NURS90010 Management Of Non Tunneled

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NURS90010 Management Of Non Tunneled

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NURS90010 Management Of Non Tunneled

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Course Code: NURS90010
University: The University Of Melbourne

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Country: Australia

Question:

Discuss About The Management Of Non-Tunneled Dialysis Catheters.

 
Answer:
Introduction

In the field of therapeutic medical treatment, the practice of ‘dialysis’, is concerned with the mechanical removal of nitrogenous toxins, solutes and urea from the human body, with the aid of a device, known as a ‘dialyzer’. Dialysis is undertaken during critical renal conditions, such as the occurrence of Renal Failure or Chronic Kidney Disease, where the kidneys present in the human body, are unable to perform their usual functions, as highlighted above. With respect to dialysis, there are two methods: hemodialysis and peritoneal dialysis (Goff et al., 2015). With respect to the operation of a mechanical device for the purpose of conductance of a normal physiological functioning, the requirement and adherence to certain guidelines, related to the installation and management of catheters, is imperative to ensure patient safety and rapid recovery (Figueiredo et al., 2016).
The presence of catheters, in medical practice, outlines a tube with a thin diameter, formulated using medically safe components, which are used to enhance surgical operations, through insertion in the body cavities. In the field of dialysis, catheterization is an essential procedure, employing the usage of a catheter to establish connections between the blood vessels and the dialyzing equipment (Wallace et al., 2016). The usage of non-tunneled catheters is of utmost importance during the requirement of Renal Replacement Therapy. The primary physiological sights outlining the installation of non-tunneled catheters for dialysis, are the right section of the internal jugular vein, with further connection to the vein in the femur (Mendu et al., 2017).
 
The following essay highlights the requirement of a learning guideline for the installation of non-tunneled dialysis catheters in the emergency dialysis unit, followed by a rationale justifying its implementation and usage, the barriers required to overcome and an effective evaluation procedure highlighting its efficiency. The latter section sheds light on the salient features of the teaching and training guidelines regarding the management of non-tunneled dialysis catheters in an emergency dialysis unit.
With respect to the usage of non-tunneled catheters in dialysis, a number of complications are associated, which are typically related due to implementation of incorrect insertion procedures, and are not due to infectious causes. The insertion process of non-tunneled catheters are associated with the vascular region of the human body, and hence, the occurrence of complications or malfunctions, due to faulty insertion techniques, are prevalent. The occurrence of physiological complications in the patients, citing mechanical causative factors, are primarily present during the first seven days after insertion (Clark et al., 2016). Some of the factors influencing distorted mechanical insertion, are associated with faulty positioning of the patient, distorted position of the tip of the catheter, as well as kinking of the same. such faulty procedures may result in fatal complications affecting the health of the patient, and include injury to the vascular region, occurrence of large clots in the blood vessels or hematoma, irregular heart rhythm or arrhythmia, profuse internal bleeding and embolism (Mendu et al., 2017). Hence, in accordance to the occurrence of such complications, the assurance of optimum health and safety of the patient undergoing dialysis and catheterization outlines the principle rationale of this teaching guideline related to the management of non-tunneled catheter dialysis in the emergency dialysis unit (Chopra et al., 2015).
The rationale behind using this teaching tool, is for the assurance of provision of safe and quality treatment practices, in order to ensure optimum health and recovery for the patient (McArdle et al., 2017). With respect to this guideline, the teaching plan will require the procurement and utilization of several tools, for the purpose of its effective implementation. The individual involved in the education of the personnel, would most importantly require the utilization of a non-tunneled catheters. The catheter should be examined, prior to its teaching implementation, in order to grade its quality and specificity, its length and diameter and the quantity of lumens associated with it (Kim et al., 2017). For the purpose of imparting quality and optimum teaching for the learners in the workplace, arrangements are to be made for the presence of a dummy model for exhibition of insertion, followed by a thorough presentation, regarding the possible sites of insertion. An additional section of this guideline, is educating the learners, most importantly, on the correct procedures of catheter insertion, followed by catheter removal and the possible complications associated with the implementation of faulty procedures (Wallis et al., 2014). Sterilization of equipment is imperative to the optimum assurance of safety and pathological prevention in any workplace. Hence, a part of the teaching guideline, regarding the management of non-tunneled dialysis catheters, should be awareness regarding the importance of maintenance of sterilization, followed by practical demonstrations to the learner with regards to sterilization procedures required for management of the concerned equipment. Hence, the provision of sterilization tools, carriers such as containers or carts for the equipment, and most importantly, sample catheters, is of utmost importance in the implementation of this teaching guideline (Selim et al., 2018).
Theories on ‘Adult Learning’, as opined by Knowles (2016), focus on the variety of cognitive methods employed by adults, in order to engage in learning and understanding, hence driving the need for trainers to formulate alternative modes of teaching as compared to those utilized for educating children. With respect to adult learning theory, the idea of ‘Andragogy’ emerged, as formulated in 1980, by Malcolm Knowles. The term implies the scientific and artistic rationale behind the process of learning by adults, which is highlighted by a number of factors (Knowles et al., 2016). With respect to Knowles’ andragogy, adults incorporate learning: through the transition of dependence to independence, assistance of real life experiences during learning, assumption of novel social roles for the purpose of preparation, application based knowledge through problem solving and motivation through internal rather than external cues (Ozua, 2016). With respect to the theories of adult learning, the teaching guideline proposed for the management of non-tunneled catheter dialysis in emergency dialysis unit, the following key salient features will be incorporated as the rationale for learning (Papanagnou, Sicks & Hollander, 2015):

