Central venous catheters: latest evidence for nursing practice

Chapman, S. Evidently Cochrane Blog. Published online: 15 September 2016

800px-icu_iv_1
Image source: Calleamanecer – Wikipedia // CC BY-SA 3.0

By Sarah Chapman

What are the things that you do to reduce the risk of catheter-related infection in patients with central venous catheters (CVCs)? Take a moment to run through them. Now think about each one and why you do it. I’ll give you some prompts; mentally tick off all that apply:

  1. It’s Trust policy
  2. NICE (or other) guidance recommends it
  3. There’s evidence that it’s effective
  4. I’ve always done it [this way]

That last one always made me (inwardly) howl with frustration whenever I heard it, but I know you evidence-seekers won’t have ticked that one. It would be great to tick the first three, but can you? There might be more howling over those. I was rather shocked (ok, call me naïve) to discover that reliable evidence supporting the replacement of peripheral venous catheters only when clinically indicated, duly recommended by the UK’s epic3 National Evidence-Based Guidelines as being both safe and cost-saving, had not translated into practice in some hospitals. This came to light in a lively #WeNurses tweetchat on the evidence and you can catch up with it in this blog.

Skin antisepsis

I’ve also blogged here about evidence from a number of Cochrane reviews on different aspects of infection prevention for people with CVCs but since then we’ve seen the publication of more reviews, including this one on skin antisepsis. Was that on your list? Here in the UK, NICE guidance (epic3 again) recommends cleansing with chlorhexidine gluconate in 70% alcohol, or povidone iodine in alcohol for patients sensitive to chlorhexidine (tick). Can we tick off evidence of effectiveness?

The review brought together data from 12 randomised studies with 3446 CVCs (number of patients unknown), comparing different skin antisepsis regimens with each other and with none. Whilst there is nothing here to overturn the guidance, the evidence is mostly low or very low quality and, beyond saying that chlorhexidine solution may be more effective than povidone iodine, any questions about which regimen is best or whether skin antisepsis benefits patients are left unanswered.

Read the full post here

Advertisements

Childhood flu programme: information for practitioners

The Department of Health has updated its guidance document The National Childhood Flu Immunisation Programme 2016/17 Information for healthcare practitioners

flu
Image source: http://www.gov.uk/

The document includes information on:

  • what flu is
  • the flu vaccine
  • dosage
  • administering the vaccine
  • advice on vaccinating children with an egg allergy
  • further resources

Sepsis toolkit

The Royal College of General Practitioners (RCGP), in partnership with Health Education England and NHS England, has launched a Sepsis toolkit to support GPs and healthcare professionals to identify and manage the condition.

The toolkit provides a collection of tools, knowledge, and current guidance to support the identifying and appropriate management of patients with sepsis. The toolkit is aimed at GPs and healthcare professionals assessing people in the community with acute infection.

The toolkit also provides valuable information for patients, carers and parents, including an adult and child sepsis ‘symptom checker’, to illustrate the signs and symptoms they should look out for.

Additional link: RCGP press release

seps
Image source: sepsistrust.org/

Tackling falling child vaccination rates

vaccination-1215279_960_720NICE is developing priorities to help ensure unvaccinated children across the country get the protection they need.  In some areas of the country, fewer than 1 in 5 children are vaccinated against diseases such as polio and diphtheria. Experts have warned that unless uptake rates improve there is a risk of these diseases making a comeback.

Last year only a quarter of local authorities met World Health Organization targets to vaccinate 95% of children against measles, mumps and rubella.  A draft quality standard from NICE, out for consultation until 29 September, sets out how to drive up the number of under 19s who receive vaccinations.