Thank You for Joining Us! We Will Begin Shortly

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1 Thank You for Joining Us! We Will Begin Shortly

2 Vascular Access: Learn the Impact of Long-Term Catheter (LTC) Use August 9, 2016

3 How to be Present and engaged in our speaker presentations Remain open-minded and respectful in hearing other s opinions Actively participating in the discussion Speak up on the line, send in comments in the chat Be mindful of muting your phone when not speaking Don t place the call on hold, instead disconnect your line and rejoin the call when able 3

4 Objectives At the end of this presentation the participant will be able to: Discuss the negative impact of Long Term Catheter (LTC) usage in the End Stage Renal Disease (ESRD) population Identify signs of infection as related to LTC Utilize knowledge gained in clinical practice Supplement current patient educational materials as related to access choice 4

5 Speaker 1: CVC Infections and Complications Marc Babic, RN Clinic Manager Preferred Vascular Group, Cleveland East

6 Background The use of central venous catheters (CVC) for dialysis treatment has doubled in the last two decades (Wilcox, 2009). Medical advancements and early diagnosis of end-stage renal disease (ESRD) has increased the use of dialysis for ESRD treatment. A significant number of dialysis patients begin dialysis treatment emergently. About 8 in 10 of these patients start treatment with a central line, according to the CDC (2013, para. 4). 6

7 Complications of Central Venous Catheter Central Venous Stenosis Fibrin Sheath Tunnel Site Infection Septicemia Catheter Thrombosis Worst Option for Long Term Access 7

8 Temporary Catheters To be used in urgent situations For use a maximum 7-10 days Jugular or femoral placement Ultrasound guided placement Can use immediately Infection Risk Thrombosis

9 Tunneled Dialysis Catheters Femoral or Jugular Split or Single Placed with US and Fluoroscopy Can Be Used Immediately Long Term Use

10 Placement Under Fluoroscopy

11 Prepping Site for Placement

12 Catheter Placement Tray

13 Over The Wire Placement

14 Exposed Cuff of Central Venous Catheter

15 RISK OF INFECTION!!!

16 Catheter Infection Data Central venous catheter infection is the leading cause of hospitalization and death for dialysis patients (Center for Disease Control and Prevention, 2014). The Center for Disease Control and Prevention (2013) cites approximately 37,000 bloodstream infections associated with central venous catheter with a 51% increase in hospitalizations (para. 5). The average cost of hospitalization to treat catheter related infection is approximately $23,451 (Wilcox, 2009).

17 Progression of Site infection

18 Site Abscess

19 Tunnel Infection

20 Infected Tunneled Catheter Sites

21 Bacteremia related to tunnel infection

22 Areas that Harbor Bacteria

23 Before and After Infection of Site Before After

24 Types of CVC Infections There are three different types of infection concerned with central venous catheters: Insertion/Exit-Site infections, a localized infection not extending beyond the cuff into the body (Haddad, Van Cleef, & Agarwal, 2012). 60% of these infections originate from bacteria living on the patient s skin (Hadded, et al, 2012, p. 12). Tunnel Infection, which is more serious. This involves infection of the tunneled area, just beneath the skin where the catheter extends from insertion, under the skin, and then to the venous access (Hadded, et al, 2012). When this infection occurs, the catheter will need to be removed. Catheter-related bacteremia (CRB) involves positive blood culture in patients with hemodialysis catheters and no other source of infection. The rate of CRB is episodes/1000days in patients with acute HD catheters, (Haddad, et al, 2012, p. 13).

25 Exposed Cuff of Central Venous Catheter

26 Post Central Venous Catheter Placement

27 Poor Placement of Central Venous Catheter

28 Recommended Dressing

29 Chlorhexidine Gluconate Use of chlorhexidine gluconate solution and isopropyl alcohol is already in practice at PVG to clean and prep the skin prior to CVC insertion. Studies have shown that the application of the chlorhexidine gluconate permeated disc at the insertion site decreases infection rates with various central venous accesses by approximately 50% (Barnes, Concepcion, Felizardo, Moran, Peters, Shapiro, & Yu, 2010).

