Case study of Mr. Jim Karas
Discuss about the Possible causes and preventive measures associated with CVAD which is Central Venous Catheter Related bloodstream infection.
The essay aims to enumerate the possible causes and preventive measures associated with CVAD which is Central Venous Catheter Related bloodstream infection. Jim Karas was taken to hospital after he was found unconscious. Jim was later diagnosed with hypotension which is characterized by sheer dizziness, nauseas and irregular breathing. Jim later developed CVAD infection due to insertion of central venous catheter into his vein. CVAD is basically a consequence of poor insertion of catheter, which results in skin infection (Mardegan et al. 2016).
The term CVAD refers to Central venous Access Device and is administered only under specific conditions (Vepsäläine et al. 2015). In the current case study the patient Mr. Jim was admitted to hospital due to unconsciousness and difficulty in breathing. On further analysis Mr. Jim was found to be suffering from hypotension. He was provided with an oropharyngeal airway intravenous (IV) cannula and ventilation mask using 100 % oxygen. Jim was put under mechanical ventilation and though stable was showing signs of hypotension. Here medications were used to keep his blood pressure up. He depicted an increased cardiac rate and body temperature of 38.8 degree centigrade. As commented by Conley (2016), healthcare associated bloodstream infections can be prevented with the help of evidence based practices.
The prevention of Central Line associated Blood Stream Infection (CLABSI) focuses upon the following risk factors such as heavy microbial organization at the insertion site, colonization of microbes at the catheter hub, presence of neutropenia (Clare and Rowley 2017). The Center for Disease Control and Prevention (CDC) guidelines for post-insertion care of central line emphasizes upon a number of points for prevention of CLABSI such as- i) Compliance with hand hygiene requirements, ii) scrub of the access port or hub before using an antiseptic, iii) accessing catheters with sterile devices, iv) replacement of soiled dressings, V) the change of dressings need to be done under aseptic conditions using gloves (Centers for Disease Control and Prevention, 2018). For short term care sterile dressing was not required and clean technique was instituted (Blot et al. 2014). As argued by Lin et al.(2017), the lack of standard evidence based practices made the process delivery disputed. Research has pointed out that the emphasis of central line procedures must on the use of aseptic techniques and not simply following the hierarchical paradigm (Lin et al. 2017).
The Aseptic Non-touch Technique (ANTT) implies that in process of handling sterile equipment the part that comes in direct contact with the port access site is not touched (Conley 2016). As commented by de Almeida (2015), review of the professional guidelines and dressing policy can also help in closing the gap within the ANTT processes. For the purpose of this assignment evidence has been collected from systematic review literature, which qualifies to level 1 of evidence based studies. An evidence based practice has been conducted over here as they are supported through quantifiable results and argumentative literature.
Prevention of Central Line Associated Blood Stream Infection (CLABSI)
An action plan could be developed for prevention and management of the condition of the patient Jim Karas as per the ANTT guidelines such as Preparation of equipment using aseptic techniques would check microbial access at the site of entry of the access port. Additionally, sufficient dry periods should be maintained before entering the next catherer, (Blot et al. 2014). The protocol requires scrubbing of the ports for a minimum of 15 seconds followed by 30 seconds drying time (Pans et al. 2015). Provision of sufficient training sessions to the nursing staff emphasizing upon zero CLABSI as the outcome goal can help in better monitoring the conditions of Jim. On accessing the CVC of Jim, wipes containing 2% chlorhexidine in 70% isopropyl alcohol can be used to clean the hubs (Centers for Disease Control and Prevention, 2018). These have been further supported through medical reports and evidences published in the National center for Biotechnology Information (NCBI).
The catheter occlusion is complete or partial destruction of the CVAD that restricts or hinders the ability to withdraw blood, flush the catherer (Clare and Rowley 2017). The occlusions can be further divided into a number of subcategories such as mechanical, non-thrombotic and thrombotic (Conley, 2016).
In the context of Jim Karas, redness and slight warming at the site of access port was observed. Since, no other site of infection was found was the diagnosis for a CLABSI was ruled out (Bolton 2013). The doctors attending Jim karas made the hypothesis of an external mechanical occlusion based on the external observations. They seem to have been caused by clamped or kinked tubing (Pans et al. 2015). Therefore, the doctors catering to the concerns of Mr. Jim Karas removed the CVC from the site. A new CVC was inserted into the left internal jugular vein under ANTT guidelines and policies. Further antibiotics doses were provided to Jim to control the growth rate of microbial infection (Bolton 2013). Due to the presence of excessive concentration of mixtures, the drug can precipitate within the lumen resulting in catheter occlusion (Blot et al. 2014).
Inspecting the CVC and subsequent repositioning of the patient is also necessary, like making the patient stand or sit as this is a popular way of dealing with mechanical occlusion (Mardegan et al. 2016). However, during occlusion, Jim should not be injected with a syringe smaller than 10ml as the same may cause a significant damage to the catheter. Limited dosage of Urokinase can be injected into the patient. As commented by Pans et al. (2015), for long term management and prevention of the recurrence of occlusion the family members of the patient also need to be involved within the process. Here, the ANTT guidelines have been followed for monitoring the conditions of Jim. The Principle of ANTT states that if a key part is not touched the same cannot be contaminated (Clare and Rowley 2017). This reduces chances of development of infection at the site of CVC. Additionally, using alcohol rub for cleansing access ports is a precautionary measure to be applied in the context of Jim Karas. This is true in case of institutes where Methicillin Resistant Staphylococcus aureus isolates (MRSA) with vancomycin minimum inhibitory concentration (MIC) greater than 2 µg /mol have been found (Alexander et al. 2013). Until and unless the culture and susceptibility data are available for Jim, empirical combination antibiotic coverage for multidrug resistant bacteria should be used. For the management of the condition of Jim he was put under antibiotic lock therapy where broad spectrum IV antibiotics were administered. The therapy continued and the medication and dosage changed. Jim developed an occlusion on his CVC a second time over. This could be due to the attachment of the catherer tube to the skin surface for period of time (Bolton 2013).
