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Establishing a Best Practice of Central Venous Catheter Maintenance in Patients with Prostanoid Therapy

Arlene Schiro


Susan Stengrevics

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Conference: 2009 PH Resource Network Symposium

Release Date: 09.24.2009

Presentation Type: Abstracts

Arlene Schiro, RN, ACNS,BC, ACNP; Susan Stengrevics, RN, ACNS, BC, CCRN
Massachusetts General Hospital Partners Health Care System, Boston, MA 

BACKGROUND/SIGNIFICANCE: Intravenous prostanoids are the gold standard treatment for patients with functional Class III & IV pulmonary arterial hypertension. Tunneled central venous catheters (CVCs) are required for lifelong administration of these medications and present a challenge to clinicians, patients and families in their maintenance. CVC infections and bacteremias significantly contribute to morbidity and mortality. When this occurs, Peripherally Inserted Central Catheters (PICC) must be placed until resolution of the infection.

OBJECTIVES: 1) Identify types and locations of infections of 8 patients on Ellison 10 2) Investigate issues when transitioning patient to and from tunneled CVC to PICC in this high-risk, low-frequency patient population 3) Implement national best practice standards into MGH.

IMPLEMENTATION: Eight patients admitted to Ellison 10 for CVC infections while on prostanoids were examined between 9/08 and 12/08 for type of infection and problems during transition from tunneled to peripherally inserted catheter. Practice issues were identified by the NP for PAH and the CNS for Ellison 10. They invited two physicians from the Pulmonary Vascular Disease Service and the NP from the Vascular Radiology to convene a group to discuss the issues and develop protocols that would address consistency in products and promote staff familiarity.

PERFORMANCE IMPROVEMENT OUTCOME: Protocols for consistency in catheter selection, placement and priming were identified. Examination of most common pathogens emphasized need for patient education, for care of the catheter reinforces home care management. Best practice information for the prevention of CVC-related infections is now part of the education program for the Ellison 10 nursing staff.

IMPLICATIONS FOR NURSING PRACTICE, RESEARCH, POLICY, AND/OR EDUCATION: Since hospital policy dictates that patients on prostanoid therapy be admitted to Ellison 10 due to its high risk, low frequency medical therapy, it is crucial that the staff be experts in CVC infection prevention and care. A surveillance program should follow trends and address any changes through nursing research and continued education for nurses, patients and other health team members.