Case Study: Joseph Russo
CVAD (central venous access device) is a device that installed for into the body of patients who require severe fluid intake (Martin et al. 2017). CVAD is inserted in the patient who required the large amount of the intravenous fluid such as blood product or reduction, administration of the hyperosmolar drugs such as Noradrenaline, long-term access for prolonged applications and monitoring central venous patients of the patients (Sasaki et al. 2016). However, the insertion of CVAD may result in the infection. The infection is called central line-associated bloodstream infection where CVAD is a potential source of microorganism, which causes bloodstream infection (Joseph et al. 2016). The case study represents health issues of Joseph who was admitted o the hospital due to the state of unresponsiveness. Since Joseph was not conscious, a three-lumen central venous catheter into Joseph’s right subclavian vein using surgical aseptic technique and Inotropes in the form of IV noradrenaline was administrated. However, after monitoring it was observed that CVAD was the source of infection that caused bloodstream infection. Later occlusions occurred due to the infection which affected his health. This paper will illustrate the action plan for the management and prevention of CVAD associated bloodstream infection and occlusion.
In clinical practice, the central venous access device is a life-saving therapy for treating many patients. However, in the majority of cases it becomes a source of bloodstream infection due to aseptic insertion of the CVAD in patient’s body. An intravenous catheter is integral part of modern practice, which is inserted in the critically ill patients for administrating fluids (Mardegan et al. 2016). However, due to aspect handling of the intervenes cathedral and negligence in following proper protocol for intensive care patient, it becomes a potential source of the nosocomial infection bacteraemia and septicaemia (Gavin et al. 2018). Buckley et al. (2018), suggested that the risk of developing CVAD bloodstream infection with CVAD is 64 the time huge than peripheral cathedral insertion. Gavin et al. (2018), stated that approximately 12% to 25 %the death rate because of nosocomial infection is associated with the CVAD bloodstream infection which also increases the ICU staying of the patients. The associated risk factors of the infection are including presence of multi-luminal catheter, catheter-related thrombosis, anatomical site of insertion and hospital lasting before insertion. a randomized trail control suggested that the main pathogen for giving rise to the CVAD bloodstream infection are Staphylococcus aureus, Enterococcus sp, Candida sp., Klebsiella pneumonia. S. aureus is coagulase negative gram-negative microorganisms that colonize at the catheter tip. When it inserted in the patients for fluid, transmitted to the bloodstream and causes infection. The catheters are mainly contaminated by the hands of the health professionals with the intraluminal dissemination up to the catheter tip (Kovacevich et al, 2018). However, these microbes also present in the cutaneous layers, nasal mucous and insertion may provide the opportunity to access the bloodstream (Colvine, Thomson and Duerksen 2017). As observed in this case study, Joseph was suffering from the CVAD blood infection due to CVAD insertion due to his health issues when he arrived at the hospital. Diagnosis test confirmed the infection and further, it gives rise to the occlusion. Majority of these microbes shows the resistance towards braid spectrum antibiotics and require narrow-spectrum antibiotics.
Complications Associated with Central Venous Access Device Insertion
The primary prevention technique for the CVAD bloodstream infection is to follow the strict protocol for specific insertion of the catheter. Moreover, in order to prevent the infection, stringent infection control practice should be followed in every clinical setting, especially intensive care unit each time they change the uniform or check the catheter line (Garcia et al. 2018). Other central line infections practices are also are in practice for preventing the blood stream infection. These practices involve the performance of hand hygiene, application appropriate skin antiseptic, ensuring the agents applied for the hand hygiene should be dried before inserting the catheter (Colvine, Thomson and Duerksen 2017). Five all maximal sterile barriers precautions should be taken such as the use of sterile gloves, sterile gown, sterile drape, and sterile masks (Garcia et al. 2018). Once central line is placed, the infection can be prevented by maintenance of the central line practice and washing hands with alcohol-based agents to remove the infection. Moreover, in order to minimize the infection, the catheter should be removed immediately when it is no longer needed.
The blockage is the most common non-infectious complication of CVAD blood stream infection and in the majority of the causes, the catheter completely blocked so that it cannot be flushed at all. A study by Gavin et al. (2018) suggested that fibrin search is one of the most common cause thrombotic obstructions, which usually occurs after CVAD placement and developed within 2weeks. Therefore, if the catheter were blocked, forced action would be required to remove them. As observed in the case study, joseph’s catheter become occluded and admitted to the medical ward to continue IV antibiotics and on admission intact, the fluid-filled blister was observed in the left leg of the Joseph prevention and management plan can be developed for the residential support of Joseph.
Assessment of the catheter occlusion required to identify if the thrombosis obstruction causes the occlusion. Three possible strategies can be used for managing the occlusion. These strategies involved administration of thrombolytic agents, removal of thrombi and removal of catheter followed by administration anticoagulants. According to Hallam et al. (2018), the current practice of occlusion is the installation of alteplase with the concentration of 2 mg/2mL for initiating fibrinolysis. According to Takashima et al. (2018), the current recommendation includes administration of thrombolytic agents into the lumen with a dwell time for at least 30 minutes. Thrombi should be removed for managing occlusion of Joseph. Lastly, Anticoagulation prophylaxis can be given to the Joseph for the normal flow of blood where occlusion observed (Colvine, Thomson and Duerksen 2017). However, anticoagulants have several side effects that may affect the other parts of the body (Colvine, Thomson and Duerksen 2017). Therefore, nurses should contact physicians before administrating the anticoagulants to the Joseph for avoiding any severe side effects Moreover, for green leafy vegetable, mustard greens, fish, liver, and cereal can be incorporated in Joseph’s diet for healing faster (Garcia et al. 2018). Cayenne paper can be incorporated in the diet of Joseph since it is known as a natural blood thinner, which helps in smooth circulation of blood and helps to prevent a blood clot (Ullman et al. 2018).
Current Evidence-Base on Central Venous Access Device Insertion
Central venous catheter occlusion disrupts the delivery of required therapy for vulnerable patients. Therefore, in order to minimize the risk of developing occlusion, nursing practice include aseptic infusion and flushing techniques (Colvine, Thomson and Duerksen 2017). The catheter should assess properly by nurses before inserting it to the patient’s body in order to avoid any infection and occlusion (Kovacevich et al, 2018). Moreover, wearing loosely fitted clothes, socks during walking or doing daily activities, can prevent occlusion. Therefore, the residential nurse must ensure that the Joseph wears loosely fitted cloth and compression stockings for the prevention of reoccurrence of occlusion (Gavin et al. 2018). A study by Mardegan et al. (2016), suggested that staying active through exercising regularly can successfully prevent the occlusion of the patient. Therefore, nurses should engage him into freehand exercise or walking for at least 20 minutes to prevent the further clotting of (blood Mardegan et al. 2016). It will also prevent his psychological distress such as anxiety, agitation, and irritation. Residential nurses should change the position of Joseph. Moreover, salt should be excluded from Joseph’s diet for preventing the occlusion that previously observed . Martin et al. (2017), suggested that even if the salts do not cause the clotting, it enhances the damage of the blood vessels of the patient which further has negative consequences (Colvine, Thomson and Duerksen 2017). Lastly, the nurses should monitor the improvement of Joseph on daily basis and contact the physician if any abnormalities observed (Martin et al. 2017). It will help him to heal faster from the occlusion and blood infection.
Conclusion:
Thus, it can be concluded that CVAD is a potential source of microorganism which causes bloodstream infection in the patient which further associated with the morbidity. The case study represents the CVAD bloodstream infection of a patient who was admitted to the hospital because of his unconsciousness. The diagnosis confirmed the bloodstream infection of Joseph. The accumulated evidence identified microorganisms such as Staphylococcus, Klebsiella, candida that are a potential cause of infection. Therefore in order to prevent the infection safety measures such as following strict protocols, hygiene steps should be followed along with respecting handling of the catheter. Te cases study suggested that the occurrence of an occlusion in the place of catheter insertion. in order to manage the occlusion, anti-thrombolytic agents can be given to the patients. For prevention of occlusion, Joseph requires the change of the lifestyle such as sodium-free diet, exercise, loosely fitted clothes with the assistance of the residential nurse.
References:
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Buckley, B., Dreyfus, J., Prasad, M., Gayle, J., Kendter, J. and Hall, E., 2018. Burden of illness and costs among paediatric haemophilia patients with and without central venous access devices treated in US hospitals. Haemophilia.
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