• Standardized Care of Midline and Central Vascular Access Devices in Home Infusion

      Fabode, Muniratu A.; Edwards, Lori A. (2021-05)
      Problem & Purpose: Vascular Access Devices (VADs) are potential sources for healthcare-acquired infections resulting in increased morbidity and mortality. Vascular access devices refer to any device utilized for venous access, regardless of location. When this project was proposed, the project site, a home infusion company, did not have written policies for the care of midline and central VADs for home infusion patients. The administrators at the agency identified VAD infections as a problem for patients receiving home infusions. The baseline VAD-related infection rate for midline and central venous catheters was 2 per 100 in one month (2%), and the rate for occlusions was 10 per 100 (10%). A preliminary audit found that none of the agency nurses completed all the steps outlined in the Infusion Nurses Society (INS) guidelines for midline and central line dressing changes. The purpose of this project was to implement a standardized protocol for the care of midline and central venous access devices in home infusion patients based on INS recommendations and to evaluate occlusions, line-related infections, and nurse adherence to INS guidelines following education regarding the new protocol. Methods: Initially, a protocol was developed based off INS guidelines with the help of a project team at the project site. Eight full-time infusion nurses were trained to use the standardized INS protocol in caring for home infusion patients. Numbers of occlusions and line-related infections were reported in aggregate by the agency after implementing the protocol. Weekly tracking of the project was conducted with observations and review of documentation to determine adherence to the protocol. Results: Nurses adherence to the protocol increased dramatically from 0% to 100%. The number of line-related bloodstream infections decreased from 2 to zero from the beginning to the end of the project. Rates of occlusions were not affected by the new protocol. Conclusions: An evidence based VAD protocol is a feasible practice change to initiate in the home care setting to reduce or prevent infection rates. Mandatory requirement by the state for this competency at the time of hire is expected to sustain the practice change.