Now that you have completed a series of assignments that have led you into the active...

Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project, briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction? (My Project is based on central line catheter infection prevention) Please provide reference. Thank you

Expert Solution

Catheter-related infections remain among the top three causes of hospital-acquired infection .The skin around the site is the most common portal of entry of infection for nontunneled central venous catheters.The major mechanism for entry is bacterial adherence followed by migration along the catheter.The second most common portal of entry of bacteria is via contamination of the catheter hub during its manipulation.it is typically seen in tunneled central venous catheters.

Central venous catheters carry an increased risk of related infection and bacteremia compared with peripheral catheters.Multilumen central venous catheters have a higher risk of bloodstream infection than single lumen catheters.When i began the project i was under assumption that timing of insertion is not a relevant subject to central venous line related infection.But when i further reinvestigated ,i found out that i was wrong .Residents who had atleast attended a one day infection control course could reduce catheter-related infections to an extent.The timing of insertion is also important and an increaded incidence of catheter-related infections is seen with catheters placed in patients that have been in the intensive care unit for more than 6 days.

I was of the opinion that the catheter once placed should be taken care of and strict infection control practices be taken .But recent studies shows that guidewire exchanges are associated with increased catheter colonization ,exit site infection and bacteremia.Guidewire exchanges are preferred over new site insertion because of the decreased risk of pneumothorax or bleeding complications.it is an effective method for ruling out catheter-related infection in febrile ,nonseptic patients.Therefore every attempt should be taken to sterilize the entire external portion of the catheter,guidewire and surrounding skin.The removed catheter should be cultured and if infected ,the guidewire-placed catheter must be removed.Guidewire exchanges should not be performed in patients with confirmed or suspected sepsis.

Reference Safdar N,Maki DG:Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients.Chest 128:489-495,2005.

Nightingale answered 2 years ago

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