Challenging central line poor practice
Abstract:
Objective: To explore intensive care nurses’ experiences with and perceptions of using a standardised central venous catheter procedure to prevent bacterial contamination when accessing patients’ central venous catheters.
Design and methodology: This study employed an interpretative qualitative design. Data was collected through semi-structured, individual interviews and Qualitative Content Analysis was used in data analysis.
Setting: Seven Norwegian intensive care nurses were recruited using a purposeful sampling strategy.
Findings: Three main themes were identified. 1). Individualised practice revealed varying knowledge of and commitment to following the central line procedure. 2). Risk desensitisation revealed a continuous use of central lines, acute situations and a lack of information on infections, which affect usage. 3). Professional working culture showed nurse-to-nurse interaction, which promoted compliance with the procedure. Their interplay created a team spirit whereby nurses worked together to improve patient safety.
Conclusions: This study shows the diversity and complexity of factors affecting intensive care nurses’ procedure compliance when accessing central lines. The themes of Individualised practice and Risk desensitisation pose a substantial threat to healthcare quality and patient safety in the ICU. Exposure to infection risks could be reduced by applying these themes to inform and strengthen continuing education programs and audit processes. The theme of Professional working culture shows the positive influence nurses can have on each other, promoting compliance when accessing central lines. Intensive care nurses should be aware that their voice matters and that challenging poor practice does not have to be confrontational. Leadership should look for ways to encourage this type of nurse-to-nurse interaction.
Reference:
Morris KY, Jakobsen R. Central venous catheter access and procedure compliance: A qualitative interview study exploring intensive care nurses’ experiences. Intensive Crit Care Nurs. 2022 Jan 4:103182. doi: 10.1016/j.iccn.2021.103182. Epub ahead of print. PMID: 34996676.