A snapshot of guideline compliance reveals room for improvement: A survey of peripheral arterial catheter practices in Australian operating theatres

Authors

  • Heather Reynolds RN,

    PhD Candidate, Corresponding author
    1. Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
    2. Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Queensland, Australia
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  • Joel Dulhunty MBBS PhD,

    Research Fellow
    1. Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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  • Marion Tower RN PhD,

    Deputy Head of School of Nursing and Midwifery
    1. Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Queensland, Australia
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  • Kersi Taraporewalla MBBS MClinEd,

    Associate Professor
    1. Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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  • Claire Rickard RN PhD

    Professor
    1. Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Queensland, Australia
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Abstract

Aim

To report a study in Australian operating theatres of compliance by the anaesthetic team with best peripheral arterial catheter practice for blood gas sampling and infection prevention. Comparisons are made with research recommendations and Centres for Disease Control Guidelines.

Background

There is wide global usage of peripheral arterial catheters in the operating theatre for haemodynamic monitoring and blood gas analysis. Frequent blood sampling from arterial catheters can lead to statistically significant blood loss and provide an infective potential. Evidence-based research and clinical guidelines prescribe best practice.

Design

Cross-sectional descriptive survey

Methods

Data were collected in 2009 from 64 major Australian hospitals using a self-designed internet survey.

Results/Findings

Hand hygiene prior to catheter insertion was the only infection prevention practice entirely adherent with guidelines. The recommended ratio of discard to dead space volume of 2:1 to decrease unnecessary blood loss during blood gas sampling was reported by only 11 (17%) respondents. Less than 32 (50%) respondents used the preferred solution, chlorhexidine to disinfect the insertion site. Access ports were reported as ‘never disinfected’ before use by 30 (47%) respondents.

Conclusion

The complex operating theatre environment presents barriers, which contribute to non-adherence with guidelines. These barriers need to be identified to plan strategies for improvement. A quality audit tool is proposed for development by nurses in collaboration with the anaesthetic team, providing a needed method to assess ongoing compliance with best peripheral arterial catheter care. Further international research would test the generalizability of our Australian findings.

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