PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
Ms. MARITA JOSE
FIRST YEAR M.Sc. NURSING
CHILD HEALTH NURSING
YEAR 2010 – 2012
VARALAKSHMI COLLEGE OF NURSING,
No:19, KIADB ROAD,
CHOKKASANDRA,
T.DASARAHALLI,
BENGALURU – 560 057.
0
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,
BANGALURU, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
MS. MARITA JOSE
I YEAR M.SC.(NURSING)
VARALAKSHMI COLLEGE OF
1.
NAME OF THE CANDIDATE NURSING
AND ADDRESS
NO:19, KIADB ROAD,
CHOKKA SANDRA,
T.DASARAHALLI,
BANGALORE – 560 057
Varalakshmi College of Nursing
No:19, Kiadb road,
2.
Chokka Sandra, T.Dasarahalli,
NAME OF THE INSTITUTE
Bangalore – 560
3.
COURSE OF THE STUDY Ist Year MSc. Nursing
Child Health Nursing
AND SUBJECT
4.
DATE OF ADMISSION TO
26-05-2010
THE COURSE
Knowledge and Practice of Staff
5.
Nurses Regarding Care of
TITLE OF THE STUDY
With Central Venous Catheter.
1
Child
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION:
A central venous catheter (CVC), also known as a central line, is long,
soft, thin, hollow tube that is placed into a large vein (blood vessel). A central
line is much like an intravenous (IV) catheter that is placed in a small vein in
an arm, except that a central line is longer and is placed in a large vein leading
to the heart in the neck, upper chest, leg, or arm. This type of catheter has
special benefits in that it can deliver fluids into a larger vein, and that it can
stay in the body for a much longer period of time than a usual, shorter IV.
Common reasons for having a central line include, to give IV
medications over a long period of time, to deliver IV medications as an
outpatient, to rapidly deliver large amounts of fluid or blood, to directly
measure blood pressure in a large or central vein, take frequent blood samples,
to deliver nutrition directly into the blood, to connect a person with kidney
failure to a haemodialysis machine. Some of the possible risks of a central
venous catheter are, Discomfort during placement, Bleeding, Infection,
Blocking or kinking, pneumothorax.
In general, the tube will stay in as so long as it is needed and the catheter
is not blocked or infected. This may be days or months. Anything that touches
the catheter site and anything that goes into the catheter must be sterile the
catheter may be infected if the patient has: redness, tenderness, or swelling
where the catheter enters the skin Fever or chills. The catheter may be blocked
if it is difficult or impossible to flush. The catheter may be coming out of the
vein if the length of catheter outside the skin is getting longer1.
2
Central venous catheters are often mandatory devices when caring for
critically ill children. They are required to deliver medications, nutrition, and
blood products, as well as for monitoring hemodynamic status and drawing
laboratory samples. Central venous catheters carry a particularly high risk of
infection and these infections can be life threatening. Advanced practice nurses
possess the power to influence catheter-related line infections in their critical
care units. Understanding current recommendations for catheter material
selection, site selection, site preparation, and site care can affect rates of
catheter-related bloodstream infections2.
The exit site of central venous line is a potential site of infection, as it is
a long term break in the skin’s integrity. As a potential source of infection, the
exit site requires careful monitoring and scrupulous hygiene. Certain
procedures should be followed to ensure that the exit site of all central lines are
monitored and cared for meticulously and treated as necessary. All healthcare
professionals are responsible for their own actions and must exercise their own
professional judgment at all times3.
Catheter-related bloodstream infections, a type of hospital-acquired
infection, are an important cause of increased length of stay, mortality, and cost
among hospitalized patients. Patients with central venous access devices are at
highest risk for CLABSIs for a variety of reasons, such as frequent
manipulation of the catheter, access required for an extended period of time,
and urgent placement of some catheters without regard to strict aseptic
technique etc.
Several strategies have been proposed to prevent CLABSIs including
hand
hygiene,
aseptic
technique,
catheter
securement
devices,
and
antimicrobial impregnated catheters. Some of these interventions are costly
and/or time consuming; however, hand hygiene is inexpensive and relatively
3
simple to implement. Nurses are often at the frontline of central line care, and
the profession has the potential to significantly impact the reduction in
CLABSIs by adopting these measures4.
