title: Management of Central Venous Access Device-Associated Skin Impairment: An Evidence-Based Algorithm.
abstract: Patients relying on central venous access devices (CVADs) for treatment are frequently complex. Many have multiple comorbid conditions, including renal impairment, nutritional deficiencies, hematologic disorders, or cancer. These conditions can impair the skin surrounding the CVAD insertion site, resulting in an increased likelihood of skin damage when standard CVAD management practices are employed. Supported by the World Congress of Vascular Access (WoCoVA), developed an evidence- and consensus-based algorithm to improve CVAD-associated skin impairment (CASI) identification and diagnosis, guide clinical decision-making, and improve clinician confidence in managing CASI. A scoping review of relevant literature surrounding CASI management was undertaken March 2014, and results were distributed to an international advisory panel. A CASI algorithm was developed by an international advisory panel of clinicians with expertise in wounds, vascular access, pediatrics, geriatric care, home care, intensive care, infection control and acute care, using a 2-phase, modified Delphi technique. The algorithm focuses on identification and treatment of skin injury, exit site infection, noninfectious exudate, and skin irritation/contact dermatitis. It comprised 3 domains: assessment, skin protection, and patient comfort. External validation of the algorithm was achieved by prospective pre- and posttest design, using clinical scenarios and self-reported clinician confidence (Likert scale), and incorporating algorithm feasibility and face validity endpoints. The CASI algorithm was found to significantly increase participants' confidence in the assessment and management of skin injury (P = .002), skin irritation/contact dermatitis (P = .001), and noninfectious exudate (P < .01). A majority of participants reported the algorithm as easy to understand (24/25; 96%), containing all necessary information (24/25; 96%). Twenty-four of 25 (96%) stated that they would recommend the tool to guide management of CASI.
authors.affiliation: Daphne Broadhurst, CVAA(c), BSN, RN, Medical Pharmacies, Ottawa, Ontario, Canada. Nancy Moureau, VA-BC, CPUI, CRNI, BSN, RN, PICC Excellence, Inc, Hartwell, Georgia; Greenville Hospital System, Greenville, South Carolina; and Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Queensland, Australia. Amanda J. Ullman, PhD, MAppSc, GCert PICU, RN, Centaur Fellow, School of Nursing and Midwifery, Griffith University, Nathan Campus, Queensland, Australia; and Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Queensland, Australia.
authors.forename: Daphne
authors.initials: D
authors.lastname: Broadhurst
authors.forename: Nancy
authors.initials: N
authors.lastname: Moureau
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ullman
mesh_terms: D000465:Algorithms; D000891:Anti-Infective Agents, Local / Q000494:pharmacology / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000451:nursing* / Q000517:prevention & control; D062905:Central Venous Catheters / Q000009:adverse effects*; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D032921:Consensus; D020000:Decision Support Systems, Clinical / Q000592:standards*; D055318:Evidence-Based Nursing; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012867:Skin / Q000293:injuries / Q000382:microbiology; D017592:Skin Care / Q000451:nursing*
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine