Central venous catheters (CVC) are an integral tools used in blood stem cell transplant with registered nurses responsible for maintenance and catheter care. However, CVC practice guidelines in the literature are inconsistent or absent. Gaps in the evidence generated several research questions regarding potential variability in CVC practice across Canada and the impact that variability may have on healthcare spending and patient outcomes. A survey of Canadian practice revealed differences in CVC practice across the nation that coincide with discrepant and/or absent guidelines. Device-associated complications such as catheter-related bloodstream infection (CRBSI) are both costly and avoidable. Current cost-analyses within the blood stem cell transplant population were also absent in the literature. The cost of a single CRBSI was estimated using a case controlled comparison of records. The study quantified how costs can be contained through prevention efforts and identified the importance of nursing research targeting infection control. One prevention area was tested in terms of infection outcomes with tunneled triple lumen subclavian catheters used by blood stem cell transplant recipients. The descriptive study compared three different nursing strategies for CVC exit site care (transparent dressing, no dressing, or gauze dressing) in terms of CRBSI and cost. Results indicated each strategy poses similar CRBSI risks with significant differences in expense. Maximum value was attributed to transparent dressings followed by removing the dressing and lastly using a gauze dressing. The no dressing strategy was a more cost-effective alternative when a transparent dressing cannot be tolerated. Further analysis of the data generated in this project is ongoing with the intent to delineate other areas of nursing influence on CRBSI within the study sample and identify further potential areas for cost containment.
Date of publication
Keeler, Melanie, "Cost-Effectiveness Analysis of Tunneled Central Venous Catheter Dressings in Canadian Blood Stem Cell Transplant" (2014). Nursing Theses and Dissertations. Paper 19.