A prospective study on staff training: a key factor in reducing
intravascular catheter sepsis conducted in, Birmingham children's hospital,
monitored the frequency of sepsis in central venous catheters used for
administering parenteral nutrition. A total of 58 central venous catheters were
studied for a period of 12 months, 26/58 (45%) of catheters were removed
because of proved sepsis. The possible causes were examined. As a result
protocols were modified and an intensive staff training programme
implemented throughout the hospital. The catheter sepsis rate was significantly
reduced with only 9/107 (8%) catheters becoming infected. These findings
emphasise the key role that education of staff plays in controlling central
venous catheter sepsis and the importance and cost effectiveness of special
nursing staff in implementing such measures5.
An article on Prevention of central venous catheter-related infection in
the intensive care unit states that, prevention of catheter-related infection
involves several measures which should be used in combination, like use of a
checklist to guide catheter insertion and maintenance; adequate training of the
nursing staff involved in the management of vascular access and an adequate
patient-to-nurse ratio; the use of maximal sterile barrier precautions during
catheter insertion; preference for a chlorhexidine-based solution for skin
antisepsis; cleaning hands with an alcohol-based hand rub solution before any
manipulation of the infusion line; and removing any useless catheters.
Healthcare workers caring for a patient with a central venous access device
need to be adequately trained, and assessed as being competent in using CVCs
and adhering to infection prevention practices6.
4
6.2 NEED FOR THE STUDY
Central venous catheterization (CVC) is necessary for a great number of
inpatients, particularly children. Though indispensable, CVC is not without
risk. The use of central venous catheters may be associated with adverse
events, originated during or after insertion of the catheter. The literature shows
that nurses knowledge and knowledge on practice have an important role in
prevention of complications associated with CVC.
About 250 000 bloodstream infections related to central venous catheter
(CVC) placement develop in patients in US hospitals annually7. Most catheterrelated bloodstream infections (CR-BSIs) develop in patients in intensive care
units (ICUs) and result in an estimated 90 000 deaths a year8.
Bloodstream infections are among the most common infections in
PICUs and suggested that such infections are a significant source of morbidity
for critically ill children. Reducing the occurrence of CR-BSIs in critically ill
children is important to health care providers and organizations9.
Access to a vessel can be gained via percutaneous puncture or with use
of open surgical techniniques. “Seldinger” percutaneous technique is the most
frequently used. CVCs are inserted via the subclavian vein, internal and
external jugular veins or umbilical vein in newborns. The tip of the catheter can
be placed into the right atrium, superior or high inferior vena cavaWhen
inserting CVC, the operator should be very experienced and cautious, given
that possible complications are numerous and some of them can be very serious
Percentage of known catheter-related complications range from 0.7 to 26%.
A retrospective study on use of central venous catheters in children
conducted in Croatia. During the study period 1300 patients aged from 0 to 18
years were admitted to the PICU. A total of 352 CVCs were inserted in 300
5
children. Patient age ranged from 0 to 18 years. The average catheter insertion
time was 12.88 days. they noted 66 (18.8%) of CVC-related complications.
Complications related to CVCs insertion were malposition of catheter (5.4%)
and pneumothorax (0.9%). Occlusion of CVCs (4.3%), catheter related
bloodstream infections (CRBI) (4.0%), dislodgment (3.7%) and catheter
damage (0.6%) were complications associated with length of CVCs use. They
conclude that central venous catheterization is a safe and efficient procedure
with minimal complications in pediatric patients10.
A report of the study on Medium and long term central venous access in
children, conducted in St. John’s Medical College Hospital, Bangalore,
Karnataka, From September 2000 to August 2001, 104 central venous access
devices (CVAD) were inserted in 91 children, governed by a uniform protocol.
There were 12 insertion related complications-all of which were minor. The
incidence of non-infectious complications was 20% (rate of 13.7/1000 line
days) and was influenced by the child’s age and insertion site. Femoral route
was the safest. Incidence of catheter associated infections (CAI) was 15.4%
(rate of 11/1000 line days). There was no major complication, though more
than 50% insertions were in neonates and infants. In our practice, use of CVAD
is feasible and safe, especially in neonates and infants11.
