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Description

Problem
In 2020, the Hematology/Oncology unit noticed an increased trend in Intravascular Access Devices (IVADs) needing to be removed due to infection or dehiscence of the incision.

Key EBP Practices
A Clinical Nurse Specialist, Central Line Nurse, Bone Marrow Transplant Doctor, and four Interventional Radiologist Surgeons came together to discuss potential causes of the increase in line removals. Team decided to track unplanned line removals. Unplanned line removal criteria are met when a central line is removed within 30 days of placement from an infection or dehiscence. Evidence shows studies looked at 30-day periods for line removals, and line removals would be as low as 1-4 percent.

Implementation/Pilot Testing
Project started in 2020. Goal rate for the end of the year was to be less than or equal to 5 percent. At the end of 2020, the unplanned removal rate was 4.9%. Due to barely meeting the goal, the project will continue in 2021. A mini bedside review (BSR) was completed with every unplanned line removal. The BSR reviewed when the line was placed, removed, and the reason. BSR’s were discussed by the team to find potential causes for removals. Three changes were made by the surgeons: change from Skin Affix to Dermabond to close the incision, the use of an occlusive drape for the sterile field versus blue towels, and a larger separation from the incision to IVAD device.

Outcomes
By the end of June 2021, the rate equaled 0%. There were no unplanned line removals from January to June. This has been incredible. The plan is to continue to monitor the unplanned line removals through the end of 2021.

Publication Date

2021

Disciplines

Pediatric Nursing

IR Unplanned Line Removals

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