There is a need for provision of an environment outlining interaction and cooperation, and hence, an application based learning area will be utilized, where the learners will be taught through practical demonstration, along with coordination between peers as well as cooperation from the teacher.
There is a requirement for assessment, in order to evaluate the capabilities and opinion of the concerned learners, followed by development of teaching guidelines, as per the unique requirements of the leaner. Hence, prior to implementation of the teaching guideline, a conductance of a competency assessment may be utilized, in order to analysis the specific knowledge capacity of each learner, and incorporate the appropriate teaching methods accordingly.
The instructor should impart the education sequentially, in order to ensure optimum learning and cognition. With respect to the aforementioned teaching protocol, each task of education will be incorporated in sequence, with respect to development of consecutive understanding, as per the learner’s potential.
The teaching protocol so utilized, should undergo appropriate evaluation and amendment procedures, in order to analyze its functionality. The evaluation of the teaching guideline aimed at the management of non-tunneled catheter dialysis in the emergency dialysis unit, will be mentioned in the following sections of the essay.

Learning resources are often subject to various barriers and difficulties, which act as hurdles for their implementation. With respect to the learning resource for the management of non-tunneled dialysis catheters in an emergency dialysis unit, one of the most important factors is the utilization of a dummy model for imparting education, on the various techniques involved in optimum catheter installation. Hence, there may be mishaps encountered, when the learning resource is implemented with the aid of real-life patient situations, one of them being, contamination due to improper sterilization. Hence, as a solution, novel workers part of the learning workforce, must be educated thoroughly on the importance of sterilization procedures for ensuring optimum health and safety of the patient (Parienti et al., 2015).  Likewise, in the unlikely event of a patient inflicted with catheter infection, a number of treatment and recovery procedures are to be employed. These include urgent removal of the concerned catheter inflicted with infection and immediate antibiotic treatment to the patient (Gavin et al., 2017). Additionally, blood samples of the concerned patient must be collected and examined for infection by pathological strains, and managed accordingly with the aid of antibiotic medication (McArdle et al., 2017).
 
Another issue of concern, regarding the implementation of this learning protocol for learners, to be implemented on live patients, is the presence of patient difficulties, concerning the installation and insertion of catheters. Often patients are incorrectly positioned, or exhibit considerable stiffness in muscles, which may present considerable hindrance to the installation of non-tunneled catheters, further resulting in injuries and the resultant harmful hemorrhagic complications. Hence, prior to catheter installation, learners should be educated regarding the importance of assisting patients in relaxation, which will not only help in correct catheterization, but also in the development of health patient and workforce relationship (Miller et al., 2016).
Learners engaging in the learning process, will be required to learn, understand, perform and demonstrate the following fields respectively, in order to complete the learning package (Smyth, McArdle & Gardner, 2016).:

Assessment of learner competency and imparting education
Incorporation of Sterilization methods
Types of catheters and materials
Location for Insertion and selection of sites
Antibiotic treatment
Precautions for insertion
Catheter Removal

