My facility is trying to build into our daily nursing IV assessment a section related to CVAD daily necessity review. Is anyone aware of any guidelines as to standard indications for a CVAD, similar to those put out by CDC for indications for foley catheter use?
I have not seen such a list of indications yet, however the SHEA 2014 Compendium Update on CLABSI recommended the use of such a list. When you look at the literature on VAD removal, I have found a list of indications to continue to use the CVAD. That list includes:
Clinical instability of the patient (eg., alteration in vital signs, oxygen saturation, etc.)
Prescribed continuous infusion therapy (eg., parenteral nutrition, fluid and electrolytes, medications, blood or blood products)
Hemodynamic monitoring
This list was compiled from
Tejedor SCMDS, Tong DMDMPH, Jason Stein MS, et al. Temporary Central Venous Catheter Utilization Patterns in a Large Tertiary Care Center: Tracking the “Idle Central Venous Catheter”. Infection control and hospital epidemiology. 2012;33(1):50-57.
Dumyati G, Concannon C, van Wijngaarden E, et al. Sustained reduction of central line–associated bloodstream infections outside the intensive care unit with a multimodal intervention focusing on central line maintenance. American Journal of Infection Control. 2014.
Weeks KR, Hsu Y-J, Yang T, Sawyer M, Marsteller JA. Influence of a multifaceted intervention on central line days in intensive care units: Results of a national multisite study. American Journal of Infection Control. 2014;42(10):S197-S202.
Zingg W, Sandoz L, Inan C, et al. Hospital-wide survey of the use of central venous catheters. Journal of Hospital Infection. 2011;77(4):304-308.
Milstone AM, Reich NG, Advani S, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics. 2013;132(6):e1609-e1615.
So you may have to work backwards on this issue - from a list of when a CVAD should be continued to when it is originally indicated. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861