1. July Core Intervention Assignment (for the BSI QIA)
#6 Catheter Reduction

2. 6. Catheter Reduction
Incorporate efforts (e.g., through patient education, vascular access coordinator) to reduce catheters by identifying and addressing barriers to permanent vascular access placement and catheter removal.

3. Catheter Facts
In 2010, more than 380,000 patients in the United States relied on hemodialysis for treatment of their end-stage kidney disease. About 8 in 10 of these patients start treatment with a central line.
CDC estimates 37,000 central line-associated bloodstream infections may have occurred in U.S. hemodialysis patients in 2008.
A dialysis patient is more than 100 times more likely to get a bloodstream infection from a common resistant bacteria, methicillin-resistant Staphylococcus aureus, than other people.
Source: CDC

4. Questions to Review How many patients have catheters in your facility?
Does each catheter patient have an access placement plan?
Have these access placement plans been followed through for each patient?
Does any of the data need updating?
Identify barriers for patients that have not or refuse to follow up for access placement evaluations.
How many access infections has your facility had since January 2018?
How many of those access infections were catheter related?

5. How to View Your Access Related Bloodstream Infections in NHSN

6. Tunneled Catheters Early recognition is important to prevent:
Potential complications are:
Early recognition is important to prevent:
Malfunction due to mechanical causes like
Poor placement technique
Retraction with or without exposure of the cuff
Cracked hub or broken clamps
Thrombosis/Fibrin sheath formation
Infection
Exit site
Tunnel infection
Central vein stenosis
Loss of the vascular site if the catheter falls out
Inadequate dialysis clearance
Bacteremia- and sepsis-related morbidity and mortality
Source: Atlas of Dialysis Vascular Access | Tushar J. Vachharajani, MD, FASN, FACP

7. The next few slides depict common problems associated with tunneled catheters…

8. Fibrin Sheath
Source: Atlas of Dialysis Vascular Access | Tushar J. Vachharajani, MD, FASN, FACP

9. Intraluminal Thrombus
Source: Atlas of Dialysis Vascular Access | Tushar J. Vachharajani, MD, FASN, FACP

10. Exposed Cuff
Source: Atlas of Dialysis Vascular Access | Tushar J. Vachharajani, MD, FASN, FACP

11. Tunnel Infection
Source: Atlas of Dialysis Vascular Access | Tushar J. Vachharajani, MD, FASN, FACP

12. Suggestions to Reduce Catheters
Dedicated, persistent team
Vascular Access Manager
Communication
Education
All Staff
Patients