A prospective , longitudinal study conducted in south western united
states for Reducing central venous catheter-related blood stream infections in
children with cancer .51 catheter hub cultures were obtained from 27 children
with cancer, and 121 nurses participated in the educational intervention.CVC
hub cultures were obtained prior to and three months after an educational
intervention. A written pre- and post education assessment was used to evaluate
the nurses learning.post-test mean score of 87% was significantly higher than
the pre-test mean score of 72% prior to the education program, 57% of the hubs
were culture positive, and after the educational program , the proportion of
6
culture-positive hubs were reduced to 36%. A comprehensive educational
program increases nurse’s knowledge of CVC care and reduces CVC hub
colonization and catheter related blood stream infections in children with
cancer12.
From the above findings and from the researchers own experience while
working in a pediatric intensive care unit several incidence of complications
related to central venous catheter occurred in children from this researcher
realized that nurses have a vital role in caring central venous lines for
preventing complications in children that occur as a result of central venous
line.
7
6.3 STATEMENT OF THE PROBLEM
A Study To Assess The Effectiveness of Self Instructional Module On
Knowledge And Practice of Staff Nurses Regarding Care of Child with Central
Venous Catheter in Selected Hospitals, Bengaluru.
6.4 OBJECTIVES OF THE STUDY
1. To assess the existing level of knowledge and practice of staff nurses
regarding care of child with central venous Catheter.
2. To determine the effectiveness of self instructional module on the
knowledge and practice of staff nurses regarding care of child with central
venous Catheter.
3. To correlate the knowledge and practice of staff nurses regarding care of
child with central venous Catheter.
4. To associate the pre test knowledge and practice of staff nurses with selected
demographic variable.
6.5 OPERATIONAL DEFINITION
Effectiveness - It refers to the improvement of knowledge and level of practice
of staff nurses adopted in care of child with central venous Catheter and
determined by significant difference in pre-test and post test knowledge scores.
Self Instructional Module- It refers to self sufficient written information on
central venous catheter regarding, definition, indication, uses, procedure for
care and complications and its prevention.
8
Knowledge- It refers to correct response of staff nurses regarding care of child
with central venous catheter and measured by structured knowledge
questionnaire and expressed in terms of knowledge scores.
Practice- It refers to the ability of the staff nurses to do their care of central
venous catheter by verbalize answer regarding central venous catheter care.
Staff nurses- Refers to the nurses who are registered in Karnataka Nursing
Council and have the Diploma or Degree certificate and who are providing care
for the child with central venous catheters in selected pediatric units.
Care of child-
It refers to the nursing measures on routine care of child with
central venous catheter between birth to eighteen years such as dressing the site
daily using aseptic techniques, inspecting the site for any redness, checking the
line for patency, monitoring the central venous pressure, so as to reduce the
incidence of central line related complications like infection, occlusion,
pneumothorax, damage of the catheter.
Central venous Catheter - It refers to the catheter placed into a large vein in
the neck (internal jugular vein or external jugular vein), chest (subclavian vein)
or groin (femoral vein),umbilical vein( neonates). It is used to administer
medication or fluids and obtain blood tests for child who is critically ill.
6.6 ASSUMPTION
a. Staff nurses may have some knowledge and practices in meeting the care of
child with central venous lines.
b. Administration of self instructional module may help to update the new
information regarding care of child with central venous catheter among staff
nurses.
9
6.7 HYPOTHESIS
H1 -There will be a significant correlation between knowledge and practice of
staff nurses regarding care of child with central venous catheter.
H2-There will be a significant association between knowledge and practice of
staff nurses on care of child with central venous catheter with their selected
demographic variables.
6.8 REVIEW OF LITERATURE
A review of literature related research and theory on a topic has become
a standard and virtually essential activity of scientific research projects
“literature review is a critical summary of research on a topic of interest , often
prepared to put a research problem
in contact or as the basis for an
implementation project.’’ Review of literature was undertaken to gain in depth
knowledge on various knowledge on various aspect of the problem under this
study.13
In this study the relevant literature reviewed has been organized and presented
under the following headings:
1.
