The introduction of a nutrition clinical nurse specialist results in a reduction in the rate of catheter sepsis
ABSTRACT Catheter-related sepsis remains the major confounding factor in the long-term delivery of TPN. Previous studies have shown that the introduction of clinical nurse specialists (CNS) can lead to a reduction in sepsis from TPN catheters. This retrospective study aimed to determine the impact of a nutrition CNS on the rate of catheter-related sepsis. Furthermore, the cost of providing such a service was examined to see if it was offset from the savings obtained from reducing venous access infection.
Prior to the employment of a nutrition CNS, the total number of septic catheter complications were retrospectively collected over a 12-month period. Following appointment of the CNS, all patients requiring TPN were prospectively studied for signs of catheter-related sepsis and the data collected over a 4-year period.
The overall sepsis rate (cumulative percentage) fell significantly in the 4-year period after the nutrition CNS was appointed, from 52% to 2.3%. The reduction in venous catheter access was accompanied by a decrease in cost related to wastage of TPN and insertion of new Hickman lines.
The role of the CNS is primarily to improve the quality of care provided, but also to provide cost effectiveness. We have demonstrated that in addition to reducing infection rate of central venous catheters; the cost of employing a nutrition CNS is almost completely covered by the savings resulting from the reduction in wasted central venous catheters, TPN and operating time.
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- "To provide data to the boards of nursing to assist them in determining the level of regulation appropriate for NPs and CNSs USA Quantitative Electronic survey response rate 11% so postal version of survey conducted response rate 30% n = 1,529 NPs n= 1,344 CNSs (-) Response rate (+) Sample size (-) Non random sample Seymour et al., (2002) To examine the understandings and experiences of postholders in relation to the Macmillan Nurse role UK Grounded theory. Semi-structured interviews n=44 Macmillan Nurses and n=47 key colleagues (-) Multiple interviewers (+) Variety of sites (+) Sample size Scott (1999) To describe the roles, activities & skills of the clinical nurse specialist in the USA USA Descriptive study Postal survey n = 724 CNSs Subscribers to CNS journal (+) Sample size (+) Questionnaire pretested and used in pilot study twice (-) Purposive sample (+) Theoretical framework (+) Content validity addressed Sutton et al., (2005) "
Article: Parenteral nutrition.[Show abstract] [Hide abstract]
ABSTRACT: Parenteral nutrition becomes necessary when the gastrointestinal tract has insufficient function as to afford sufficient fluid, electrolyte and nutrient absorption. Indications for this therapy include prolonged postoperative ileus, prolonged intestinal obstruction, short bowel syndrome, various malabsorptive disorders, proximal enteric fistulas for which an enteral feeding tube cannot be placed distal to, severe acute pancreatitis and severe mucositis/esophagitis. Parenteral nutrition, although typically delivered through a large central vein, can also be infused peripherally with special techniques. Rarely, intradialytic parenteral nutrition is required. Parenteral nutrition includes macronutrients (protein in the form of a balanced, free amino acid solution, carbohydrate in the form of a dextrose monohydrate and fat in the form of a lipid emulsion), fluid, electrolytes (sodium, potassium, magnesium and acetate/chloride to adjust pH), minerals (calcium, phosphorous, iron in some individuals), trace minerals (zinc, copper, selenium) and vitamins (water and fat-soluble). Numerous complications may develop as a result of parenteral nutrition including mechanical issues related to the catheter for solution delivery or its insertion, that include infection, occlusion (venous thrombosis or non-thrombotic occlusion), electrolyte disturbances and hyperglycemia, as well as hepatic, renal, pulmonary, and bone complications. Therapy should be appropriately prescribed and rigorously monitored for efficacy and safety.The Australian nurses' journal 10/1980; 10(3):36-40.
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ABSTRACT: The care of the patient with gastrointestinal disease is complex and challenging. The reasons for the complexity are varied and different for each patient. Any of these variables can affect the nutritional health of the patient, an essential element of care that supports healing, recovery, and improved quality of life. A nutritional assessment, an evaluation of the patient's nutritional status, can be used to establish the patient's weight history, dietary habits, tolerances, and likes and dislikes. Intake and output values from this assessment provide information relating to the patient's ability to meet his or her nutritional requirements orally or whether alternate methods for nutrition support need be considered, such as a feeding tube or a central intravenous catheter. Parenteral nutrition is the intravenous nutrition supplementation required when the oral or enteral route for nutrition support is unavailable or impossible. In this article, a clinical case scenario for a 34-year-old man with a history of cancer and an extensive bowel resection will be presented to better explore the decision-making process for determining appropriate nutrition support. In addition, various issues the health practitioner needs to consider when managing the nutritional health of the complex gastrointestinal patient will be explored, relative to Jean Watson's Theory of Caring.Gastroenterology Nursing 01/2006; 29(4):283-8; quiz 289-90. DOI:10.1097/00001610-200607000-00002 · 0.56 Impact Factor