Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates -A report from 13 years of service

Evan Alexandrou, Timothy R. Spencer, Steven A. Frost, Nicholas Mifflin, Patricia M Davidson, Ken M. Hillman

Research output: Contribution to journalArticle

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 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.

Original languageEnglish (US)
Pages (from-to)536-543
Number of pages8
JournalCritical Care Medicine
Volume42
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

Fingerprint

Central Venous Catheters
Catheters
Nurses
Infection
Punctures
Catheterization
Dialysis
Organizational Efficiency
Subclavian Vein
Catheter-Related Infections
Patients' Rooms
Pneumothorax
Tertiary Healthcare
Critical Care
Patient Safety
Observational Studies

Keywords

  • bacteremia
  • catheter-related infections
  • catheterization
  • central venous catheter
  • clinical nurse specialist
  • peripheral catheterization

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates -A report from 13 years of service. / Alexandrou, Evan; Spencer, Timothy R.; Frost, Steven A.; Mifflin, Nicholas; Davidson, Patricia M; Hillman, Ken M.

In: Critical Care Medicine, Vol. 42, No. 3, 03.2014, p. 536-543.

Research output: Contribution to journalArticle

Alexandrou, Evan ; Spencer, Timothy R. ; Frost, Steven A. ; Mifflin, Nicholas ; Davidson, Patricia M ; Hillman, Ken M. / Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates -A report from 13 years of service. In: Critical Care Medicine. 2014 ; Vol. 42, No. 3. pp. 536-543.
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AU - Mifflin, Nicholas

AU - Davidson, Patricia M

AU - Hillman, Ken M.

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AB - 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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KW - catheter-related infections

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KW - clinical nurse specialist

KW - peripheral catheterization

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