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Intravascular site care: are critical care nurses practicing according to written protocols?
H Roach1, E Larson, D B Bartlett
1Georgetown University Hospital, Department of Nursing, Washington, DC 20007-2197, USA.
Objective:
To observe and describe site care for intravascular devices, to identify internurse variations in site care, and to compare written protocols for site care with actual practice in one geographic area.
Design:
Observational, descriptive study.
Setting:
Adult critical care units in one community, and one university teaching hospital in the Washington, D.C., metropolitan area.
Sample:
Direct observation of 86 central and 30 peripheral site care episodes.
Results:
A total of 116 site care episodes were observed on five critical care units. There were wide variations between units from the same hospital in gloving practices and use of aseptic technique. Significant differences across both hospitals, as well as between individual units, were noted for a number of other practices including: time since last site care, use of ointment and skin adhesive, type of dressing used, and duration of care. In both hospitals, compliance with all steps of the written protocol was similar-23.2% and 23.3%. Compliance with documentation requirements ranged from 53.3% to 85.7%, and was significantly different between the two hospitals with regard to recording the dressing change and whether the dressing label and chart agreed.
Conclusions:
Intravascular site care varies significantly among critical care units within the same institution, as well as between different hospitals, and varies from written protocol. Standardized, well-defined site care protocols and education of staff, along with quality improvement surveillance systems are needed to ensure consistent quality intravascular site care.