SNGP3004: Central venous catheters (CVCs) play a vital role in the management of patients requiring haemodialysis, facilitating the delivery of life-sustaining therapies: Professional Practice Project, Assignment, UOS, Singapore

Central venous catheters (CVCs) play a vital role in the management of patients requiring haemodialysis, facilitating the delivery of life-sustaining therapies. However, their use is not devoid of risks. According to Hajji et al., 2022, there were 49 cases of CRI among 167 patients for 40 months. In another study, 152 patients receiving maintenance haemodialysis were enrolled and evaluated for catheter-related bloodstream infections (CRBSI). Among those screened, 34.2% (52 out of 152) were diagnosed with CRBSI (Opoku-Asare et al., 2023). In response to this challenge, healthcare providers have turned to intervention bundles as a promising strategy to mitigate CRBSI risks associated with CVC use.

Hemodialysis is a life-sustaining treatment for individuals with kidney failure, requiring the insertion of central venous catheters. While CVCs offer immediate vascular access, they concurrently introduce the risk of CRBSIs, which can lead to severe complications, including septicaemia and endocarditis, significantly jeopardizing patient health outcomes. Given the gravity of CRBSIs in haemodialysis patients, exploring the efficacy of intervention bundles becomes paramount.

Intervention bundles, comprising a set of evidence-based practices bundled together, offer a comprehensive approach to infection prevention. These bundles typically include elements such as strict catheter care protocols, antimicrobial catheter locks, education for healthcare providers, and patient-centred interventions. Understanding the effectiveness of intervention bundles in reducing CRBSIs in haemodialysis patients holds immense clinical significance. Not only does it directly impact patient safety and outcomes, but it also carries economic implications by potentially reducing healthcare costs associated with CRBSI management and treatment.

By addressing this, healthcare providers can refine their practices, optimize patient care, and contribute to the broader goal of enhancing the quality of life for individuals undergoing haemodialysis. Through a comprehensive examination of existing literature and evidence, this essay aims to provide valuable insights into an essential aspect of infection control in haemodialysis settings, ultimately informing clinical practice and improving patient outcomes.

Local studies have highlighted the prevalence and impact of CRBSIs in haemodialysis patients within specific healthcare facilities. For instance, a study conducted in Singapore revealed that 110 patients (16.2%) developed CRBSI in haemodialysis patients, resulting in 14.5% mortality and significantly prolonging hospital stays (Yap et al., 2018). On an international scale, CRBSIs remain a pervasive issue, with numerous studies documenting their prevalence and associated complications. Research conducted by the International Nosocomial Infection Control Consortium (INICC) reported 4,270 CRBSIs in 45 developing countries (Rosenthal et al., 2024). These findings emphasize the global impact of CRBSIs on haemodialysis patients and the imperative for standardized preventive measures.

Despite considerable research on catheter-related bloodstream infections (CRBSIs), there is a significant gap in the literature concerning the effectiveness of intervention bundles designed specifically for haemodialysis patients. While intervention bundles have demonstrated success in lowering CRBSI rates in various healthcare settings, their efficacy in the context of haemodialysis remains uncertain due to the unique characteristics and needs of this patient population. Current interventions primarily focus on managing bloodstream infections after they occur (Rebmann & Barnes, 2011), highlighting the need for proactive strategies to prevent CRBSIs from developing in the first place.

This study aims to address the question: “Do intervention bundles reduce catheter-related bloodstream infections from central venous catheters used for haemodialysis in adults?” By investigating this question, the study seeks to fill the existing gap in the literature and provide clarity on the effectiveness of intervention bundles tailored specifically to haemodialysis patients. Understanding whether intervention bundles can effectively reduce CRBSIs in this population is crucial for informing evidence-based practices and improving patient outcomes in haemodialysis settings.

MEDLINE, CINAHL, and ProQuest Nursing and Allied Health were chosen as they are essential databases for accessing peer-reviewed literature on topics such as catheter-related bloodstream infections (CRBSIs), haemodialysis, and infection control. MEDLINE provides extensive coverage and high-quality evidence, while CINAHL caters to nursing and allied health professionals, offering diverse literature on haemodialysis and infection prevention. ProQuest Nursing and Allied Health offers a comprehensive selection of scholarly journals, dissertations, and conference proceedings relevant to intervention strategies in reducing CRBSIs among haemodialysis patients.

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A systematic search was conducted of the following electronic databases on April 15, 2024: MEDLINE, CINAHL, and ProQuest Nursing and Allied Health. Key search terms were combined using Boolean operators: “Intervention bundles” or “care bundles” and “central venous catheters” or “Catheterization, central venous” or “central line catheters” and “nursing interventions” and “haemodialysis catheters” or “HD catheters” and “adults”. No time restrictions were imposed on the search. The inclusion criteria included intervention bundles, central venous catheters, the reduction of CRBSIs, haemodialysis catheters, and studies involving adults.

The search was restricted to articles published between 2014 and 2024, written in English, and included scholarly or academic journals. The chosen limits for the search period, language, and publication type aim to ensure the inclusion of recent, high-quality literature. These limits facilitate the incorporation of up-to-date evidence while maintaining accessibility and credibility, thereby enhancing the validity and reliability of the review findings.

The quality of the articles was assessed using the Critical Appraisal Skills Programme (CASP) and the critical appraisal tools from the Joanna Briggs Institute. A total of 45 articles were rejected during the appraisal process. These rejections were primarily attributed to poor reporting, where articles lacked clear and comprehensive descriptions of methods and results. Insufficient reporting hampers the assessment of study quality and replication of findings. Additionally, some articles were rejected due to inadequate quality, as they did not meet predefined criteria for transparency, rigour, and relevance. This stringent approach aims to ensure the inclusion of only high-quality research evidence in the review.

Information was extracted and organized into a summary table containing details such as the reference, study design and objectives, sample size, methods, findings, and comments. This is shown in Figure 1. Thematic analysis was employed to evaluate the validity of the study findings and determine the overall direction of the findings across the pool of studies.