Literature related to knowledge of staff nurses regarding care of
central venous lines.
2.
Literature related to practice of staff nurses regarding care of
central venous lines.
3. Literature related to complications of central venous lines in
children.
10
1. Literature Related to Knowledge Of Staff Nurses Regarding Care Of
Central Venous Lines.
An exploratory study for evaluating central venous catheter care in a
pediatric intensive care unit. A convenience sample technique was used to
collect data in 2 phases, including 30 days to establish baseline information and
30 days each during which patients received dressing care for a central venous
catheter with a transparent dressing alone and with a transparent dressing plus a
chlorhexidine-impregnated dressing. Nurses also participated in a survey of
knowledge about infection control practices related to central catheters. Few
differences were found between the transparent dressing alone and a
chlorhexidine-impregnated
dressing
plus
the
transparent
dressing.
A
serendipitous finding was the number of times that central catheters were
accessed daily. The results of this project suggest that infection control efforts
may be most appropriately focused on processes rather than on products.14
A literature review on Educational interventions to reduce the rate of
central catheter related blood stream infections in the NICU states, Costeffective and successful educational interventions aimed at nurses have been
shown to decrease CR-BSIs with adults, but no such studies address neonatal
nurses. This literature review examined how educational interventions could
help neonatal nurses reduce infection rates in patients with central venous
catheters. Four databases were searched: PubMed, CINAHL, Cochrane, and
OVID. Of Ten studies that measured CR-BSIs before and after educational
interventions, nine showed a post intervention reduction in the rate of CR-BSIs
of 40 percent or greater, and the tenth reported a reduction rate of 21 percent.
All of the educational programs had additional intervention components, so it is
not possible to ascribe all the success to the education, but this review suggests
that this topic needs to be studied with the NICU population.15
11
A retrospective, interventional study on Systematic intervention to
reduce central line-associated bloodstream infection rates in a pediatric cardiac
intensive care unit , Boston using an interrupted time-series design to compare
central line-associated bloodstream infection. Their goal was to determine
whether an intervention involving staff education, increased awareness, and
practice changes would decrease central line-associated bloodstream infection
rates. The estimated mean pre intervention central line-associated bloodstream
infection rate was 7.8 infections per 1000 catheter-days, which decreased to 4.7
infections per 1000 catheter-days in the partial intervention period and 2.3
infections per 1000 catheter-days in the full intervention period. A
multidisciplinary, evidence-based initiative resulted in a significant reduction
in central line-associated bloodstream infections in their pediatric cardiac
ICU.16
2. Literature related to practice of staff nurses regarding care of central
venous lines.
A cross-sectional, descriptive, self-report survey regarding hand
washing practices surrounding central venous catheter (CVC) care. Nurses
working in pediatric intensive care units were included in the survey. A total of
30 nurses from 7 hospitals completed the survey. When comparing nurses'
clean hand washing practices to hospital policy, the percentage of nurses who
performed according to policy ranged from 17% to 100%. For aseptic hand
washing, performance in accordance with policy ranged from 10% to 100%.If
1 minute was required, there were 17% of nurses who reported washing for less
time. If 2 minutes was required, 75% were noncompliant, and for 3 minutes,
100% were noncompliant.. The authors note the large amount of variation in
the hand washing practices of these nurses, noting that healthcare-associated
12
infections are a cause of poor patient outcomes. They identify a need for
standardized guidelines in pediatric intensive care units in17.
3. Literature related to complications of central venous lines in children
An observational study conducted in Italy about Central venous
catheter-related complications in children with oncological/hematological
disease. 418 central venous catheters were inserted in 368 children, overall, 234
complications were observed in 169 devices (40%). Four types of possible
complication were defined, mechanical, thrombotic, malfunctioning and
infectious. The overall complication rate was 2.2 (95%): it was 0.87 (n=93) for
infectious complications; 0.78 (n=84) for malfunctioning; 0.45 (n=48) for
mechanical complications; and 0.08 (n=9) for thrombotic complications. The
main reason for developing complication is, type of central venous catheters,
underlying disease and patient age being the three main factors that affect the
incidence of CVC-related complications.18
A prospective surveillance study about Infectious complications of
peripherally inserted central venous catheters in children was conducted in
Israel. A total of 279 PICCs were inserted in 221 patients. Mean dwell time
was 30 days. 177 (63%) of all PICC placements were free of complications.
