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  • Central Venous Catheter Placement by Advanced Practice Nurses Demonstrates Low Procedural Complication and Infection Rates—A Report From 13 Years of Service

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    Author(s)
    Alexandrou, Evan
    Spencer, Timothy R
    Frost, Steven A
    Mifflin, Nicholas
    Davidson, Patricia M
    Hillman, Ken M
    Griffith University Author(s)
    Alexandrou, Evan
    Year published
    2014
    Metadata
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    Abstract
    Objectives: To report procedural characteristics and outcomes from a central venous catheter placement service operated by advanced practice nurses. Design: Single-center observational study. Setting: A tertiary care university hospital in Sydney, Australia. Patients: Adult patients from the general wards and from critical care areas receiving a central venous catheter, peripherally inserted central catheter, high-flow dialysis catheter, or midline catheter for parenteral therapy between November 1996 and December 2009. Interventions: None. Measurements and Main Results: Prevalence rates by indication, site, and catheter ...
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    Objectives: To report procedural characteristics and outcomes from a central venous catheter placement service operated by advanced practice nurses. Design: Single-center observational study. Setting: A tertiary care university hospital in Sydney, Australia. Patients: Adult patients from the general wards and from critical care areas receiving a central venous catheter, peripherally inserted central catheter, high-flow dialysis catheter, or midline catheter for parenteral therapy between November 1996 and December 2009. Interventions: None. Measurements and Main Results: Prevalence rates by indication, site, and catheter type were assessed. Nonparametric tests were used to calculate differences in outcomes for categorical data. Catheter infection rates were determined per 1,000 catheter days after derivation of the denominator. A total of 4,560 catheters were placed in 3,447 patients. The most common catheters inserted were single-lumen peripherally inserted central catheters (n = 1,653; 36.3%) and single-lumen central venous catheters (n = 1,233; 27.0%). A small proportion of high-flow dialysis catheters were also inserted over the reporting period (n = 150; 3.5%). Sixty-one percent of all catheters placed were for antibiotic administration. The median device dwell time (in d) differed across cannulation sites (p < 0.001). Subclavian catheter placement had the longest dwell time with a median of 16 days (interquartile range, 8-26 d). Overall catheter dwell was reported at a cumulative 63,071 catheter days. The overall catheter-related bloodstream infection rate was 0.2 per 1,000 catheter days. The prevalence rate of pneumothorax recorded was 0.4%, and accidental arterial puncture (simple puncture-with no dilation or cannulation) was 1.3% using the subclavian vein. Conclusions: This report has demonstrated low complication rates for a hospital-wide service delivered by advance practice nurses. The results suggest that a centrally based service with specifically trained operators can be beneficial by potentially improving patient safety and promoting organizational efficiencies.
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    Journal Title
    Critical Care Medicine
    Volume
    42
    Issue
    3
    DOI
    https://doi.org/10.1097/CCM.0b013e3182a667f0
    Copyright Statement
    © 2014 LWW. This is a non-final version of an article published in final form in Critical Care Medicine, March 2014 - Volume 42 - Issue 3 - p 536–543. Reproduced in accordance with the copyright policy of the publisher. Please refer to the journal link for access to the definitive, published version.
    Subject
    Clinical sciences
    Nursing
    Acute care
    Publication URI
    http://hdl.handle.net/10072/64519
    Collection
    • Journal articles

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