Registered Nurse, Vascular Access Team Penn Medicine Lancaster General Health Lititz, Pennsylvania
Purpose - What was the goal of the study?: A nurse driven protocol was developed to consider individualized patient vascular access and evaluate central line necessity. The protocol would provide guidance for line removal with nursing autonomy and provider collaboration. The patient safety goal was to decrease central line infections.
Background - What was the problem? Why was it important?: The Central Line Infection Prevention committee (CLIP) at our facility included providers, nurses, administration, and the infection control prevention team. This team was developed to address the rising number of central line infections and meet the goals of the Centers for Disease Control to prevent patient harm. National Healthcare Safety Network healthcare-associated infection (HAI) measures for reimbursement of payment was also a driver for change. This nurse driven protocol was developed by our Vascular Access team (VAT) based on evidence. CLABSIs increased patient morbidity and mortality as well as stressed the healthcare system. The development of the protocol was important to reduce line days while not compromising the patient's vascular needs. The protocol included a consult to the VAT to evaluate line necessity as well as a vessel assessment and identify possible complications related to removal.
Results - What were the findings?: In a six month trial we tracked 582 vein assessments for central line removal. Majority of idle lines resulted in early removal with only 20% (114) recommended to be maintain related to necessity and vein preservation. No harm resulted from the protocol. No CLABSIs occurred in the lines maintained and no lines needed to be replaced due to premature removal. The protocol was approved by the Medical Executive Committee and continues to drive early removal of idle lines. In the Fiscal year of 2021 the VAT team completed 711 vein assessments with 20% maintained based on critical needs and vein preservation. Collaboration and increased awareness with the care team has changed the culture at our organization and continues to support overall safety goals for the patients we care for. In fiscal year 2021 this initiative significantly decreased CLABSIs, in the critical care area with the highest line days, by 63%. The protocol continues to be a part of our key approach to improve patient outcomes and decrease line related complications.
Conclusions - What do the final outcomes mean?: Our study found that we were able to remove unnecessary or idle central lines in 80% of our patients. With the 20% of the lines maintained related to vein preservation, no CLABSIs or patient harm resulted. As a result we also had some unexpected findings such as improved central line care and increased awareness related to vein integrity and preservation. We additionally gained the trust of our providers while improving patient outcomes.