Twenty-six catheters (9.3%) were dislodged accidentally; 38 (13.6%) were
removed for mechanical problems: tears in 5, leaks in 12, and obstructions in
21; 38 (13.6%) were removed for an infectious complication: phlebitis in 13
(4.6%), exit-site infection in 10 )(3.5%), PICC-associated bloodstream
infection in 12 (4.3%), and PICC-related bloodstream infection in 4 (1.4%); 15
more were removed for presumed infection (5.3%).PICCs are safe and may be
used for prolonged periods. Accidental dislodgement is not uncommon and
may be prevented by use of sutures, occlusive dressing, and education of
patients, families, and medical staff.19
13
Prospective cohort study on Central venous access via external jugular
vein in children was conducted in USA. The study was conducted over a period
of 15 days in a11- bed PICU, the patients who had CVC via external jugular
vein were the sample. The catheters were used for an average of 7.5 days
(range, 1-28 days). Catheter malfunction occurred in 4 (1.21/100 catheterdays), and catheter-related bloodstream infections occurred in 2 patients
(6.04/1000catheter-days). No thrombotic complications were clinically
detected. The external jugular vein is a viable site for central venous access
with a low complication rate in pediatric patients.20
A descriptive study on Decreasing PICU catheter- associated blood
stream infections conducted in Poland. The CVC complications were analyzed
according to the CVC type, blood product transfusion (BT) and parenteral
nutrition (TPN). A total of 566 CVCs were taken ranging from two days to
2583 days , 297 complications were observed: 81 catheter infections , 77
mechanical complications , 59 no aspiration events , 52 thrombotic occlusion
and 28 tunnel infections. At the end of the study period 121 (28%) CVCs were
prematurely removed . CVC's related complications were relatively rare. Most
common were infections and concerned catheters and these complications were
most frequent in patients receiving BP and TPN. Risk of mechanical
complications was higher in catheters than ports.21
A multi-institutional, interrupted time-series study on Central venous
catheters in children with cancer. Risk of complications, was conducted in 29
PICUs across the United States. Two central venous catheter-care practice
bundles comprised their intervention: the insertion bundle of pediatric-tailored
care elements and the maintenance bundle derived from the Centers for Disease
Control and Prevention recommendations. They used comparable modeling to
assess the relative importance of the insertion versus maintenance bundles; the
14
results showed that the only significant predictor of an infection-rate decrease
was maintenance-bundle compliance (RR: 0.41 [95% CI: 0.20-0.85]; P = .017).
Maximizing insertion-bundle compliance alone cannot help PICUs to eliminate
CA-BSIs. The main drivers for additional reductions in pediatric CA-BSI rates
are issues that surround daily maintenance care for central lines, as defined in
their maintenance bundle. Additional research is needed to define the optimal
maintenance bundle that will facilitate elimination of CA-BSIs for children22
A prospective study on Percutaneously inserted central catheters in the
newborns conducted in turkey. They did a prospective collection and analysis
of the data of all infants who underwent PICC placement. The success rate of
PICC insertion was 88.5%. PICCs were removed electively for 72 times
(54.1%) and due to catheter-related complications for 61 times (45.9%). The
main complication rate was the mechanical occlusion (12.7%). There were no
statistically significant differences in the number of complication rates
according to the insertion site, the position of the catheter tip, or the size of the
catheter. Mechanical complications were the common reason for removal and
they did not see complications more serious.23
A prospective study on Reduction of bloodstream infections associated
with catheters in paediatric intensive care unit: stepwise approach, conducted in
a 292 bed tertiary care children's hospital, Arkansas. Significant decreases in
rates of infection occurred over the intervention period. These were sustained
over the three year follow-up. Annual rates decreased from 9.7/1000 days with
a central venous catheter in 1997 to 3.0/1000 days in 2005, which translates to
a relative risk reduction of 75% (95% confidence interval 35% to 126%), an
absolute risk reduction of 6% (2% to 10%). A stepwise introduction of
interventions to reduce nosocomial infections can be implemented successfully.
