Essay Example on CVAD Line Change: Adverse Events & Risk Factors

Introduction

CVAD dressings are always done at least after every seven days or even earlier if the dressing becomes loosened or soiled Takashima et al. (2018). However, if a person is diaphoretic or the site is discharging/bleeding, a sterile gauge can be used on the site until the issue is managed.

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The most common adverse event(s) associated with CVAD Line Change.

Like any other minor medical procedure, a change of CVAD can cause infections, nerve injury, and also catheter malposition. Nerve injury is the density of or direct harm to the nerve tracts either inside the body or near a CVAD insertion site. Commonly, nerves and blood vessels travel in the same paths within the body. Therefore, there is a possibility of either permanent or temporary damage of nerve in times of CVAD line change. However, prevention calls for early exposure through nonvascular assessment of possible margins in PICC lines and evaluating for possible nerve injury either directly or indirectly (Takashima et al. 2018). The damage can be managed with early detection and engage a conversation with a specialist of vascular access specialist to create a vascular admission plan.

During such procedures, there are chances of contracting infections. Because it involves instruments, disinfection cannot give a guarantee that a germ-free method will be made since other aspects like environmental contagion can also occur. Thus, microbial contamination is a common phenomenon, and if not carefully checked, then the patient's life is compromised. Consequently, ultimate care has to be observed as one engages the aseptic technique to avoid causing harm than protecting a patient.

Most contemporary research that has influenced a change in CVAD Line Change

Among many studies on CVAD line change, a standard evidence-based guideline has been advanced to harmonize how the procedure is undertaken tremendously. This paper is going to focus on a consensus dubbed Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. The article was published online on 29 January 2013, authored by Moureau et al. and can be accessed through https://doi.org/10.1093/bja/aes499A significant gap in the standard and negligible requirements for the preparation on insertion methods and maintenance of CVADs has been in existence. However, this contemporary consensus has brought some light on standardized procedures in terms of preparation for all the nurses involved in the process. A global evidence-based consensus task force was constituted through WoCoVA to offer guidelines and definitions for both preparation and insertion of CVADs. The research was a revolutionary to the field because cases of infections and management of inline changing of CVADs proved to be easier since then.

First, tip location standardization has offered by the study has eased the current debate. Tip positionn defines a device to be non-central, central, or peripheral. With a non-central tip, the site is significantly associated with an increase of complications related to the catheter. Risks that are catheter linked vary much depending on the position of the tip, especially to the right side of the atrium. Therefore, defining and standardizing the precise location of the cavo-atrial catheter has raised lots of debate. There are varying opinions from the experts on whether the tip should be either below or above the CAJ. Therefore, with this research, a mutual consensus was provided and hence easing the debate and giving the right way forward. Mitigation of risks like infections of CVADs, the study proposes CRBSIs mechanisms to be consensually considered.

A clinical guideline that addresses CVAD line change and its relevance

The relevant and current guidance on CVADs discusses the Central Venous Access Devices (CVAD) Clinical Practice Standard authored by directed by the WA Country Health Service. The policy was the last review in June 2019, with its next review date being January 2024 ad effective since 25 June 2019. The guideline can be assessed through http://www.albanyhealthcampus.health.wa.gov.au/fileadmin/sections/policies/Managed/Central_Venous_Access_Device_CVAD_Management_Clinical_Practice_Standard_TS4KSNFPVEZQ_210_6726.pdfAs above discussed in part three, the policy guideline on the management of CVADs vigorously enforce the consensus standard operating procedures as proposed. Besides, the policy gives more elaborate management approaches to CVAD line change management compared to the contemporary study discussed in three above.

According to Moureau, et al. (2013), catheter insertion site has to be visually inspected or even palpated in an intact dressing to establish any tenderness in the time of review. The process of change should allow one to review carefully and thus cleanse the insertion site. In case of signs of localized infections, a swab has to be taken and referred to medical personnel. However, where the gauge is used, devise dressing has to be covered with a waterproof in case one interacts with water.

The policy also affirms that in case of excess bleeding during line change from the insertion site, a gauge pressure can be applied and consequently cover with a dressing that is sterile and transparent. The patient is discharged with CVAD, calls for continued care, and also the management of the device. Thus before a discharge is done, both patient's cognitive and physical abilities to care for the CVAD need to be assessed. With the follow-up appointments ensured, managing of CVADs becoming easy. Therefore, for the nurses engaged in management and CVADs line changes, their role becomes more comfortable with precision because of the consensual standardization of pieces of training and procedures.

