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Impact of Kamishibai Card Process on Compliance With the Central Venous Line Maintenance Bundle

Frith, Julia DNP, RN, CIC; Hampton, Debbie PhD, MSN, RN, FACHE, NEA-BC, CENP; Pendleton, Michelle DNP, RN, CPHQ; Montgomery, Vicki L. MD, FCCM; Isaacs, Pam BSN, MHA, CIC

doi: 10.1097/NCQ.0000000000000405

Background: The Kamishibai Card (K-Card) process is a storytelling methodology designed to help identify barriers and remove or redesign them.

Purpose: The purpose of this study was to evaluate the effectiveness of the K-Card process for central venous line (CVL) maintenance bundle compliance in a pediatric intensive care unit.

Methods: A retrospective evaluation of the implementation of the K-Card process was performed using a pretest and posttest design.

Results: A total of 1003 central venous catheter maintenance observations were completed during the study period. A statistically significant change was noted in one element of the CVL maintenance bundle, tubing timed and dated. The most frequent cause for noncompliance with the CVL maintenance bundle was incomplete communication during handoff, followed by device associated factors (failure of device, use of device, and availability of device).

Conclusions: The K-Card process had a positive impact on CVL maintenance bundle compliance in the study setting.

Norton Healthcare, Louisville, Kentucky (Drs Frith and Pendleton and Ms Isaacs); University of Kentucky College of Nursing, Lexington (Dr Hampton); and Pediatric Critical Care Medicine, University of Louisville, and Division of CARE Innovation at Norton Children's Hospital, Louisville, Kentucky (Dr Montgomery).

Correspondence: Julia Frith, DNP, RN, CIC, Norton Healthcare, 234 E. Gray St Louisville, KY 40202 (

This project work was fully funded through the University of Kentucky College of Nursing and Norton Healthcare academic partnership.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Accepted for publication: March 4, 2019

Published ahead of print: April 16, 2019

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