Evidence Summaries- Devices
Moureau NL, Flynn J. Disinfection of needleless connector hubs: Clinical Evidence Systematic Review. Nursing Research and Practice, 2015, Article ID 796762. doi:10.1155/2015/796762
Moureau and Flynn (2015) published a systematic review related to disinfection of needleless connectors (NC). Literature meeting inclusion criteria was rated according to the National Health and Medical Research Council Guidelines (NHMRC 2009). The review yielded a large number of studies with 67 papers and 34 abstracts meeting requirements for inclusion and grading. The studies and abstracts were grouped for NC disinfection practices prior to access, the impact of hub contamination on infection, and measures of education and compliance that promote aseptic access. Results of this study indicated a lack of compliance with disinfection of access sites despite educational initiatives and improved disinfecting agents. Use of passive disinfection caps resulted in the greatest effectiveness when more than 80% compliance was achieved with the products.
Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD011447. DOI:10.1002/14651858.CD011447.
On the basis of available data, we conclude that two-dimensional ultrasound offers small gains in safety and quality when compared with an anatomical landmark technique for subclavian (arterial puncture, haematoma formation) or femoral vein (success on the first attempt) cannulation for central vein catheterization. Data on insertion by inexperienced or experienced users, or on patients at high risk for complications, are lacking. The results for Doppler ultrasound techniques versus anatomical landmark techniques are uncertain.
The review found no evidence to support changing catheters every 72 to 96 hours. Consequently, healthcare organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would spare patients the unnecessary pain of routine re-sites in the absence of clinical indications. To minimise peripheral catheter-related complications, the insertion site should be inspected at each shift change and the catheter removed if signs of inflammation, infiltration, or blockage are present.
Some evidence indicates that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the risk of infection. Other evidence suggests that mortality increased within the neonatal population with infrequent administration set replacement. However, much the evidence obtained was derived from studies of low to moderate quality.
This review confirms the effectiveness of antimicrobial CVCs in improving such outcomes as CRBSI and catheter colonization. However, the magnitude of benefits in catheter colonization varied according to the setting, with significant benefits only in studies conducted in ICUs. Limited evidence suggests that antimicrobial CVCs do not appear to significantly reduce clinically diagnosed sepsis or mortality. Our findings call for caution in routinely recommending the use of antimicrobial-impregnated CVCs across all settings. Further randomized controlled trials assessing antimicrobial CVCs should include important clinical outcomes like the overall rates of sepsis and mortality.