References

Centers for Disease Control and Prevention. Bloodstream infection event (central line-associated bloodstream infection and non-central line associated bloodstream infection). https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf (Accessed November 14, 2020)

Ares G, Hunter C. Central venous access in children: indications, devices and risks. Curr Opin Pediatr. 2017; 29:(3)340-346 https://doi.org/10.1097/MOP.0000000000000485

Ullman AJ, Marsh N, Mihala G, Cooke M, Rickard CM. Complications of central venous access devices: a systematic review. Pediatrics. 2015; 136:(5)e1331-e1344 https://doi.org/10.1542/peds.2015-1507

Ullman AJ, Cooke M, Kleidon T, Rickard CM Road map for improvement: point prevalence audit and survey of central venous access devices in paediatric acute care. J Paediatr Child Health. 2016; 53:(2)123-130 https://doi.org/10.1111/jpc.13347

Ullman AJ, Cooke ML, Mitchell M Dressings and securement devices for central venous catheters (CVC). Cochrane Database Syst Rev. 2015; 2015:(9) https://doi.org/10.1002/14651858.CD010367.pub2

O'Grady NP, Alexander M, Burns LA Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011; 52:(9)e162-e193 https://doi.org/10.1093/cid/cir257

Szydlowski EG, Rudolph JA, Vitale MA, Zuckerbraun NS. Bloodstream infections in patients with intestinal failure presenting to a pediatric emergency department with fever and a central line. Pediatr Emerg Care. 2017; 33:(12)e140-e145 https://doi.org/10.1097/PEC.0000000000000812

Opstrup S, Jemec BE, Garvey LH. Chlorhexidine allergy: on the rise and often overlooked. Curr Allergy Asthma Rep. 2019; 19:(23)1-10 https://doi.org/10.1007/s11882-019-0858-2

Loewenthal M, Dobson P, Boyle M. Chlorhexidine 2% and choice of transparent dressing increase skin reactions at central venous catheter insertion sites. Am J Infect Control. 2016; 44:(12)1712-1714 https://doi.org/10.1016/j.ajic.2016.020

Vascular Access/IV

Managing central venous catheter dressings: a short gut syndrome case study

27 January 2022
Association for Vascular Access
02 January 2022
Volume 31 · Issue 2

Abstract

Central venous catheters are necessary in treatment and care of pediatric patients with short gut syndrome. Despite necessity, central venous catheters come with the risk of developing CLABSI. This manuscript describes a complex, pediatric gastroenterology patient with multiple risk factors who developed a CLABSI. Short gut syndrome patients can develop skin conditions and complications that may challenge nursing practice to mitigate CLABSI. Further research is needed on preventing CLABSIs in complex pediatric patients to provide the best practice implications for nursing.

HIGHLIGHTS

Central venous catheter care may be complicated by complex patient considerations.

Central-line associated bloodstream infection (CLABSI) risk factors are multifaceted.

Case report to highlight patient complexity that challenges bundled practices.

Central venous catheters (CVCs) are necessary during treatment of intestinal failure to maintain adequate hydration, nutritional status, and delivery of medications. A CVC is defined as an intravascular catheter that terminates at or close to the heart or in one of the great vessels and is used for infusion, withdrawal of blood, or hemodynamic monitoring.1 Various types of CVCs are used in the pediatric population, including peripherally inserted central catheter (PICC), nontunneled or tunneled CVC, implanted venous access devices, hemodialysis catheters, and apheresis catheters. Despite the necessity for CVCs, postinsertion CVC complications are common and include central line associated blood stream infections (CLABSI), catheter dislodgment or migrations, catheter breaks, local site infections, skin integrity issues, and/or mechanical occlusions.2–4 Roughly 8% of all hospitalized pediatric patients require care with a CVC, equating to approximately 5 million placed each year.2,5

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Central venous catheter
Central line-associated bloodstream infection
Risk factors