Use of Aseptic Non-touch Technique (ANTT)
For prevention of skin infection, like with Jim, one must ensure to use antimicrobial catheters. To attain the highest level of safety, the doctor should also check whether aseptic technique is being used which include the primary steps like removal of hair on skin, especially at the insertion site should be removed with clipper (Clare and Rowley 2017). Additionally, the equipment with which the CVAD will be inserted into the supraclavicular veins of Jim should be taken out in the open to prevent fusion with airborne bacteria (Alexander et al. 2013).
To avoid possibility of skin infection, the doctor can prepare a disinfectant mixed with alcohol or a solution of iodine if the patient has allergic reaction (Lin et al. 2017). A background check of the medical condition of Jim could help in removing any disparity over here. The highest risk factor of skin infection is generally during the patient’s stay in the intensive care units like in case of Jim, he had developed redness and (Mason and Ferrall 2014) It is evident as his consequently results in severe pain and tenderness stretching throughout the catheter site. These are some of the preventive measure to keep at bay CVAD related skin infection.
The catheter inserted through the epidermis and stratum corneum results in a persistent wound that refuses to heal (Vepsäläinen et al. 2015). If the catheter is centrally inserted, it will probably be placed in neck or trunk. However, with peripherally inserted catheter an incision is made on scalp or limb. This wound becomes a breeding ground of bacteria and blood infection. Therefore for monitoring the conditions of Jim the doctors should rely upon medical-grade liquids. The facts presented over here have been supported through evidences from systematic review literature. This represents the correctness of facts and data presented.
Conclusion
The assignment evaluates the different precautionary methods of central blood line associated blood stream infection which needs to be in compliance with the regulations as stated in centers for disease control and prevention. The ANTT studies promote the use of disinfectants before and after using a catherer which prevents the possible entry of microbes at the site of infection. Additionally, the uses of antibiotic lock therapy where broad spectrum antibiotics have been use to prevent the advancement of CLABSI have been successful. The background check of the patients for any kind of antibiotic resistance can also prevent the development of the infection. However, to prevent the infection from spreading one should immediately inform the doctor under symptomatic expressions such as high body temperature, stiffness in the muscle, crack in the catheter or stinging near the site.
Reference List:
Alexander, M., Corrigan, A.M., Gorski, L.A. and Phillips, L., 2013. Core curriculum for infusion nursing. Lippincott Williams & Wilkins.
Blot, K., Bergs, J., Vogelaers, D., Blot, S. and Vandijck, D., 2014. Prevention of Central Line–Associated Bloodstream Infections Through Quality Improvement Interventions: A Systematic Review and Meta-analysis. Clinical Infectious Diseases, 59(1), pp.96-105.
Bolton, D., 2013. Preventing occlusion and restoring patency to central venous catheters. British journal of community nursing, 18(11).
Centers for Disease Control and Prevention. (2018). CDC Works 24/7. [online] Available at: https://www.cdc.gov/ [Accessed 4 Jan. 2018].
Clare, S. and Rowley, S., 2017. Implementing the Aseptic Non Touch Technique (ANTT®) clinical practice framework for aseptic technique: a pragmatic evaluation using a mixed methods approach in two London hospitals. Journal of Infection Prevention, 19(1), pp.6-15.
Conley, S.B., 2016. Central Line-Associated Bloodstream Infection Prevention: Standardizing Practice Focused on Evidence-Based Guidelines. Clinical journal of oncology nursing, 20(1).
Cortez, K., Murphy, B.R., Almeida, K.N., Beeler, J., Levandowski, R.A., Gill, V.J., Childs, R.W., Barrett, A.J., Smolskis, M. and Bennett, J.E., 2002. Immune-globulin prophylaxis of respiratory syncytial virus infection in patients undergoing stem-cell transplantation. The Journal of infectious diseases, 186(6), pp.834-838.
Lin, K.Y., Cheng, A., Chang, Y.C., Hung, M.C., Wang, J.T., Sheng, W.H., Hseuh, P.R., Chen, Y.C. and Chang, S.C., 2017. Central line-associated bloodstream infections among critically-ill patients in the era of bundle care. Journal of Microbiology, Immunology and Infection, 50(3), pp.339-348.
Mardegan, K., Curtis, K., Radford, S., Cameron, D. and Grayson, L., 2016. Implementation of a Central Venous Access Device (CVAD) maintenance bundle to decrease the rate of organisation wide CVAD related infections. Infection, Disease & Health, 21(3), p.130.
Mason, T.M. and Ferrall, S.M., 2014. Central Venous Access Devices: An Investigation of Oncology Nurses’ Troubleshooting Techniques. Clinical journal of oncology nursing, 18(4), p.421.
Pans, S.J., Molmans, E., Marczinski, S.C., Bijker, J.B. and Snijdelaar, D.G., 2015. Aseptic non-touch technique in the operating room: keep it simple. Nederlands tijdschrift voor geneeskunde, 159, pp.A9471-A9471.
UpToDate. (2017). Smarter Decisions. Better Care.. [online] Available at: https://www.uptodate.com/home [Accessed 27 Dec. 2017].
Vepsäläinen, K., Lassila, R., Arola, M., Lähteenmäki, P., Möttönen, M., Mäkipernaa, A. and Riikonen, P., 2015. Complications associated with central venous access device in children with haemophilia: a nationwide multicentre study in Finland. Haemophilia, 21(6), pp.747-753
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