Right Line, Right time; Improving access, safety and timeliness with central venous access device insertion

Chief Investigator

Evan Alexandrou RN MPH PhD

Academic Institution

SoNM and Department of Intensive Care – Wollongong University and Liverpool Hospital

Date of Endorsement

21/03/2023

Outline

Nearly 90,000 people admitted to intensive care units in Australia every year, need a central venous catheter (CVC) for direct access to the bloodstream so lifesaving treatment can be given. Dialysis CVCs are also crucial for the 14,600 Australians with kidney failure that require dialysis annually to stay alive. The correct insertion and position of a CVC is critical for its function. However, 25% of people can suffer serious complications during CVC insertion or dwell. A misplaced CVC can lead to blood vessel wall erosion causing uncontrolled bleeding and possible death. Consequently, confirmation of CVC position is essential before use, usually by X Ray, but this can delay commencing urgent treatment. Interventional radiology suites predominantly insert dialysis CVCs but are in high demand, and people needing these dialysis catheters incur waiting times that delays dialysis treatment.

AIM:

My VISION is to improve access, safety and timeliness of CVC insertion for chronic and critically ill patients.

My APPROACH is to transform the way CVCs are inserted.

Aim 1:
Improve time to urgent treatment for people admitted to ICU.

Aim 2:
Improving patient access for kidney dialysis through a nurse-led bedside insertion model

OBJECTIVES:

  1. To determine whether a nurse-led model for TVC insertion is non inferior to current practice (medical insertion with fluoroscopic guidance) related to procedural and catheter outcomes.
  2. Determine the superiority of this alternative approach in terms of cost and reducing overall reliance on interventional suites and operating theatres.