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Central Venous Catheter Placement by Advanced Practice Nurses Demonstrates Low Procedural Complication and Infection Rates—A Report From 13 Years of Service*

Alexandrou, Evan RN, MPH1,2,3,4,5,6; Spencer, Timothy R. RN BHealth2,3,4; Frost, Steven A. RN, MPH1,2,4,7,8; Mifflin, Nicholas RN BNursing3,4; Davidson, Patricia M. RN, PhD5; Hillman, Ken M. MD4,7,8

doi: 10.1097/CCM.0b013e3182a667f0
Clinical Investigations

Objectives: To report procedural characteristics and outcomes from a central venous catheter placement service operated by advanced practice nurses.

Design: Single-center observational study.

Setting: A tertiary care university hospital in Sydney, Australia.

Patients: Adult patients from the general wards and from critical care areas receiving a central venous catheter, peripherally inserted central catheter, high-flow dialysis catheter, or midline catheter for parenteral therapy between November 1996 and December 2009.

Interventions: None.

Measurements and Main Results: Prevalence rates by indication, site, and catheter type were assessed. Nonparametric tests were used to calculate differences in outcomes for categorical data. Catheter infection rates were determined per 1,000 catheter days after derivation of the denominator. A total of 4,560 catheters were placed in 3,447 patients. The most common catheters inserted were single-lumen peripherally inserted central catheters (n = 1,653; 36.3%) and single-lumen central venous catheters (n = 1,233; 27.0%). A small proportion of high-flow dialysis catheters were also inserted over the reporting period (n = 150; 3.5%). Sixty-one percent of all catheters placed were for antibiotic administration. The median device dwell time (in d) differed across cannulation sites (p < 0.001). Subclavian catheter placement had the longest dwell time with a median of 16 days (interquartile range, 8–26 d). Overall catheter dwell was reported at a cumulative 63,071 catheter days. The overall catheter-related bloodstream infection rate was 0.2 per 1,000 catheter days. The prevalence rate of pneumothorax recorded was 0.4%, and accidental arterial puncture (simple puncture—with no dilation or cannulation) was 1.3% using the subclavian vein.

Conclusions: This report has demonstrated low complication rates for a hospital-wide service delivered by advance practice nurses. The results suggest that a centrally based service with specifically trained operators can be beneficial by potentially improving patient safety and promoting organizational efficiencies.

1School of Nursing and Midwifery, University of Western Sydney, Sydney, NSW, Australia.

2South West Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

3Central Venous Access Service and Parenteral Nutrition, Liverpool Health Service, Liverpool, NSW, Australia.

4Intensive Care Unit, Liverpool Health Service, Liverpool, NSW, Australia.

5Cardiovascular and Chronic Care, University of Technology, Sydney, NSW, Australia.

6Australian Vascular Access Teaching and Research Group, Griffith Health Institute Centre for Health Practice Innovation, Griffith University, Brisbane, Australia.

7Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

8The Simpson Centre for Health Services Research, The Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia.

* See also p. 731.

This work was performed at Intensive Care Unit, Liverpool Health Service, Liverpool, NSW, Australia.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: e.alexandrou@uws.edu.au

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins