Classy Writers

Classical Writers


he use of central line venous catheters are often used in critical care settings. The use of these devices carry significant relevance and necessity in the delivery of a variety of medications to include vesicants in interventions of providing life saving measures. However, a downfall in the use of these devices include the incidence of possible infection. In efforts to combat these infections, studies in the use of protective caps have been performed to dictate prevalence of reduced infections. The clinical research problem being addressed in this subject is as follows: Would the use of protective alcohol infused caps utilized in central venous line catheters decrease the incidence of CLABSI rates? Specifically, the protective cap would maintain on the needless central line connection before and after use. A uniform approach would be utilized in protecting the site from contamination by replacing the cap both before and after accessing the site. The critical care setting is being identified here with the population existing in critical care units where central venous line catheter devices are used. The variables in this research question include central venous line catheters, infections with the use of these devices, and protective alcohol infused caps. The efforts towards decreasing CLABSI rates continues to be researched as the cost of CLABSI’s entail significant rise in healthcare costs. Ramirez, Lee, and Welch (2012) states, “The Centers for Disease Control and Prevention estimate the cost of CLABSIs is substantial, both in terms of morbidity and financial resources expended. Their estimate is that, on average, hospitals have an increase in patient length of stay by 2 to 5 days for every CLABSI”. Each CLABSI event is variable, but is estimated by Ramirez, et al., 2012 to be on average as reported in literature to be $16,350. #2 Reply provides substantive feedback to peer (100-150 words) Pressure injuries occur when patients are subjected to intense and/or prolonged pressure in combination with friction and shear (Joint Commission 2016). Nutrition, skin care, turning and repositioning, and the use of risk assessment tools have been shown to decrease the risk of hospital acquired pressure injuries (MedlinePlus 2018). Patients are at high risk for hospital acquired pressure injuries (HAPI) in the operating room. That is due to multiple factors including patients have the potential of remaining in the same position for hours on end, increased skin moisture due to soiled linen from irrigation, and bodily fluids, as well as compromised nutritional status due to NPO requirements prior to surgery. There is limited research on pressure ulcer assessment tools aside from the Braden and Norton scales which account for the knowledge gap. Pressure ulcer risk must be reported for all hospitalized patients in the United States per requirements of the Center for Medicare and Medicaid Services. (Sundaram, et al., 2017) The Braden scale uses a point system to assess risk. Mild risk is a score of 15-18, moderate risk scores 13-14, high risk scores 10-12, and severe risk is any score less than 9. Oftentimes patients at high risk undergo increased risk prevention protocols. The Braden scale is not useful in the Operating Room. Every patient is severely high risk due to anesthetics effecting sensory perception, activity, and mobility. Would the use of a modified Braden scale including length of surgery and interventions associated with score levels decrease the incidence of pressure ulcers in surgical patients? I hypothesize that the use of an Operating Room specific modified Braden tool to determine Intraoperative specific risks, as well as the use of suggested interventions would reduce incidents of HAPI which can present later in the patient’s admission. The target population would be surgical patients. The variables tested would include amount of HAPIs and modified Braden scores before and after implementation of the new assessment tool. The settings are the perioperative environments including Admitting, Intraoperative, and PACU.

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