The process of evaluation is imperative to analyze the effectiveness of the learning resource. With respect to this, the learners who have undergone the educational experience, can be evaluated through the use of practical or demonstrative examinations. Practical or application based lab work assessments have been proven to be efficient in evaluating the learner performance and ability, as well the credibility of the teaching protocol so used (Suskie et al., 2018). In addition, a feedback interview or survey conductance can be performed by the instructor, with learners as the subject, where opinions of the concerned subject group can be evaluated, which can further pose as key features or amendments of the required learning protocol (Yengin, 2017). Further, in situations which require the involvement of novel workforce in performance of live patient catheter installations, interviews or surveys conducted on the concerned patients can prove to be beneficial, in the assessment of the efficiency of the learning resource regarding the management of non-tunneled dialysis catheter in emergency dialysis unit. Feedback procedures would eventually aid in the enhancement and improvement of learning protocols (Coulter et al., 2014). Finally, an additional alternative procedure to assist in the evaluation of the above mentioned learning protocol, would be the implementation of follow up procedures of discharged patients. This would include extensive communication by the workforce with the concerned subject, which would highlight their opinion and current health status resulting in further reflection on the efficiency of the required learning resource (Khatib et al., 2014).
Hence, to conclude, the above learning protocol is imperative to aid in imparting education regarding the management of non-tunneled dialysis catheters in the emergency dialysis unit, with respect to the prevalent occurrence of harmful damage and patient complications, due to installation and insertion of catheters using faulty techniques. However, the learning resource, is subject to shortcomings, which can be eradicated with the appropriate corrective procedures. Lastly, the utilization of effective feedback procedures will further aid in the evaluation and improvement of the functionality of the concerned learning resource tool.
The following paragraphs will highlight on the key features pertaining to the performance and conductance of a learning resource for the management of non-tunneled dialysis catheter in emergency dialysis units.
Module Title: Management of Non-Tunneled Dialysis Catheters in Emergency Dialysis Unit
With respect to the installation and insertion techniques of catheters, the development of learning protocols is imperative, in order to serve as a precautionary aid for the future occurrence of malpractices or medical mishaps (Figueiredo et al., 2016).
Purpose Statement
The purpose of the following learning package is to impart education and practical knowledge on the management of non-tunneled dialysis catheters in emergency dialysis unit.
Aim
To impart adequate practical knowledge on the management of the non-tunneled dialysis catheters in the emergency dialysis unit, for the prevention of occurrence of medical complications, due to improper catheter installation procedures.
Target Audience
The target audience for the proposed learning package, would be nurses who are new to the workforce, and have been recruited for the purpose of serving renal patients. (Mendu et al., 2017). An evaluation test is to be conducted, prior to commencement of the learning package, in order to evaluate the competency levels of the learners, in order to qualify for the training. (McArdle et al., 2017).
Learning Objectives
Upon completion of the learning package, the student can be expected to present the following outcomes:

Cognitive outcomes: A clear understanding on the proper management of non-tunneled dialysis catheters in the emergency dialysis units and an awareness of the possible medical complications for improper conductance of the same.
Affective outcomes: A sense of empathy and understanding towards the possible discomfort exhibited by patients during dialysis catheter installation and polite management of the same.
Behavioral: An extensive ability to incorporate and perform the appropriate procedures required for the purpose of correct installation of non-tunneled catheters in patients undergoing dialysis.

 
Material Sources Required
The following materials will be required for implementation of the learning package:

Written instructions for students, clearly stating each procedure required for the completion of specific tasks.
Internet facilities to demonstrate or present educative and interactive audio-visual information to the students.
Equipment like sterilizing liquids, clippers, suture removers, dressing materials, antibiotic medications and ointments, sample catheters and dummy models may be required to demonstrate the tasks.
Experienced workers may be involved in the learning process to further enhance student learning as well for the management of possible mishaps conducted by the new workforce.

Preparation
The following procedures are to be employed, in order to develop the learning package:

The instruction of the learning packaged must be printed and prepared clearly, followed by theoretical matter, for the purpose of reading by the learner.
Appropriate time schedule is to be prepared for the learning package, listing the number of days in the week required for completion or performance of learning protocols.
Learners interested for the training, must be consulted for voluntary consent, followed by a competency examination to further undergo qualification for the training.
The equipment required, followed by the chemical components, must be arranged prior to commencement of the learning package.

