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Objective To understand the current practice status of central venous access device(CVAD)maintenance among intensive care unit(ICU)nurses in secondary and above medical institutions in Shandong province,and to provide a basis for further implementation of effective measures to reduce the incidence of central catheter-related bloodstream infections.Methods The CVAD maintenance practice questionnaire was compiled based on domestic and international evidence related to CVAD maintenance,and a survey was conducted in October 2022 to investigate the status of ICU nurses' CVAD maintenance practice in secondary and above medical institutions in Shandong Province.Results There were 1 492 nurses participated in the survey and 1 461 valid questionnaires were recovered,with a valid recovery rate of 97.92％.The type of CVAD used by the nurses was mainly central venous catheters[92.3％(1349/1461)],and the item with the best assessment at each operation was patency of the catheter[81.1％(1185/1461)],and the worst was the patient's feeling[40.7％(594/1 461)].When assessing catheter patency,[59.8％(873/1 461)]of nurses drew back blood into the catheter.In the use of infusion connectors,three-way connectors[76.0％(1 110/1 461)]and heparin caps[62.3％(910/1 461)]were most frequently used.When sterilizing needleless connectors,most nurses could follow the correct range of disinfection,but the time of disinfection needed to be extended,and the most used items for disinfection were povidone-iodine cotton balls/swabs[44.3％(647/1 461)].The timing of changing infusion connectors needs to be standardized.Most nurses would choose saline for catheter flushing,and the number of nurses choosing saline versus heparinized saline when locking the catheter was about 50％.Most nurses can use correct size syringes and follow standardized techniques for flushing and locking.When performing CVAD maintenance,84.7％(1 237/1 461)of nurses chose a specialized care package kit.The most used skin antiseptic was povidone-iodine[63.7％(931/1 461)].Most nurses could follow the standardized range of skin disinfection,but awareness of drying needs to be improved.Dressings covering puncture points were most frequently transparent[99.7％(1 457/1 461)]and gauze[94.7％(1 383/1 461)],and the frequency of gauze dressing changes needs to be standardized.Hand hygiene and aseptic awareness of nurses during CVAD maintenance was good,but hand hygiene and the timing of wearing sterile gloves need to be standardized.Conclusions ICU nurses' CVAD maintenance practices were generally in line with the latest evidence-based recommendations,but assessment,use of maintenance-related items,and hand hygiene and aseptic technique need to be further standardized.It is recommended that nursing administrators enhance ICU nursing human resource allocation as much as possible and form a central line associated bloodstream infection(CLABSI)prevention and control management system to gradually reduce the morbidity of CLABSI within the ICU.
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BACKGROUND: When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. METHODS: A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. RESULTS: A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). CONCLUSION: Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs.