A central venous catheter, also known as a central venous line (CVL), is a long flexible tube that is inserted into a large vein by a doctor to give important medical treatments (Centers for Disease Control and Prevention (CDC), 2010). The end of this tube stops near the heart allowing nutrition, fluid, blood, or medication treatments to be given within seconds. A CVL is important for critically ill patients because it allows medications to be given quicker and in higher doses (CDC, 2010). 

CLABSIs is a serious infection that can result in sepsis or death. It occurs when a bacteria or virus enters the bloodstream through a CVL. The CDC states, “About 1 in 20 patients gets an infection each year while receiving medical care” and of those patients 1 in 4 will die from a bloodstream infection from having a CVL (CDC, 2011a). This is a problem because CLABSIs are largely preventable when healthcare providers and nurses use proper infection prevention control methods. Although there are several healthcare-associated infections that cause harm to patients, CLABSIs are associated with the highest rates of preventable mortality (Association for Professionals in Infection Control and Epidemiology (APIC, 2015).   

Any patient that has central venous access, whether it be a PICC line, a subclavian or femoral central line, a tunneled dialysis catheter, or a Mediport can be affected by a CLABSI (CDC, 2010). Since a CLABSI is considered a healthcare-associated infection it is not covered under health insurance, so with each new CLASBI about $70,000 is added to the healthcare system (Woten & Mennella, 2018). 

CLABSIs can greatly affect patients in a number of ways. CLABSIs can result in prolonged hospitalizations, further complications for patients, as well as increased healthcare costs (Health Research & Educational Trust, 2018). In hopes of trying to kill the bacteria causing the infection, patients will also require high doses of potent antibiotics. Patients with central line infections also have 2.27-fold increase in morbidity and mortality (Health Research & Educational Trust, 2018). CLABSI patients have a higher risk for developing sepsis, multisystem organ failure and even death (APIC, 2015).  

A CLABSI can occur at any time. During the insertion of a CVL, an infection can occur if the line is not inserted under sterile conditions (CDC, 2011b). If a line is accessed without using proper aseptic technique it can result in the patient acquiring a CLABSI (CDC, 2011b). Also, if a CVL dressing change is not done using the appropriate steps and tools to keep the site sterile, there can be transmission of bacteria to the patient.  As one can see, there are several ways in which a CLABSI can occur.       

Patients with CVLs are not just in the hospital; there are a number of setting where a CLABSI can occur including long-term care facilities, outpatient facilities, dialysis centers, and even at home (CDC, 2010). If the healthcare professionals at these facilities or the home health nurses do not know how to properly care for a CVL, a patient can get a CLABSI.

Since the implementation of the CLABSIs bundles, the United States has seen a 58% decrease in central line infections (Woten & Mennella, 2018). In 2001, it was estimated about 43,000 CLABSIs, as compared to 2009 where there were approximately 18,000 (Woten & Mennella, 2018). The steps and interventions within the CLABSI bundle have proven to help reduce and prevent central line infections. 

As stated before, Nurses are the frontline protectors of patients with CVLs. They are the one performing the CLABSIs bundle and the ones observing the patients for signs and symptoms of a bloodstream infection. The most important step to the prevention of infection is hand hygiene; patient hygiene is also of high importance.  Nurses are responsible for ensuring that a patient with a central line catheter has a CHG bath every 24 hours while that line is in. They are also in charge of assessing the insertion site and dressing every 12 hours to may sure the dressing is clean dry and intact and the insertion site is not red, swollen, or has drainage. Nurses have many tasks to ensure they are using the most aseptic techniques to reduce the risk of their patient acquiring a CLABSI.

In a 12-hour shift nurses are responsible for a great deal of things from medication administration, wound care, assistance with activities of daily living, to all the maintenance activities such as line changes, dressing changes, and assessments.  It is easy to see how some things can be missed or forgotten about; a nursing work list could be very useful as a way for nurses to have a visual reminder of each task required throughout the shift.  It would be helpful if the electronic medical record (EMR) had alerts for the nurse to change the central line dressing, or change the IV tubing and access ports.

The prevention of CLABSIs is a team effort among all healthcare members.  Education for not only the nurses but the physicians as well would promote an increased understanding of current evidence-based policies and procedures; additionally, it would aid in a collaborative culture between the healthcare team for CLABSI reduction. 

Part of the CLABSI bundle involves daily assessment for the need of the CVL. As a measure to reduce the amount of time CVLs are in place, it would be helpful to have an organized method for a comprehensive review of all CVLs on a unit.  This tool could be used by the charge nurse, and list each patient with a CVL, the indication, date of insertion, and number of days in place.  This could then be used in daily rounds to address the need for the CVL in each patient; this is in an effort to reduce the duration of time CVLs are in place as risk for infection increases every day a CVL is in. 

Throughout my education at Sentara College, I learned the importance of being a patient advocate. Being a patient advocate is mentioned in the American Nurses Association’s Code of Ethics for Nurses which states “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (American Nurses Association, n.d.). The nurse is the one who knows the patient better than any other personnel. It is their duty to do right by the patient and advocate for them endlessly. Being a patient advocate would mean standing up for my patient to ensure they receive the best possible care from me, as a nurse, and from the doctors in charge of their care.  

Infection Prevention 

Infection prevention has been a major concept throughout my experience at Sentara College because nurses have the ability to directly impact patient outcomes. There are several ways in which infection can be prevented, however it is up to the nurse to use their knowledge and clinical judgment to prioritize infection prevention thought out their practice.