Completing the Learning Package
Learners are required to learn, perform and practice the following protocols for completion of the learning package.
Incorporation of Sterilization Methods
The incorporation of effective sterilization methods holds great priority in the conductance of medical practices, the misconduct of which, will lead to the contaminations of the catheter, and the resultant infections.. The learners must be taught to engage in washing hands prior to, as well after the insertion of catheters. The learning package additionally necessitates the usage of gloves for the performance of catheter installation, and utilize disinfectants to undertake the sterilization protocols (Mimoz, Chopra & Timsit, 2016).
Types of Catheters and materials
The learning package prioritizes the usage of catheters which enhance the blood flow rate (Reddy & Srikanth, 2015). With respect to patients with microbial infections, the usage of catheters lined with protective, medical microbial coverings may be employed. (Smyth, McArdle & Gardner, 2016).
Location of Insertion and Selection of Sites
Non-tunneled catheters for dialysis are aimed at gaining vascular access. Hence, careful selection of appropriate sites, prior to catheter installation, is of utmost importance for the learners. In accordance to this proposed learning packaged, the required locations meant for installation of non-tunneled catheters must be decided using X – rays targeted at the chest region of the patient (McArdle et al., 2017). The vein at the femur is considered appropriate for catheter insertion, as compared to the vein at the jugular region due to its complications. Radiological or ultrasound processes may be utilized during insertion, in order to aid in precise location of the installation point, along with provision of adequate guidance pathways while conductance of the same. Hence, learners must ensure the usage of appropriate diagnostic and technological aids in the management of non-tunneled dialysis catheters (Helm et al., 2015).
Antibiotic Treatment
Learners must ensure adequate performance of hematological tests and diagnostics, in order to examine the presence of microbial infections in the patients. Infection acquired after the commencement of dialysis, may required antibiotic medications. Additionally, as per the guidelines, learners may perform the application of antibiotics during patient maintenance procedures, for the prevention of Staphylococcus aureus proliferation. However, learners must perform the same with prior medical supervision, to prevent the possibility of antibiotic-resistant pathogenic growth (McArdle et al., 2017).
Precaution for Insertion
Prior to insertion, the learners must ensure adequate hair removal via clippers, along with disinfection and sterilization of the concerned site, with the utilization of disinfectants, in order to maintain patient hygiene and prevention of contamination (Chopra et al., 2015).
 
Catheter Fixation and Removal
The proposed learning package encourages learners to utilize skin sutures or fixation equipment to enhance catheter grip in the patient. The task must be performed aseptically using gloves to prevent contamination. With respect to removal of the catheter, it is compulsory for the learners to engage in thorough inspection of the location, to analyze signs and symptoms of infection, followed by communication feedback with the patient regarding the perception of  any form of discomfort (Smyth, McArdle & Gardner, 2016).
Didactic Sessions
The learners will required to attend audio-visual presentations of the salient features of the learning package, for thorough understanding of the procedures required for the management of non-tunneled dialysis catheters.
Evaluation
Upon commencement of the learning process, the learners will be evaluated, in order to analyze the capability, knowledge and understanding of the learners, retained during the education process. The following would be evaluated:

Development of skills: A practical or lab-based evaluation assessment can be performed, in order to evaluate the extent of practical learning retained by the learner.
The practical assessment will also evaluate whether the student is engaging in presenting the required behavioral or attitudinal changes imperative to the process.
A written examination may be performed in order to assess the theoretical knowledge of the concerned learner. 

