Recent orders
Exit Site Infection Central Venous Catheter Care of Dialysis Patients
Exit Site Infection: Central Venous Catheter Care of Dialysis Patients
Student A
West Chester University
Abstract
This analysis was done to collect data on infection control in the outpatient dialysis setting for those with a central venous catheter as their hemodialysis access device by comparing two prospective studies done by Beathard (2003) and Young (2005). Both researchers implemented strict infection control protocol into hemodialysis catheter care procedure which resulted in decreased exit site infections and catheter-related bacteremia. Beathard (2003) saw an average difference in exit site infections of 5.29 per 1,000 catheter-days over a 33-month data collection period while Young (2005) reported a 2.1% rate of exit site infections in a 21-day study period, a significant change from previously reported 3-13% rate in her studies. Both studies required education and compliance of procedure by staff for outcomes to be successfully measured.
Exit Site Infection: Central Venous Catheter Care of Dialysis Patients
The use of central venous catheters (CVCs) in hemodialysis patients has become a widely used practice in the chronic care dialysis setting. Although the use of a graft or fistula is superior and a longer lasting access route, many patients end up with a permanent CVC access (Beathard, 2003). This evidenced-based analysis examines infection risks associated with the care of central venous catheters. According to Beathard (2003), CVCs that are maintained correctly lead to a decrease in catheter-related bacteremia (CRB), which requires that health care providers are informed of CVC care guidelines and strictly follow the set standards. In her study, Young (2005) examined exit site infection (ESI) rates in double and triple lumen catheters and concluded that strict adherence to sterile precautions for CVC procedures leads to a decrease in ESI.
The Center for Disease Control has guidelines for maintenance of CVCs for the outpatient setting, including staff education and training and the use of a fistula or graft for chronic renal failure (O’Grady et al., 2011). Currently in the chronic care dialysis setting, CVCs are maintained using clean technique – this means that gloves and supplies used to remove the old dressing and clean the access that leads directly into their right atrium are not aseptic or sterile. The proposed change for nursing practice is to elevate the standard of care for CVCs and require that all CVCs be maintained using full sterile procedure. This inquiry into evidenced based practice seeks to find if, for patients on hemodialysis, a clean versus an aseptic CVC technique will result in a decreased CRB or ESI rates.
Search Study
To conduct research for this review, Boolean phrases such as “central venous catheter infection and dialysis” and “exit site infection of central venous catheters” were processed using the EBSCOhost databases. Criteria for the search included peer reviewed articles with available pdf full text since 2005. The results were expanded by allowing search for like terms and in-text search for terminology. Google scholar was first used to identify relevant studies and assist in narrowing search terminology. Ovid database returned results that needed to be narrowed and then EBSCOhost database was successfully utilized.
Literature Review
Beathard (2003) examined infection rates of hemodialysis patients with central venous catheters over a period of 24 months and compared his findings to data from charts documented during the “control period,” nine months before initiation of the study. Young (2005) examined how elevating the standard of care by implementing protocol for exit sites of CVCs decreases exit site infections (ESI) of hemodialysis patients over 21 days. Both studies took place at outpatient dialysis facilities and were prospective; Beathard’s (2003) population size was 700 patients while Young’s (2005) study consisted of 473. Beathard (2003) used the clinic’s existing CVC policy and procedure plus implemented a set of new “prophylaxis protocol” designed to prevent CRB. Young (2005) implemented exit-site care using sterile field with sterile supplies and cautions that sterile technique must be maintained. Central and peripheral blood samples were drawn two hours before CVC insertion, filled both tubes with minimum 5 milliliters (mL) of blood, and sent all specimens to the same lab; the lab was trained on handling of the specimens and only a registered nurse (RN) who had been trained to collect labs was able to collect the blood samples. Young’s (2005) study used the same blood collection method when the CVC was removed and more blood cultures were drawn, both centrally and peripherally.
To analyze the data, Beathard (2003) and Young (2005) both use a chi-square test with a 0.05 or less significance value. Beathard’s (2003) ex post facto control group showed an average CRB incidence of 6.97 per 1,000 catheter-days while the study group showed an average incidence of 1.28 per 1,000 catheter-days; the study met the significance with p < 0.05, showing that the CRB prophylaxis protocol was effective. Young’s (2005) study revealed a 3 per 1,000 catheter-day incidence, with 2.1% (10 out of 473) of the population contracting an ESI, an incidence lower than the 3-13% of previous studies.
Limitations. Young’s (2005) study did not specify an antibiotic for treatment of positive pre-insertion blood culture, which is listed as a variable in her work. The results reveal that some CVCs were removed after 5 days, which could have led to falsely low ESI results of 2.1%. Beathard (2003) No study limitations were offered in either research article.
Conclusion
Beathard’s (2003) CVC prophylaxis protocol includes using face masks and clean gloves, iodine to clean CVC hubs, and limited hub exposure to air; this set of standards requires an educated nurse and proper CVC maintenance by staff, leading to decreased CRB rates. The study supports the idea that for hemodialysis patients, a clean versus sterile procedure is necessary and leads to a decrease in CRB incidence. The entire essence of his study depended upon staff education and compliance with CVC protocol. Per Beathard (2003), the study “demonstrates that it is possible to reduce the incidence of CRB to a relatively low level and maintain it there using basic principles directed toward the protection of the catheter hubs at the time of use in the dialysis facility” (p. 4005).
