Deborah Richardson

Optimal frequency of changing intravenous administration sets: is it safe to prolong use beyond 72 hours?

OBJECTIVE To determine the safety and cost-effectiveness of replacing the intravenous (IV) tubing sets in hospitalized patients at 4- to 7-day intervals instead of every 72 hours. DESIGN Prospective, randomized study of infusion-related contamination associated with changing IV tubing sets within 3 days versus within 4 to 7 days of placement. SETTING A tertiary university cancer center. PATIENTS AND METHODS Cancer patients requiring IV infusion therapy were randomized to have the IV tubing sets replaced within 3 days (280 patients) or within 4 to 7 days of placement (232 patients). Demographic, microbiological, and infusion-related data were collected for all participants. The main outcome measures were infusion- or catheter-related contamination or colonization of IV tubing, determined by quantitative cultures of the infusate, and infusion- or catheter-related bloodstream infection (BSI), determined by quantitative culture of the infusate in association with blood cultures in febrile patients. RESULTS The two groups were comparable in terms of patient and catheter characteristics and the agents given through the IV tubing. Intent-to-treat analysis demonstrated a higher level of tubing colonization in the 4- to 7-day group versus the 3-day group (median, 145 vs 50 colony-forming units; P=.02). In addition, there were three episodes of possible infusion-related BSIs, all of which occurred in the 4- to 7-day group (P=.09). However, when the 84 patients who received total parenteral nutrition, blood transfusions, or interleukin-2 through the IV tubing were excluded, the two groups had a comparable rate of colonization (0.4% vs 0.5%), with no catheter- or infusion-related BSIs in either group. CONCLUSION In patients at low risk for infection from infusion- or catheter-related infection who are not receiving total parenteral nutrition, blood transfusions, or interleukin-2, delaying the replacement of IV tubing up to 7 days may be safe, as well as cost-effective

Infusion therapy team and dressing changes of central venous catheters.

OBJECTIVE To determine whether central venous catheter (CVC) dressing changes could be performed by ward nurses rather than by the infusion therapy team (ITT) nurses without increasing the risk of catheter-related infection. DESIGN Retrospective cohort study using prospectively collected data. The study extended from January 1995 to June 1996. SETTING The University of Texas M.D. Anderson Cancer Center, a referral cancer center. PATIENTS The study group was a random sample of 483 patients who received CVC dressing changes by ward nurses during the study period. A random sample of 483 patients who received CVC dressing changes by the ITT constituted the control group. RESULTS The risks of catheter-related septicemia were 1.7% among cases and 1.4% among controls (risk ratio, 1.14; 95% confidence interval [CI95], 0.26-6.42; P=.70). There also were no significant differences between the two groups in the risks of catheter-related site infection (risk ratio, 0.50; CI95, 0.02-4.12; P=.25) or any catheter-related infection (risk ratio=1.00; CI95, 0.27-3.64; P=.59). CONCLUSIONS Provided that aseptic techniques (including maximal barrier precautions during insertion) are maintained, the responsibility of CVC dressing changes could be delegated to the ward nurses without increasing the low risk of CVC-related infection, resulting in an estimated cost saving in excess of

Management of infection and occlusion associated with vascular access devices

90,000 per year.

A Chronicle of Experience-Past, Present & Future:M.D. Anderson Cancer Center Infusion Therapy Team

OBJECTIVE To provide an overview of the etiology, assessment, diagnosis, and management of infections and occlusions that occur with venous access devices (VADs). CONCLUSIONS The two major complications of VADs are infections and occlusions. Several strategies have been attempted to prevent and treat infections and occlusions; however, one specific method has yet to be determined. As a result, major controversies exist regarding the best method to manage these complications. Controlled randomized studies are needed to examine each type of VAD in relation to preventive and treatment strategies. IMPLICATIONS FOR NURSING PRACTICE Preservation of VADs demands the development of and adherence to specific guidelines for maintenance care as well as an awareness of the incidence, presentation, and management of complications. Clearly, prevention is the key to effective management of infection and occlusion associated with VADs. Nurses must be familiar with institutional policies and procedures for the care of VADs.

JAVA Revises Peer-Reviewer Guidelines

Abstract Infusion Therapy and vascular access devices have had a profound impact on nursing practice over the years. The domain of nursing practice lends itself to providing an open window of opportunity for the nurse to enter different arenas of nursing practice and to develop expertise in a chosen field. That is what happened at the M.D. Anderson Cancer Center, Houston, TX, in the 1970s. This article provides an overview of the history of the Infusion Therapy Team along with current and future practice.

Central Venous Catheter Insertions: The Value of Pre-Insertion Interview

Abstract When a manuscript is submitted to the Journal of the Association for Vascular Access (JAVA), it undergoes a stringent review process by two to three peer reviewers who are experts in the field of vascular access. To ensure that authors are provided the most helpful review possible, JAVAs Publications Committee felt that an assessment of reviewer guidelines used in the past several years was in order. Therefore, a small task force of members from JAVA s Publications Committee reviewed the existing guidelines and, over a three-month period, updated them. The goal of these revised guidelines is for peer reviewers to be able to provide authors with highly detailed and informative reviews. For reviewers, the new guidelines will clarify the type of information required in a review, which in turn, will generate more detailed feedback for the authors. Both authors and JAVA reviewers will find these new guidelines important because they will ultimately improve the quality of the manuscripts published in the Journal.

Long-Term Silicone Central Venous Catheters Impregnated With Minocycline and Rifampin Decrease Rates of Catheter-Related Bloodstream Infection in Cancer Patients: A Prospective Randomized Clinical Trial

Abstract Working in a large oncology hospital, central venous catheters are indispensable devices in which to deliver chemotherapy regimens and other supportive care medication administration. The necessity for a central venous catheter (CVC) initiates a patient education process that requires informing, educating and preparing the patient for the insertion and post-management requirements. It is crucial to organize and plan the strategies necessary to meet the needs of patients in a timely manner, decrease cost, and improve patient outcomes. By interviewing patients prior to a CVC placement, patients can be better prepared for the procedure, learning needs can be identified and patient education can begin. Patients and family members view the “Informed Consent” video, which explains the insertion procedure, risk, benefits, alternatives, possible complications and catheter care requirements. This article will focus on how the need for the interview process was identified and implemented and the format for an interview.