗的所有患者以及入住所有住院病房接受中心静脉导管(CVCs)治疗的所有患者。由重症监护医学主任创建了一个使用基于正式循证方案的培训计划,该主任实施了该计划并提供了初始培训,目的是对机构内的RTs进行静脉和ACs正确插入的教育。使用简单描述性统计分析该计划的结果。在对RTs进行血管通路置管的5年回顾性研究中,仅发生了两起不良事件。我们的RTs进行了3878次ACs置管,无并发症发生。他们还进行了6471次CVCs置管,仅出现两起并发症(均为气胸)。总体而言,RT团队的成功率为94.45%,并发症发生率极低,为0.03%。我们发现将RTs纳入血管通路角色在满足机构和患者需求方面非常成功。