Dr Amanda Corley1,2,4, Professor Melissa Bloomer1,3, Dr Mari Takashima4,5, Professor Amanda Ullman2,4,5, Professor Samantha Keogh2,6, Professor Fiona Coyer2,4, Professor Nicole Marsh1,2,4,6
1School of Nursing and Midwifery, Griffith University, Nathan, Australia, 2Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia, 3Intensive Care Unit, Princess Alexandra Hospital , Wooloongabba, Australia, 4School of Nursing, Midwifery and Social Work, University of Queensland, South Brisbane, Australia, 5Children's Health Queensland Hospital and Health Service, Centre of Children's Health Research, South Brisbane, Australia, 6School of Nursing, Queensland University of Technology , Australia
Biography:
Amanda is a critical care nurse and researcher of over 25 years’ experience. She is a Postdoctoral Research Fellow with the School of Nursing and Midwifery at Griffith University and is based at the Royal Brisbane and Women’s Hospital. She holds a PhD and has a strong national and international track record in patient-focused clinical and health services research. She has published over 90 peer-reviewed publications and 4 book chapters, with career funding of >$2.5m in competitive and industry grants. Her research interests include respiratory management in ICU and vascular access devices, particularly haemodialysis catheters and extracorporeal membrane oxygenation cannulae.
Abstract:
Introduction
Haemodialysis catheters (HCs) are large-bore catheters inserted in central veins of the groin or neck to facilitate renal replacement therapy (RRT) in critically ill patients with acute renal failure. HCs have the highest failure rate of all central venous catheters at 7% and their unique management needs to maintain blood-flow may contribute to failure and infective complications. We aim to describe HC infection prevention and post-insertion care practices.
Methods
Cross-sectional internet-based survey of Australian critical care nurses across seven care domains. Results are reported descriptively.
Results
From 138 respondents, 68 (49%) were registered nurses, 25 (18%) clinical nurses and 28 (20%) clinical nurse specialists/consultants, from adult ICUs (75%), with an average 14 years ICU experience. One-in-four respondents reported their ICU RRT policy did not include specific infection prevention recommendations to guide practice. Infection prevention components used for HC dressing change were a dressing pack (in 91% of respondents), ANTT® and handwashing with water and soap (both 80%, respectively), sterile gloves (76%), and non-sterile gown (67%). Only 22% of respondents reported using sterile gowns and 5% reported using sterile drapes. Disinfection of needleless connectors prior to HC accessing was reported by 90% of respondents, with a drying time of >15 seconds reported by 59%. Two-thirds of respondents reported that specimens were always collected from HCs suspected of infection.
Conclusion
This survey describes current HC post-insertion care practices in ICU and preliminary findings suggest significant opportunities exist for improvement in infection prevention practices to decrease patient harm.