Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services

Alexandrou, Evan; Murgo, Margherita; Calabria, Eda; Spencer, Timothy R.; Carpen, Hailey; Brennan, Kathleen; Frost, Steven A.; Davidson, Patricia M.; Hillman, Ken M.

doi:10.1016/j.ijnurstu.2011.08.011

« Previous Next »International Journal of Nursing Studies
Volume 49, Issue 2 , Pages 162-168, February 2012

Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services

Evan Alexandrou
- School of Nursing and Midwifery, University of Western Sydney, New South Wales, Australia
- Central Venous Access Service and Parenteral Nutrition, Liverpool Health Service, New South Wales, Australia
- University of New South Wales, New South Wales, Australia
- Intensive Care, Liverpool Health Service, New South Wales, Australia
- University of Technology Sydney, New South Wales, Australia
- Curtin University, New South Wales, Australia
- Corresponding author at: School of Nursing and Midwifery, University of Western Sydney, NSW, Australia. Tel.: +61 2 9685 9506; fax: +61 2 9685 9599.
Margherita Murgo
- Clinical Excellence Commission, New South Wales, Australia
Eda Calabria
- Clinical Excellence Commission, New South Wales, Australia
Timothy R. Spencer
- Central Venous Access Service and Parenteral Nutrition, Liverpool Health Service, New South Wales, Australia
- University of New South Wales, New South Wales, Australia
- Intensive Care, Liverpool Health Service, New South Wales, Australia
Hailey Carpen
- Nepean Hospital, New South Wales, Australia
Kathleen Brennan
- University of New South Wales, New South Wales, Australia
- Critical Care Services, Bankstown Health Service, New South Wales, Australia
Steven A. Frost
- School of Nursing and Midwifery, University of Western Sydney, New South Wales, Australia
- Intensive Care, Liverpool Health Service, New South Wales, Australia
Patricia M. Davidson
- University of Technology Sydney, New South Wales, Australia
Ken M. Hillman
- University of New South Wales, New South Wales, Australia
- The Simpson Centre for Health Services Research (affiliated with) The Australian Institute of Health Innovation, University of New South Wales. New South Wales, Australia

Received 30 March 2011; received in revised form 17 June 2011; accepted 31 August 2011. published online 26 September 2011.

Abstract

Background

Nurse-led central venous catheter placement is an emerging clinical role internationally. Procedural characteristics and clinical outcomes is an important consideration in appraisal of such advanced nursing roles.

Objectives

To review characteristics and outcomes of three nurse-led central venous catheter insertion services based in intensive care units in New South Wales, Australia.

Design

Using data from the Central Line Associated Bacteraemia project in New South Wales intensive care units. Descriptive statistical techniques were used to ascertain comparison rates and proportions.

Participants

De-identified outcome data of patients who had a central venous catheter inserted as part of their therapy by one of the four advanced practice nurses working in three separate hospitals in New South Wales.

Results

Between March 2007 and June 2009, 760 vascular access devices were placed by the three nurse-led central venous catheter placement services. Hospital A inserted 520 catheters; Hospital C with 164; and Hospital B with 76. Over the study period, insertion outcomes were favourable with only 1 pneumothorax (1%), 1 arterial puncture (1%) and 1 CLAB (1%) being recorded across the three groups. The CLAB rate was lower in comparison to the aggregated CLAB data set [1.3 per 1000 catheters (95% CI=0.03–7.3) vs. 7.2 per 1000 catheters (95% CI=5.9–8.7)].

Conclusion

This study has demonstrated safe patient outcomes with nurse led CVC insertion as compared with published data. Nurses who are formally trained and credentialed to insert CVCs can improve organisational efficiencies. This study adds to emerging data that developing clinical roles that focus on skills, procedural volume and competency can be a viable option in health care facilities.

Keywords: Central venous catheters, Nurse led care, Vascular access, Clinical nurse specialist