This requires a multidisciplinary team, support from hospital leadership,
ongoing data collection, shared data interpretation, and introduction of
evidence based interventions24
15
A Matched case-control study conducted in Children's Hospital Boston.
To identify risk factors for central line-associated bloodstream infection (BSI)
in patients receiving care in a pediatric cardiac intensive care unit. During the
study period , 67 central line associated BSIs occurred in 61 patients.
Unscheduled medical admissions, presence of noncardiac comorbidities,
extended device utilization, and specific medical therapies are independent risk
factors for central line-associated BSI in patients receiving care in a pediatric
cardiac intensive care unit .25
A prospective study conducted in brazil to evaluate their experience and
the complications from CVC placed percutaneously in children at a public
hospital. During the study period, 155 central venous catheters were inserted
into 127 patients over a nearly 8-month period were analyzed. There were 51
(32.9%) complications, of which 33 (21.3%) were mechanical and 18 (11.6%)
suspected catheter-related infection. These complications were responsible for
the removal of the catheter. Knowledge of anatomy and familiarity with
seldinger technique highly increase the catheterization success rate, with few
surgical complications. A better nursing care of CVC is emphasized. The
available modern venous catheters have contributed to improve the quality of
pediatric medical care. Nowadays, the percutaneous CVC is the preferred
method in pediatric patients.26
16
7 MATERIALS AND METHODS
7.1 Source Of Data:
Data will be collected from the staff nurses working in selected pediatric
unit who are providing care for child with central venous catheter.
7.2 METHOD OF DATA COLLECTION
i) The Research Design
Non experimental descriptive correlational design.
ii) Research Variables
Dependent variable
The Knowledge and practice of staff nurses on care of child with central
venous catheter.
Independent variable
Self instructional module regarding care of child with central venous catheter.
Demographic variable
The demographic variables of staff nurses such as age , gender, designation ,
qualification , working experience and previous exposure to any information.
iii) Setting
The setting will be the pediatric units of
Bengaluru.
17
the selected hospitals of
iv) Population
In this study the population will be the staff nurses who are working in
pediatric units of selected hospitals in Bengaluru.
V) Sample
The staff nurses who are fulfilling the inclusion criteria will be the sample.
Sample size will be 60.
vi) Criteria for sample selection
Inclusion criteria:
-Staff nurses who are working in the pediatric units in selected hospital
Bengaluru.
-Both male and female nurses.
Exclusion criteria:
- Staff nurses who are on night duty during the time of data collection.
- Staff nurses who had attended in-service education or conference regarding
care of child with central venous catheter.
vii) Sampling technique.
Non probability purposive sampling technique.
viii) Tool for data collection
Section A- Self administered structured questionnaire will be used to assess the
demographic data such as age, gender, designation, qualification, working
experience and previous exposure to any information.
18
Section B- Self administered structured questionnaire will be used to assess the
knowledge of staff nurses regarding care of child with central venous catheter.
Section C- Self administered structured questionnaire will be used to assess the
practice of staff nurses regarding care of child with central venous catheter
ix) Methods of data collection
Phase- I: Assess the existing knowledge and practice of staff nurses regarding
care of child with central venous catheter with the help of structured
questionnaire.
Phase-II: Administer self instructional module on care of central venous
catheter
Phase-III: After a period of one week, post test will be conducted to assess the
level of knowledge and practice of staff nurses by using same structured
questionnaire.
Duration of data collection: 4 weeks
x) Plan for data analysis
Numerical data obtained from sample will be organised and analysed
with the use of both descriptive and inferential statistics. Master coding sheet
will be prepared based on the numerical data obtained from the sample.
Descriptive statistics
-
Frequency and percentage will be used to study the demographic
variables.
19
-
Mean, median, range and standard deviation will be used to determine
the level of knowledge and practice regarding care of child with central
venous catheter.
Inferential statistics
-
Correlation coefficient will be used to find out the correlation between
knowledge and practice of staff nurses.
-
-Chi-square test will be used to associate knowledge and practice with
selected demographic variables.
-
Level of significance will be set at 0.05to interpret the hypothesis and
findings.
