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American Journal of Critical Care. 2009;18: 514-520 doi:10.4037/ajcc2009168
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

Evaluating Central Venous Catheter Care in a Pediatric Intensive Care Unit

By Carol Hatler, RN, PhD, Linda Buckwald, RN, BS, MPH, Zoraida Salas-Allison, RN, BS and Cathleen Murphy-Taylor, RN, BS. Carol Hatler is director of nursing research, Linda Buckwald is a mentor, Zoraida Salas-Allison is a manager, and Cathleen Murphy-Taylor is a staff nurse at St Joseph’s Hospital and Medical Center in Phoenix, Arizona.

Corresponding author: Carol Hatler, RN, PhD, Director, Nursing Research, 350 W. Thomas Road, Phoenix, AZ 85013 (e-mail: carol.hatler{at}chw.edu).

Background Catheter-related bloodstream infection remains an important health problem for hospitalized children. Although placement of a central venous catheter is a life-saving intervention for critically ill children, these same central catheters are a potential source of infection.

Objectives Few studies that directly address care of central venous catheters for children in intensive care units have been reported. This evaluation was designed to describe the extent of evidence-based practices for care of insertion sites of central venous catheters in the pediatric intensive care unit of an urban tertiary care center. Another goal was to determine the influence of 2 different regimens for dressing changes on rates of catheter-related bloodstream infections and costs.

Methods A convenience sample and an exploratory design were used to collect data in 2 phases, including 30 days to establish baseline information and 30 days each during which patients received dressing care for a central venous catheter with a transparent dressing alone and with a transparent dressing plus a chlorhexidine-impregnated dressing. Nurses also participated in a survey of knowledge about infection control practices related to central catheters.

Results Few differences were found between the transparent dressing alone and a chlorhexidine-impregnated dressing plus the transparent dressing. A serendipitous finding was the number of times that central catheters were accessed daily.

Conclusions The results of this project suggest that infection control efforts may be most appropriately focused on processes rather than on products.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Recognize the necessity and risks associated with use of central venous catheters (CVCs) in critically ill children.
  2. Describe the role of protocols on outcomes in critically ill children with CVCs.
  3. Discuss the conclusions and limitations noted by the researchers and their implications for a pediatric critically ill patient with a CVC.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


Related articles in AJCC:

Central Venous Catheters in Pediatric Patients
Linda Bell
AJCC 2009 18: 522. [Full Text]  





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Copyright © 2009 by the American Association of Critical-Care Nurses.