Central venous access device (CVADs) policy review

Identifу уоur hоspital poliсy on the maintenance of central lines. Conduct a literature search to explore whether this policy is based on the lasted <6 years evidence. At least three highly relevant and specific evidence-based resources must be referenced.

Critique and synthesise current clinical guidelines and relevant supporting evidence-based literature which addresses this topic. Present a thorough critique of the identified hospital policy against your chosen evidence. Rationalise whether or not some components or all of the policy needs revising to be consistent with current literature regarding maintenance of central lines. Make recommendations for policy change/development that are evidence-based, considering the implications and resources in your practise area.

You may choose to focus on selected aspects of a policy to suit your learning or practice area

The Hospital policy in the maintenance of central lines

A catheter is an intravascular access device that gets rid at or near the heart and other delicate vessels; this is also known as the central line which is used for infusion, hemodynamic monitoring, dialysis or haemofiltration. A central line may be inserted peripherally or centrally in a patient; the device must terminate in or near the heart to qualify a central line (The Joint Commission, 2012). Before performing the central line insertion there are policies made to govern the process for quality service preventing risks, the policies made include;

Provision of Clinical Procedures Manual

The purpose for this is to provide medical professionals with instruction on the ongoing care of the central venous access device which are the central venous catheters (CVC), peripherally inserted central catheters (PICC). Implanted venous ports (IVP) the purpose is to prevent the development of central line bloodstream infections (CLABSI), ensure ongoing patency of the (CVAD), and provide standards for (CVAD) placement confirmation, site assessment and catheter necessity (The Joint Commission, 2012).

The Literature of the policy

The policy provides the clinical procedure manual with the right ways of carrying out the health reforms in the health care in the provision of the central venous. The policy provides the right people to handle the case, and that is the registered nurses, endorsed enrolled nurses and the registered midwives to perform the practice. The policy bares the other professional especially those that are not designated to do the task. Moreover, the system allocates the risks that are associated with the work which are the infections, catheters migration, the pinch-off syndrome to create awareness for the nurses and the midwives in carrying out the insertion. Additionally, the policy introduces the various techniques like the maintenance of patency known as flushing that should be highly considered to prevent the accumulation of blood and the precipitation of blood in the catheter lumen during the task. The policy mentioned with the various principle outlined in the document provides the measures that are in line with the article from Grady (2011) on the healthcare infection control systems and the guidelines on the prevention of the intravascular catheter-related infections.  Moreover, the joint commission (2012) provides the guidelines and initiatives for the prevention of the central line-associated bloodstream infections. The Eviq cancer online education (2015) on the principles of the central venous access devices that supports the manual procedures to the nurses and the other recognized midwives. These concerns are in line with the principles provided in the manual for the task on the central line insertion.

The hospital policy vs. chosen evidence

The selected evidence provides the guidelines for the governance of the safety and the quality in the healthcare organizations but on the other hand, does not outline the principles and the procedure of the task provided on the catheter. The hospital policy provides a natural factor on the right procedure to be followed by the elements on the line catheter. The system provides an extension method on the persons who are entitled to handle the catheter insertion to the patients. Among the provision includes the policy for the identification of the patients before carrying out the procedure to prevent the risks that are involved in the process. The chosen evidence, on the other hand, does not provide the method for the identification of the patient before the process begun. The preferred evidence does not gives guidelines on the required or authorized personnel for the provision of the course since all the health providers cannot be allowed to provide the services for the sake of safety. Therefore, the chosen evidence does not give a clear outline on the protection as it claims such as the Grady (2012).

The Rationale

The content of the policy for the maintenance of safety issues of the patient does not need any adjustment for its efficiency (The Joint Commission, 2012). The system content meets the substance of the protection of the patients through the effective guidelines that are provided in the manual. It was realized that the absence of procedural content for the health providers on the insertion of the catheter led to some serious but avoidable mistakes that could be avoided through an effective procedure. Moreover, apart from the procedure, the hospital policy has also set that the only required and qualified people to carry out the operation are the recognized nurses and the qualified midwives in the health sectors. These exist to makes sure that the patient’s safety is protected by regulating the personnel to perform the tasks. Additionally, the policy document manual provides the risks factors to be understood by the providers to prevent the spread of the infection through careless actions. These allow the qualified providers to take care while handling the operation due to the risk factors that are involved and can be cost when not taken care of efficiently. Therefore, the content is in line with the maintenance of the central lines.

Recommendations

The policy on the maintenance of the central line is based on the provision on the procedural manual that is used in the maintenance of safety measures and protection. A clinical procedure manual is perhaps a good approach for the aspect of the care in the central venous protocol since it provides the mechanism for the protection and safety association. Despite that, the policy ought to consider another aspect of the matter such as the involvement of the right management system and the resource availability for carrying out the process. Therefore, the policy should add the reasoning and provision of the resources and good management since such matters may affect or hinder the delivery of health. The advancement of technology in the surgery section through the use of the modernized equipment will ensure that the safety measures are taken care of efficiently. For example in the article by the Joint Commission (2012) provides another area of focus based on the modernization of the healthcare through the change of instruments.

Moreover, the level of skills concern through recognized nurses and midwives as the significant effect for the prevention of the infection is perhaps not everything for the maintenance purposes. Therefore, the manual should consider providing the issue of management of the staff since skilled personnel cannot perform well in the absence of motivation and various practice management principles. The case should involve all the matters that are influenced by the directorate because every healthcare performance success depends so much on good management.  The Camp-sorrell (2011) provides the issue of good management that is tagged with cost and maintenance of the human resource as a matter of concern. Therefore, the policy should incapacitate the issue of management.

References

Camp-Sorrell, D. (ED) (2011) Access device guidelines recommendations for nursing practice and education. Pittsburgh, PA: Oncology Nursing Society.

EviQ Cancer Education Online (2015) Principles of Central Venous Access Devices. Accessed March 2016: https://education.eviq.org.au/courses/central-venous-access-devices.

O’Grady, NP, Alexander, M, Burns, LA, Dellinger, EP, Garland, J, Heard, SO, Lipsett PA, Masur, H, Mermel, LA, Pearson, ML, Raad, II, Randolph, AG, Rupp, ME, Saint, S. Healthcare Infection control Practices Advisory Committee (2011). 2011 Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 52(9), 162-193.

The Joint Comission (2012) Preventing central line-associated bloodstream infections a global challenge, a global perspective. Oak Brook, IL: Joint Commission Resources.