NephrologyNursingJournalJanuary-February2014Vol.41,No.167ShowerandNo-DressingTechniqueForTunneledCentralVenousHemodialysisCatheters:AQualityImprovementInitiativeTunneledcentralvenouscathe-ters(CVCs)havebeenusedforsometimeasavascularaccessforhemodialysis.CVCsareusedwhenoptimalandmoreperma-nentarteriovenoushemodialysisac-cessiseithernotanoptionornotdesiredbythepatient.Theyareoftennotthepreferredvascularaccessbyhealthcareprovidersduetothehighassociatedmorbidityandmortality,oftenrelatedtoinfection.Hemo-dialysiscathetersarethemostcom-moncauseofrepeatedlyhighratesofhospitalizationforinfectioninthispopulation(UnitedStatesRenalDataSystem[USRDS],2013).Preventingcatheter-relatedbacteremiabeginswithgoodCVCcare(Lok&Mokrzycki,2011).AnessentialcomponentofthisisthecareoftheCVCexitsiteandCVCexitsitedressingpractices–anareainwhichnursingexpertisecandirectlyimpactpatientoutcomes.RegardlessofthetypeofdressingappliedtotheCVCexitsite,mosthemodialysiscentersareclearwithpatientinstructionstoavoidgettingthecatheterdressingwet.Infact,manypatientswithCVCsarein-structednottoshoweratall.FortheJulieAnnLawrenceSuzanneSeilerContinuingNursingEducationNote:Authors’biographicalstatementsandacknowledgmentscanbefoundonthefollowingpage.Editor’sNote:PleaserefertothearticlebyEilizabethC.Evans,DebraHain,TamaraM.Kear,LeslieA.Dork,andChristineSchrauf,“Hemo-dialysisCatheterOutcomesPilotStudy:NoDressingCoveragewithPrescribedShowering,”whichappearsonpages53-64,72ofthisissue,foraddi-tionalinformationonthistopic.StatementofDisclosure:Theauthorsreportednoactualorpotentialconflictofinterestinrela-tiontothiscontinuingnursingeducationactivity.Note:AdditionalstatementsofdisclosureandinstructionsforCNEevaluationcanbefoundonpage73.Thisofferingfor1.4contacthoursisprovidedbytheAmericanNephrologyNurses’Association(ANNA).AmericanNephrologyNurses’AssociationisaccreditedasaproviderofcontinuingnursingeducationbytheAmericanNursesCredentialingCenterCommissiononAccreditation.ANNAisaproviderapprovedbytheCaliforniaBoardofRegisteredNursing,providernumberCEP00910.ThisCNEarticlemeetstheNephrologyNursingCertificationCommission’s(NNCC’s)continu-ingnursingeducationrequirementsforcertificationandrecertification.Copyright2014AmericanNephrologyNurses’AssociationLawrence,J.A.,Seiler,S.,Wilson,B.,&Harwood,L.(2014).Showerandno-dressingtech-niquefortunneledcentralvenoushemodialysiscatheters:Aqualityimprovementinitiative.NephrologyNursingJournal,41(1),67-72.Self-carepracticesandquality-of-lifenuancesjuxtaposedourtunneledhemodialysiscen-tralvenouscatheter(CVC)protocols.Despiteouradvice,individualswithCVCswereshowering.Asaqualityimprovementinitiative,wecomparedthestandardCVCdress-ingpracticestothe“showerandno-dressing”technique.After1380cathetermonths(n=119)infectionrateswere0.31eventsper1000catheterdays.The“showerandno-dressing”techniqueappearstobeasafeCVCdressingoptionwithimprovedqualityoflife,noincreaseininfectionrates,andcost-effectiveness.KeyWords:Centralvenouscatheters,catheter-relatedbloodstreaminfections,patientsafety,sterilization,dressings,continuousqualityimprove-ment.GoalTodiscusstheoutcomesofaqualityimprovementinitiativeusingtheshowerandno-dressingtechniquefortunneledhemodialysiscatheters.Objectives1.Discussinterventionsimplementedinthe“showerandno-dressing”techniqueproject.2.Reviewthepatientresponsestothe“showerandno-dr...
