CVAD Liaison UNC Health Wake Forest, North Carolina
Purpose - What was the goal of the study?: Goals/
Purpose: The goal was to educate bedside nurses in an ICU setting on the correct mechanism for push-pause flushing and patency awareness, including interventions.
Background - What was the problem? Why was it important?: Intraluminal biofilm development has been associated with bacterial formation within central lines. Central line-associated bloodstream infections (CLABSIs) continue to be an important focus; they are preventable. Maintenance practice initiatives have not historically included occlusion prevention. A six month retrospective study concluded 50% of maintenance CLABSIs in adults hospital-wide have documented occlusions (sluggish, partial, or total). Push-pause flushing has been identified in literature as a preventive measure and considered best practice for preventing biofilm development. The knowledge of the push-pause flushing technique must be explored. The push-pause flushing technique is currently being taught in nursing curriculum. This is a newer concept, and many nurses have not seen a demonstration of the correct technique. As an integral part of the CVAD Stewardship project, patency education was selected as a unit-specific focus. Gaps in nurses’ knowledge of patency awareness have been identified.
Results - What were the findings?: -65 nurses total educated and assessed -Of the nurses assessed, 27% demonstrated a continuous flush technique as their primary flushing technique. -Only 47% demonstrated correct mechanics for push- pause flushing. -Following a visual demonstration on the correct technique, 100% of nurses performed the correct mechanics of push-pause flushing post education. -18% of nurses were unable to identify the difference between a total and partial occlusion. -20% of nurses were unable to identify the correct intervention for a partial occlusion. -47% of nurses did not know the correct intervention for a total occlusion.
Conclusions - What do the final outcomes mean?: Return demonstration and direct observation of the push-pause flushing technique is a very effective tool in receiving new information. These education techniques improved nurses’ knowledge and understanding of the flushing practice. Patency education should remain a focus in CLABSI prevention due to gaps in knowledge. Ongoing assessments and interventions are needed to ensure competency and understanding of flushing modalities, especially in a setting with a high turnover rate.