 
References
Chopra, V., Flanders, S. A., Saint, S., Woller, S. C., O’Grady, N. P., Safdar, N., … & Pittiruti, M. (2015). The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Annals of internal medicine, 163(6_Supplement), S1-S40.
Clark, E. G., Akbari, A., Hiebert, B., Hiremath, S., Komenda, P., Lok, C. E., … & Sood, M. M. (2016). Geographic and facility variation in initial use of non-tunneled catheters for incident maintenance hemodialysis patients. BMC nephrology, 17(1), 20.
Coulter, A., Locock, L., Ziebland, S., & Calabrese, J. (2014). Collecting data on patient experience is not enough: they must be used to improve care. BMJ (Clinical research ed.), 348(mar26 1), g2225-g2225.
Figueiredo, A. E., Bernardini, J., Bowes, E., Hiramatsu, M., Price, V., Su, C., … & Brunier, G. (2016). ISPD guideline/recommendations: a syllabus for teaching peritoneal dialysis to patients and caregivers. Peritoneal Dialysis International, pdi-2015.
Gavin, N. C., Button, E., Keogh, S., McMillan, D., & Rickard, C. (2017). Does Parenteral Nutrition Increase the Risk of Catheter?Related Bloodstream Infection? A Systematic Literature Review. Journal of Parenteral and Enteral Nutrition, 41(6), 918-928.
Goff, S. L., Eneanya, N. D., Feinberg, R., Germain, M. J., Marr, L., Berzoff, J., … & Unruh, M. (2015). Advance care planning: a qualitative study of dialysis patients and families. Clinical Journal of the American Society of Nephrology, CJN-07490714.
Helm, R. E., Klausner, J. D., Klemperer, J. D., Flint, L. M., & Huang, E. (2015). Accepted but unacceptable: peripheral IV catheter failure. Journal of Infusion Nursing, 38(3), 189-203.
Khatib, R., Schwalm, J. D., Yusuf, S., Haynes, R. B., McKee, M., Khan, M., & Nieuwlaat, R. (2014). Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PloS one, 9(1), e84238.
Kim, Y. J., Lee, S. M., Park, H. R., Sohng, K. Y., & Kim, S. J. (2017). Development of Evidence-based Nursing Practice Guidelines for Peripheral Intravenous Catheter Management in Hospitalized Children and Adult. International Journal of Studies in Nursing, 3(1), 82.
Knowles, M. S., Holton III, E. F., & Swanson, R. A. (2014). Andragogy in practice: expanding the usefulness of the andragogical model. In The Adult Learner (pp. 86-108). Routledge.
McArdle, J., Smyth, W., Wicking, K., & Gardner, A. (2017). Haemodialysis central venous catheter exit site dressings in the tropics: a crossover randomised controlled trial. Wound Practice & Research: Journal of the Australian Wound Management Association, 25(4), 200.
Mendu, M. L., May, M. F., Kaze, A. D., Graham, D. A., Cui, S., Chen, M. E., … & Waikar, S. S. (2017). Non-tunneled versus tunneled dialysis catheters for acute kidney injury requiring renal replacement therapy: a prospective cohort study. BMC nephrology, 18(1), 351.
Miller, L. M., MacRae, J. M., Kiaii, M., Clark, E., Dipchand, C., Kappel, J., … & Pike, P. (2016). Hemodialysis tunneled catheter noninfectious complications. Canadian journal of kidney health and disease, 3, 2054358116669130.
Mimoz, O., Chopra, V., & Timsit, J. F. (2016). What’s new in catheter-related infection: skin cleansing and skin antisepsis. Intensive care medicine, 42(11), 1784-1786.
Ozuah, P. O. (2016). First, there was pedagogy and then came andragogy. Einstein journal of Biology and Medicine, 21(2), 83-87.
Papanagnou, D., Sicks, S., & Hollander, J. E. (2015). Training the next generation of care providers: focus on telehealth. Healthcare Transformation, 1(1), 52-63.
Parienti, J. J., Mongardon, N., Mégarbane, B., Mira, J. P., Kalfon, P., Gros, A., … & Savary, B. (2015). Intravascular complications of central venous catheterization by insertion site. New England Journal of Medicine, 373(13), 1220-1229.
Reddy, J. V., & Srikanth, D. (2015). The polar fluid model for blood flow through a tapered artery with overlapping stenosis: effects of catheter and velocity slip. Applied bionics and biomechanics, 2015.
Selim, S. M., El-Seoud, A. R. A., Mohamed, A. A. H., & Ibrahim, S. A. A. R. (2018). EFFECT OF INFECTION CONTROL PROGRAM ON CATHETER ASSOCIATED URINARY TRACT INFECTION IN INTENSIVE CARE UNITS AT ZAGAZIG UNIVERSITY HOSPITAL. Zagazig University Medical Journal, 24(5).
Smyth, W., McArdle, J., & Gardner, A. (2016). Central venous catheter exit site dressings: Balancing patients’ needs, nurses’ experiences and the research evidence. Wound Practice & Research: Journal of the Australian Wound Management Association, 24(1), 41.
Suskie, L. (2018). Assessing student learning: A common sense guide. John Wiley & Sons.
Wallace, E. L., Fissell, R. B., Golper, T. A., Blake, P. G., Lewin, A. M., Oliver, M. J., & Quinn, R. R. (2016). Catheter insertion and perioperative practices within the ISPD North American research consortium. Peritoneal Dialysis International, 36(4), 382-386.
Wallis, M. C., McGrail, M., Webster, J., Marsh, N., Gowardman, J., Playford, E. G., & Rickard, C. M. (2014). Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial. Infection Control & Hospital Epidemiology, 35(1), 63-68.
Yengin, I. (2017). Importance of feedback in teaching, communication and information systems for learning. Komunikacija i kultura online, 1(1), 309-317.

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