Relevance of Central Vascular Devices in Infection Prevention

Introduction

Central venous devices also known as venous access devices refer to tube like appliances used by the medical personnel to access veins in order to administer therapeutic intravenous medication, intravenous nutritional therapy, diagnostic dyes and drawing of blood for diagnostic purposes. These devices are classified as catheters or ports. The difference is catheters exit through the skin and they are left to hang outside the body while ports are enclosed underneath the skin. These devices vary in shape and sizes, from neonatal appliances to adult appliances. These devices are inserted at different sites depending on the patient’s preference and ease of accessibility and the type of therapy the client is undergoing (Bander, 2017).

These appliances stay in situ for a prolonged period of time and they are best suited for people receiving chemotherapy, patients with chronic diseases that require frequent diagnostic test and unconscious patients in the intensive care unit whom require, medication, diagnostic services and nutritional therapy most of which is given in form of intravenous fluids (Bander, 2017)Use of these appliances is preferred over the normal intravenous; lines which are inserted in small veins in the arms or hands, because of their ability to maintain patency over a very long time (Parienti, 2015).

There are two types of central venous devices; peripherally inserted central catheters and external non-tunneled central catheters (Shirong Fang, 2017). Peripherally inserted central catheter is introduced into the body through a large vein in the arm and advanced into the subclavian vein. These two types are inserted at the same sites; that is the subclavian vein, the femoral vein and the internal jugular vein, their only difference is how they are inserted. The peripheral catheter is associated with minimal complications compared to the central catheter.

The devices being foreign objects in the body, they are associated with complications such as, catheter infections, cellulitis, mechanical problems, sepsis, hemothorax endocarditis and venous thrombosis (Rupam Gahlot, 2014).

The insertion of these devices should be a sterile procedure because of the increased risk of cross infection from the environment. The personnel responsible for inserting these devices should be equipped with enough knowledge about the basic principles of chain of infection and the expertise on the safe insertion of the devices, because they are associated with so many complications if the necessary precaution measure are not taken (Koo, 2016).

Since these devices remain in situ for long periods of time, catheter care and port care should be exercised after insertion to prevent the risk of developing cellulitis, catheter infection and sepsis. Some patients remain in the hospital for long periods of time, therefore, infection prevention strategies are practiced by the nurses and other medical personnel, despite this some clients may develop infections as a result of the insertion of the device (Calvache, 2016). That is why the infection prevention policies should be emphasized and taught in all health care facilities. Infection prevention is the main determinant of recovery from diseases, because of the minimized risk of cross infection.

Factors Causing Central Vascular Device Infection

Other patients may be discharged with the device in situ, for such; catheter and port care and infection prevention should be taught and emphasized at every visit (Percival, 2015). They should be taught on the sign of infection and advised to report to the emergency department as soon as they experience the signs of infection.

Central venous devices are relevant in infection prevention, because the skin is a home to normal flora which under normal circumstances it does not cause any pathologic reactions so long as the skin remains intact. This factor cannot be achieved if a client has to be catheterized, thus the normal flora may find their way into the blood stream and cause sepsis. That is why infection prevention is paramount, in ensuring that the procedure and the duration the device is in situ is complication free for the client (Kaye, 2015).

The relevance of these infections is also associated to the fact that they are very hard to eradicate because the conduit is a substance that the patient is supposed to be with for a long period of time sometimes the causative agent may develop resistant such that the body’s immune system is unable to fight the infection increasing its complication rate (Koo, 2016).

Factors associated with infections that arise as a result of insertion of the central venous devices are poor hygiene measures; the client should maintain a high level of hygiene practice because the skin is home to a number of normal flora, also the skin come into contact with the environment which has a lot of pathologic micro-organisms that remain inactive in the environment, but if they find their way into the blood stream they can be highly pathologic. Since the catheter creates an opening into the environment, quality hygienic strategies should be exercised (Calvache, 2016). Poor catheter care; since the catheter is a conduit into the blood stream high quality catheter care should be exercised to prevent risk of infection. Skin breakages associated with the procedure; during the procedure the skin protective barrier of the skin is broken and this can be a conduit for normal skin flora into the blood stream, which then can be pathologic. Inserting the devices through an unsterile procedure; insertion of these devices should be a sterile procedure. If sterility is not observed, then the client may develop catheter infections. Lack of expertise during the procedure; this procedure is conducted by qualified medical personnel who are certified to perform the procedure. They are trained and certified in order to reduce the number of complications associated with the procedure, therefore if these procedures are performed by an unqualified personnel, then the risk of infection increases (Yokoe, 2018). Poor application of infection prevention measures; the main concern is the application of the infection prevention principles if they are not well applied then the chances of the client getting an infection remain high (Yokoe, 2018).

Impact of Infections Associated by Central Vascular Devices

Central vascular devices are put in place to facilitate an accelerated healing. They are used to provide intravenous medication and blood transfusion, draw blood for diagnostic procedures and used to provide intravenous nutritional therapy. The presentation of an infection associated with the device, will result into a prolonged hospital stay and possible complication of the existing condition (Parienti, 2015).

According to the chain of infection there has to be a microorganism, the most culprit is staphylococcus aureus which is commonly found in the skin (Tong, 2015)or bacteria in the blood stream that gains access to the catheter through hematogenous spread. There has to be a reservoir which in this case is the catheter, the skin or the blood itself. The chain also shows there has to be portal of exit, which can either be the incision during insertion or other infected site in the body. There also should be a mode of transmission, in this case it is direct transmission from the skin, the blood or the catheter itself (Bennett, 2014). There has to be portal of entry which can be incision on the skin during insertion or the blood that is already infected. The final component is the susceptible host, which is the sick patient who needs a central vascular device (Rupam Gahlot, 2014).

It is important to understand the chain of infection and the principles of infection prevention and how to apply them at each stage of the chain of infection so as to minimize the chance of transmitting an infection as the practitioner performs the insertion procedure.

Managing infection through infection prevention principles is one of the most important policies in every health care facility. Many strategies have been adopted to ensure that infection associated with central vascular device insertion are reduced. These strategies are continuous medical education and on job trainings on infection prevention; this trainings and educative seminars are used to provide the medical practitioners with knowledge about infection prevention and update any recommended changes made in the policy of infection prevention (Koo, 2016). Provision personal protective equipment; these include equipment such as sterile gloves, sterile gowns both for the patient and the person inserting the catheter, sterile drapes to drape and expose only the part that is being used, mask, sterile packs used for the insertion of the catheter and waste segregation which are color coded. Provision of sterile room for the insertion of central vascular device sterile rooms ensure that there is minimal cross infection from the environment given that highest percentage of central venous devices is caused by nosocomial infections (Creedon, 2014). Use of sterilized and disinfected disposable equipment; as a practitioner it is important to ensure that you use disinfected, sterile and disposable equipment for this procedure. This ensure that there is reduced risk of cross infection and if any infection ensue with the catheter in situ the equipment can be traced back to manufacture, because sometimes infection can develop as a result of contaminated equipment from the manufacturer (Yokoe, 2018).

The number of central venous device infection can reduce tremendously if all the measures put in place are observed diligently (Creedon, 2014).

References

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