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Care bundles and peripheral arterial catheters

25 January 2024
Volume 33 · Issue 2

Abstract

HIGHLIGHTS

What we know about the topic:

Recommendations for the use of vascular access care bundles to reduce infection are followed for different devices.

The risk of arterial catheter-related infection is comparable with short-term, non-cuffed central venous catheters.

There are practice concerns for clinicians inserting and caring for peripheral arterial catheters.

What this paper adds:

The selected studies had a theme of decreased infection after using bundled strategies for all devices.

Few studies addressed use of bundles for care of peripheral arterial catheters.

High-quality research should be performed about using care bundles for insertion and care of arterial catheters.

Introduction:

A scoping review of the literature was performed.

Aims/objectives:

To find information on the use of care bundles for care of arterial, central, and peripherally inserted venous catheters.

Methods:

Data was extracted by 2 independent researchers using standardized methodology

Results:

Results of 84 studies included 2 (2.4%) randomized controlled trials, 38 (45.2%) observational studies, 29 (34.5%) quality projects, and 15 (17.9%) reviews. Populations had more adults than pediatric patients. All studies had the most prominent theme of decreased infection in all devices after using bundle strategies.

Discussion and conclusions:

The mapping of available evidence strongly supports the use of care bundles to reduce infection in the care of all intravascular devices. However, deficiencies regarding practice concerns about insertion and care of arterial catheters highlight areas for future research with the aim to eliminate the gap in the evidence of studies of care bundles for peripheral arterial catheters.

A frequently performed practice in anesthesia, critical care, and emergency medicine is insertion of a peripheral arterial catheter (AC) for hemodynamic monitoring and frequent blood sampling. With millions inserted annually in the United States, peripheral AC associated complications include dislodgement, mechanical failure, and infection.1 The risk of AC related infection has been known for over a decade to be comparable with short-term, noncuffed central venous catheters (CVCs).16 ACs have been described as the most manipulated intravascular device in Intensive Care Units and the operating room increasing risk factors, with the need for an AC bundle described in 2008 and 20101,58 to decrease risk and improve patient safety. The literature also shows that guidelines recommended by the Centers for Disease Control for AC insertion have often not been followed.9 Such evidence indicates a need for a standardized approach for insertion and care of peripheral ACs to improve practice by featuring the specified interventions of patient assessment, an appropriate aseptic technique, and correct insertion and/or securement methods. A standardized safe insertion bundle incorporating ultrasound-guidance for ACs has recently been published to promote procedural excellence.10 Standardization with a structured framework has been achieved using insertion and care bundles, initially with CVCs, incorporating specified interventions that improve practice, effectiveness, and patient safety in an efficient and cost-effective manner to minimize complications.11 To clarify, the key features of a care bundle are collective, reliable, and continuous performance to improve care.12,13 Many bundles focus on hospital-acquired infections,1418 particularly central line associated blood stream infections (CLABSIs). The landmark Michigan Keystone Intensive Care Unit Patient Safety Program in 2006 resulted in the large (66%) and sustained decreased rate of catheter related blood stream infections (CRBSIs).19 However, audit processes report improved care in many aspects of care delivery following implementation of care bundles.20 An AC care bundle to facilitate best practice for AC insertion and care is overdue.

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