Invasive procedure (female catheter insertion)

In the second place is the introduction of the female indwelling catheter as a type of invasive procedure, which the paper will discuss. Catheter insertion is routinely done before abdominal hysterectomy procedures and also other gynecological procedures. Therefore, proper preparation of the patient before the introduction is imperative to avoid catheter linked Urinary tract infections.

The most common adverse event associated with a female indwelling catheter

Despite its apparent advantages, the use of catheters for a prolonged time is highly discouraged. Long-term use of urethral catheters poses serious health hazards. Feneley, Hopley & Wells (2015) assert that indwelling catheters are more linked to the cause of urinary tract infections, which involves the bladder, urethral, and to some extent, kidneys. In a span of two to four weeks after the catheter has been inserted, bacterial will already be present in the woman's bladder.

Besides, asymptomatic bacterial colonization can be shared, though it does not pose any health hazards to the patient. Moreover, if symptomatic urinary tract infection is left untreated, it may lead to urosepsis and hence death. The rate of mortality of the residents of nursing homes with urethral catheters is even three times higher as compared to residents without a catheter. The latter is a reflection of the seriousness of the comorbid condition that prompts a clinical decision to employ the use of chronic bladder drainage rather than causation from the use of persistent drainage of the bladder. Finally, a chronic infection can result because of residual urine sump. The uninfected urine coming down from the kidneys may end up swiftly being disease-ridden and thus leading to such diseases.

Contemporary research has influenced a change in a female indwelling catheter

A Contemporary study done by Terrie Beeson and Carmen Davis, https://doi.org/10.1097/WON.0000000000000417 suggests that there are alternative to insertion of indwelling catheters that nurses can effectively adapt. The idea forms one of the strategies being adopted to reduce the use of indwelling urinary catheters and all its linked infections of the tract. Such infections have become a big challenge because of the inadequate availability of suitable appropriate for external collection devices. Beeson & Davis (2018) argue that Female urinary inconsistences dispose of the skin to potential burning, irritating pain, or even pressure injuries. From the above background understanding, such needs prompted the research to come up with better ways to mitigate and thus the mind-changing contemporary study on the issue.

Adoption of suprapubic catechization is a better alternative to the insertion of urinary catheters. According to Ahluwalia et al. (2006), the use of SPC makes the patients feel comfortable and also better tolerated as compared to a urethral catheter. However, the most typical challenges are catheter blockages, bladder stones, and infections, which SPC tries to minimize if not mitigating. With the SPC approach, patients find it more comfortable and easy to manage because changes are never painful. Having the catheter coming out through the abdomen as opposed to urethral allows some patients to resume sexual activities.

Consequently, options available for substituting a urethral catheter with an SPC should be informed that the patient will undertake long term drainage of their bladder via catheterization. Moreover, the approach may be unsuitable for some patients who exhibit a history of cancer of the bladder. Besides, for obese persons, the initial insertion of the SPC catheter may be a challenge. Therefore, besides such pre-existing conditions, SPC is the right approach towards catheterization and a revolutionary to the nursing field. As opposed to the insertion of the urethral catheters, which require regular changes, SPC comes helps mitigate some of the exposure infections.

Most current clinical guidelines on Suprapubic Catheters

From the policy and procedures guideline on suprapubic catheter: And can be accessed through https://www.saskatoonhealthregion.ca/about/NursingManual/1021.pdf. The direction was effected in September 2003 and later revised in November 2014.

Most of the facilities do not permit RNs to insert the SPC, but rather to change an existing one. If the RN is allowed to change the SPC, a provider order requires to be precipitate the directives of such a procedure. Therefore, according to the guideline, RN is able and well placed to change SPC as they do to urethral catheters. The policy thus gives more instructions to RNs in support of the SPC approach to catheterization and proper management of the practice.

Change of the SPC calls for special nursing procedures and additional competencies that require certification as targeted and identified by managers of nursing. SPC management has been highly encouraged and advised to use it by the policy. Unless there are pre-existing diseases, the procedure is supported by most patients. Because it is a less invasive procedure, its changes are not much regular and may require simple methods.

The practitioner's order requires that the nurse has to state the catheter type, size, and change frequency where applicable. Besides, the solution for irrigation has to be in place and reported, and then the catheter is removed. From such guidelines, the policy addresses the research finds, which elaborated on the same procedures. On the preference of the process in the study, the system directs that for persons of advanced age and who have no medical records of bladder cancer can opt comfortably for SPC.

Conclusion

In conclusion, the guideline gives some of the precautions to SPC like any other catheter insertion. A nurse has to do changes every four to six weeks, depending on one's medical conditions. It also forms the basis for better and advanced grounds from which more alternatives to urethral catheters.