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1、Identifying Experiences Related to Accessing Central Venous Catheters(CVCs)/Central lines for Treatment Infusions and Parenteral(IV)Nutrition(PN)Amy C.Cole,Lukasz Mazur,Nancy Havill,Karthik Adapa,Daniel R.RichardsonJune 29,2023Acknowledgements We would like to thank UNC Health and the Nursing Resear
2、ch Council for their ongoing support devoted to our research efforts.We would like to thank the Oley Foundation for their interest in supporting our research efforts.Financial Disclosures The project described was supported by the National Center for Advancing Translational Sciences(NCATS),National
3、Institutes of Health,through Grant Award Number UL1TR002489.The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.Learning Objectives1st Learning Objective:Understand the challenges and workarounds associated with accessing and chang
4、ing needleless claves in central venous catheters(CVCs)for infusion therapies.2nd Learning Objective:Recognize the emotional stressors experienced by patients,caregivers,and nurses when dealing with challenges related to accessing CVCs and administering infusions.3rd Learning Objective:Evaluate the
5、need for formal training and the development of a CVC-specific tool to address the challenges and improve CVC safety protocols in both hospital and at-home settings.BackgroundNumber of(CVCs)placed each year United States:5-million UNC:6,500Long-term care of CVCs Infection Control change claves and a
6、dministration sets regularly Patients&Caregivers(at-home)Professional Nurses(hospitals,clinics,homes)ChallengesStudy ObjectiveTo present results from an effort to design a CVC-specific tool to address current challenges in order to make improvements to CVC safety protocols when caring for patients w
7、ith CVCs in both hospital settings,as well as at-home environments.Methods Recruitment Selective sampling to recruit nurses at UNC Listing on Oley Foundation to recruit patients and caregivers Surveys(UNC nurses)Focus Groups(UNC nurses,patients and caregivers)Data Analysis Conventional content analy
8、sis(coding:open,axial,selective)Survey and focus group data was summarized using one-way contingency tablesResultsCharacteristicSurvey(Nurses)Focus Group 1Focus Group 2Age,years(n=19)(n=8)(n=4)Mean(SD)46(14)39(20)33(6)Range23-7118-7026-38SexMale51Female1474Chose not to specifyRaceCaucasian1484Black
9、or African American3Asian1Prefer not to answer1EthnicityHispanic/Latino2Not Hispanic/Latino178RoleNurse192Patient44Caregiver2Results79%37%37%79%53%47%74%42%90%90%70%90%50%30%100%20%0%20%40%60%80%100%120%DifficultyRemovingRequestedAssistanceMedicalGlovesHemostats/ClampsCVCDamagedCVCDislodgedBloodstre
10、amInfectionsTrainingNursesPatients/CaregiversReceived adequate training on how to resolve problems with clavesConcerns and risks from challenges removing clavesRemoval MethodsExperienced challenges removing clavesCategoriesSubcategoriesCodes HypervigilanceEmotional WellbeingTrust with others caring
11、for lineCarelessnessCarefulnessConcerns with others caring for lineBroken CVCsBloodstream infectionsTime in hospitalPutting clave on too tightMental WellbeingSentimentsNervous&ScaredAnger&FrustrationStressTangible Experiences Methods to remove clavesSuccessful approaches without toolsRequires grip s
12、trength Not overtighteningChallenging experiencesDifferent brands of clavesOver tightened claveResidue(blood/medicine)Not allowing alcohol to dryInstruments and suppliesHemostats/clampsMedical gloves/tourniquetsNon-medical suppliesLoss of IndependenceTime in hospitalBroken CVCsBloodstream infections
13、Distance from hospitalRequested help to remove clavesNurses(hospital/at-home)CaregiverTrainingProfessional trainingDisinfection techniquesScrubbing&drying timesMedical instruments/suppliesCaregiver responsibilityAd-hoc trainingGoogle searchExperienced nursing staffSupport groupsResults“I almost alwa
14、ys use hemostats and I have even had issues when it was unable to be removed by multiple people and was unable to change”.(BSN)“I am on TPN for the rest of my life,and so,a line infection potentially means losing access,and access is my life.”(patient)“I am really angry and frustrated that these thi
15、ngs are made with such a poor design and that no one has fixed this problem.This is not a new thing.”(patient)“It makes me angry and feels like a loss of independence on top of it,because I have to ask for help.Hopefully,somebody in my house can help,otherwise,its a trip to the hospital.”(patient)“I
16、 recently had a clave crack trying to use hemostats to remove it and blood starting back flowing from the lumen.”(BSN)Next StepsPrototype DevelopmentUsability StudyNCTraCS Pilot FundingFastTraCSOley Foundation Research AwardNurses,Patients,&CaregiversUNC Human Factors LaboratoryEvaluation of deviceS
17、afety Protocols&Training GuidelinesRevisions to current protocolsRevisions to patient training documentationAdd training course for nursesNot for DistributionHave you had trouble removing a clave from your central line?Interested?Contact us:amy_colemed.unc.eduUNC Researchers are conducting usability testing for a new device to help remove“stuck”claves.Participation includes evaluation of the device during a one-hour session in the UNC Human Factors Laboratory.Not for DistributionThank you