30 PPE IS IMPORTANT TO PROTECT THE PATIENT

31 Central Venous Stenosis Indications: Arm Swelling Increase Venous pressure Decrease in clearance Clotting Bleeding Aneurysm Causes Central Venous Catheters Ports Pacemakers

32 Thrombus Formation

33 Recirculation

34 Capsule Formation in SVC

35 Angioplasty Balloons Confidential Draft

36 Angioplasty of Central Venous Stenosis

37 Successful Angioplasty

38 Any Questions?

39 References Barnes, S., Concepcion, D., Felizardo, G., Moran, J., Peters, V., Shapiro, S., & Yu, M. (2010) Guide to elimination of infection in hemodialysis. Retrieved from a1da00bcf988/file/apic-hemodialysis.pdf Center for Disease Control and Prevention (2013, May). Following CDC protocols cuts dialysis bloodstream infections in half. Retrieved from Center for Disease Control and Prevention (2014, June). National healthcare safety network (NHSN) tracking infections in outpatient dialysis facilities. Retrieved from Haddad, N., Van Cleef, S., & Agarwal, A. (2012). Central venous catheters in dialysis: The good, the bad and the ugly. The Open Urology & Nephrology Journal 5(1), p Retrieved from Kher, V. (2011). Tunneled central venous catheters for dialysis- A necessary evil? Indian Journal of Nephrology, 21(4), p doi: / McKesson Supply Company (n.d.). Retrieved from Retrieved September 10, Wilcox, T. A. (2009). Catheter-related bloodstream infections. Seminars in Interventional Radiology, 26(2), p doi: /s

40 Patient Perspective

41 Larrine Redmond, Subject Matter Expert A Tale of Two Sisters 41

42 Larrine Redmond 42

43 Objectives At the end of this presentation the participant will be able to: Discuss the negative impact of Long Term Catheter (LTC) usage in the End Stage Renal Disease (ESRD) population Identify signs of infection as related to LTC Utilize knowledge gained in clinical practice Supplement current patient educational materials as related to access choice 43

44 Please Take the Webinar Evaluation

45 IPRO ESRD Network of New England (Network 1) Danielle Daley, MBA Executive Director Jaya Bhargava, PhD, CPHQ Operations Director Kristin Brickel, RN, MSN, MHA, CNN Quality Improvement Director Brittney Jackson, LMSW, MBA Patient Services Director Jenna Vonaa Sr. Program Support Coordinator Krystle Gonzalez Sr. Data Coordinator Heather Camilleri, CCHT Quality Improvement Coordinator VACANT Community Outreach Coordinator TBD 1952 Whitney Avenue, 2 nd Floor, Hamden, CT Phone: (203) Fax: (203)

46 IPRO ESRD Network of New York (Network 2) Susan Caponi, RN, BSN, MBA, CPHQ CEO, ESRD Program Laura Wright Administrative Coordinator II Nicole Howell, BA ITIL v3 Information Management Director Carol Lyden, RN, MSN, CNN Director, Quality Improvement John Cocchieri Data Coordinator, QI Erin Baumann, LMSW Patient Services Director Sharon Lamb Data Coordinator Jeanine Pilgrim, BS Quality Improvement Coordinator Anna Bennett Education Coordinator Emancia Brown, MSW Community Outreach Coordinator 1979 Marcus Avenue, Lake Success, NY Phone: (516) Fax: (516)

47 IPRO ESRD Network of the South Atlantic (Network 6) Shannon Wright, BSW, PMP, ITIL v3 Executive Director Ariana Lucido Operations Manager Nicole Howell, ITIL v3 Data Manager Tracey Howard Data Coordinator Susan Waite Quality Improvement Director VACANT Patient Services Director TBD Wambui Kungu Quality Improvement Coordinator Emily Watson Program Support Coordinator 909 Aviation Parkway, Suite 300, Morrisville, NC Phone: (919) Fax: (919)

48 IPRO ESRD Network of the Ohio River Valley (Network 9) Victoria Cash, MBA, BSN, RN Executive Director Wendy Cable, BSN, RN Assistant Director, Information Management Debbie DeWalt, MSN, BSN, RN Assistant Director, Quality Improvement Andrea Bates, MSW Patient Services Coordinator Michelle Kaszowski Sr. Program Support Coordinator VACANT Data Coordinator TBD Susan Swan-Blohm, BS, OCDT Quality Improvement Coordinator Nina Pollard Community Outreach Coordinator 3201 Enterprise Parkway, Suite 201, Beachwood, OH Phone: (216) Fax: (216)

49 Any Questions?

50 For more information: IPRO ESRD Program NW9: Corporate Headquarters 1979 Marcus Avenue Lake Success, NY