Unlike Beathard (2003), Young (2005) further compared ESI rates to CVC insertion site location (femoral, subclavian, jugular) resulting in a 0.54 probability and concluding that location of a CVC is not related to ESI. Intuitively one can gather that this leaves other factors in play to cause infections, such as catheter maintenance and care. Young’s (2005) study demonstrates that CVC care using sterile technique and proper education and training of staff results in a lower incidence of infection for hemodialysis patients with CVCs. Current nursing practice for CVC care needs to be elevated with a set standard of care using sterile technique to decrease ESI and CRB incidence.
References
Beathard, G. A. (2003). Catheter management protocol for catheter-related bacteremia prophylaxis. Seminars In Dialysis, 16(5), 403. doi:10.1046/j.1525-139X.2003.16087.x
O’Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S., Lipsett, P., Masur, H., Mermel, L., Pearson, M., Raad, I., Randolph, A., Rupp, M., Saint, S. (2011). Guidelines for the prevention of intravascular catheter-related infections. PsycEXTRA Dataset,1-82. doi:10.1037/e548442006-001
Young, E. J., Contreras, G., Robert, N. E., Vogt, N. J., & Courtney, T. M. (2005). Incidence and influencing factors associated with exit site infections in temporary catheters for hemodialysis and apheresis. Nephrology Nursing Journal, 32(1), 41-50.
C. N.
& Teece
existentialism means some ideas from philosophers that explain the existence of human beings
Existentialism
The term existentialism means some ideas from philosophers that explain the existence of human beings. It refrains itself from the explanations offered by science or even ancient philosophy (Wikipedia 1). Its definition differs from one author to another though most of them disagree with the concept of referring them as existentialists in avoidance of people placing them into pre-defined categories. According to Sartre, a philosopher and an author, men are nothing but what the make themselves. Hence, there nothing in the genes that makes a man to behave in certain ways. In other words, when men make certain decisions they do so because they first have the will to act in such manner (Wikipedia 1). In this, Sartre means that everyone has the freedom to do his or her wish but since freedom exists in the world, the same world is its limit. However, making of decisions does not only affect the individual acting but rather the whole humanity.
In his essay, Sartre maintains that human beings are free to what they want. However, if they seek freedom they do not only seek freedom for themselves but also the must grant freedom to other people. That is, men make choices but in making those choices, they do make them for other people. Consequently, in a bid to create the person that each individual wants to be, he or she portrays an image of the people he or she ought to be (Roberts 14). In simple terms and looking into ideas posed by a number of philosophers existence precedes essence. Hence, the meaning in the statement by Sartre is that though individuals have the capacity to make decisions they not only make those decisions for themselves but also for other people (Plantinga 21). This is true given that most of the decisions that people make have impact on other people’s lives.
In to explain the concept further philosophers use the example of a Christian. When a man decides that they want to enter into Christianity they not only make that decision for themselves, they indicate the destiny of other human beings. Hence, they involve the whole humankind in their choices since they make a decision that human beings belong to another world called heaven together with God (Sartre 1021). The same case applies to a person deciding to engage in Muslim faith since they not only make individual choices because they include humanity in his or her Muslim faith. Consequently, the meaning that Sartre seeks to bring is that each individual contributes into the way the world runs today and the beliefs contained therein. If individuals seek to change their way of life they advocate that other people should also change their way of life.
Anguish is the responsibility that a man bears upon realizing that he or she is not making decisions for him or herself only but also for the whole humanity. They realize that most of the actions they partake affect humankind (Johnson 22). One of the consequences of this realization is quietism or inability to act. One such example is a village leader who realizes that when he makes the decision of sending warriors into a battlefield he will engage other people in his decisions. Though the choice he makes might be the right one the circumstances he might choose not to act or to succumb to quietism (Sartre 1220). Another idea is that of forlornness, a belief that God does not exist. Hence, if a group of individuals came to such a conclusion they have to live with the consequences. This is so given that all the laws that humankind stand with will no longer make any sense hence everything will became possible.
To make add more sense into the argument let us examine a hypothetical scenario whereby a man has to school his kids. In the society that the man resides people do not take their children to school but due to his travelling, he understands the importance of school. He decides that the right thing to do is take his children to school however, after sometime he realizes he made a choice for the whole village. The first thought is quietism or the inability to act to the realization but after sometime chooses to take the children to school. He not only portrays to the villagers that kids should attend school but he makes a decision for them and though debates might exist over the issue he is involving more people than his intentions.
It is evident from the discussion herein that it is difficult to make decisions without involving other people and when individuals make decisions they involve humanity in their decisions. Philosophers have tried to explain the concept regarding the existence of human beings with most of them presenting a number of ideas. Some of the ideas are in discussion herein and explain the concepts that philosopher Sartre is trying to portray in his essay about existentialism. Though there are a number of criticisms surrounding the work of the author cum philosopher, he sheds light in the subject of human existence.
Works Cited
Sartre, Jean-Paul .Existentialism is a humanism. New Haven: Yale University Press, 2007.
Wikipedia. Existentialism, 2011. Retrieved from http://en.wikipedia.org/wiki/ExistentialismJohnson, Ronald. Existentialism. American Behavioral scientist, 8, 3, 1964. DOI: 10.1177/000276426400800313
Plantinga, Alvin. On Existentialism. Philosophical studies, 44,1,1-20, 1982. DOI: 10.1007/BF00353411
Roberts, David. Existentialism and Religious beliefs. Pastoral Psychology, 8, 3, 45-51, 2000. DOI: 10.1007/BF01744321