-
Analysed data will be represented in the form of tables graphs and
figures.
xi) Projected outcome
The investigator will assess the existing knowledge of staff nurses regarding
care of child with central venous catheter. The investigator will assess the
effectiveness of self instructional module in improving the knowledge and
practices of staff nurse regarding care of child with central venous lines.
7.3
Does The Study Require Any Investigations Or Intervention
To The Patients Or Other Human Beings Or Animals?
Yes, with prior consent from sample the study will be conducted in
selected hospital Bengaluru. The study requires minimum Investigation in the
form of self administered structured questionnaire on care of child with central
venous catheter. No other investigation which cause any harm will be done for
the subjects.
20
7.4 Has ethical permission clearance obtained from your institution?
The permission will be obtained from
-
Research committee of Varalakshmi College of Nursing.
-
The selected hospital authorities
Privacy, confidentiality and anonymity will be guarded.
21
8. LIST OF REFERANCES:
1. Bonnie Fah, Marianna Sockrider.ATS Patient information series central
venous catheter [Internet].American thoracic society; 2007. Available
from: http://patients.thoracic.org
2. Kline AM. Pediatric catheter-related bloodstream infections: latest
strategies to decrease risk. AACN Clin Issues. 2005 Apr-Jun;16(2):18598.
3. Claire Molloy.Procedure for the care of central venous line exit site for
children[Internet]. Solihull care trust ;2009 nov. Available from:
http://www.solihull.nhs.uk/getmedia/1b42311d-6215-4a11-bbea0bf26f94a69d/SCT(C)067v2.2009Procedure For The CareOfCentralVenousLineExitSiteForChildren.aspx.uk/getmedia/1b42311d
4. Amy .E. lodolce. Prevention of Central Line-Associated Bloodstream
Infections:The Role of Hand Hygiene and Hub Care[Internet].2010
[cited2010 sep 23]. Available from:
http://www.proce.com/hai_css/pdf/Module%202_Hand%20Hygiene.pdf
5. J W Puntis, C E Holden, S Smallman, Y Finkel, R H George, and I W
Booth. Staff training: a key factor in reducing intravascular catheter
sepsis. Arch Dis Child. 1991 March; 66(3): 335–337.
6. Denis Frasca, Claire Dahyot-Fizelier ,Olivier Mimoz. Prevention of
central venous catheter-related infection in the intensive care unit
[Internet] 2010 [cited 2010 mar 9 ] . Available from:
http://ccforum.com/content/14/2/212
22
7. Centers for Disease Control and Prevention. Intravascular CatheterAssociated Bloodstream Infections. 2005. Available from:
http://www.cdc.gov/ncidod/dhqp/dpac_iv.html
8. Centers for Disease Control and Prevention. Guidelines for the
prevention
of
intravascular
catheter-related
infections.
MMWR.
2002;51(RR10):11–12.
9. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial
infections in pediatric intensive care units in the United States.
Pediatrics. 1999;103(4):e39.
10. Julije Mestrovic, Tanja Kovacevic, Ivanka Ercegovic, Branka Polic,
Luka Stricevic, Ante Omazic, et el. Use of central venous catheters in
children. SIGNA VITAE 2006; 1(1): 20 – 24.
11. S. Rao, A. Alladi, K. Das, A.J. Cruz. Medium and long term central
venous access in children. Indian Pediatrics. 2003 Jan; 40(1):41-4.
12. Horvath B , Norvillie R, Lee D, Hyde A, hockenberry M,Gregurich M,
Reducing central venous catheter-related bloodstream infections in
children with cancer. oncol Nurs Forum.2009 Mar;36(2):232-8.
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9. Signature of the Candidate
:
10. Remarks of the Guide
:
The Synopsis of the present
study is appropriate to update the
nurses
knowledge
and
the
study is genuine, relevant, feasible
and individually benefiting.
11. Name and Designation
11.1 Guide
:
Mrs. Indira S
Associate Professor
11.2 Signature
:
11.3 Head of the Department
:
Mrs. Indira S
Associate Professor
11.4 Signature
:
11.5 Remarks of Principal
: The study is relevant
feasible and appropriate
for the speciality chosen.
11.6 Signature
:
26