The Relationship Between Intrinsic and Extrinsic …

1 AD-A239 347 :UMENTATION 'PAGE Form Approvedli11 ton Is estimated to uaerage ; hour per response. including the tine for reviewnginsT'uctirrs, searching IN p11l11,1111111111 eting and reviemng trre coIIction of information send commients regard nc) thi burden ettinate or any other asoect of ti1111 ii111111i", ilii ~educing this burden t0 'dNashi ngton Headauariers, services, Directorate for inforrmation opera t ons and Reports. 1215 Jefferson?. and to the Ofire ')f Management and Budget. Paperwork Reduction Proje<t (0704-0 t88), Washington, DC 205031. AGENCY USE ONLY (Leave blank) 2. REPORT DATE 3. REPORT TYPE AND DATES COVEREDI THESIS!04. TITLE AND SUBTITLE 5.

2 FUNDING NUMBERSThe Relationship Between Intrinsic and ExtrinsicFactors and Central Venous catheter Infectionsi n t-ho Arutely TI I Pat i nt6. AUTHOR(S)Helen Frances Edwards, Captain7. PERFORMING ORGANIZATION NAME(S) AND ADDFkESS(ES) 8. PERFORMING ORGANIZATIONREPORT NUMBERAFIT Student Attending: University of Arizona AFIT/CI/C1A- 91-0179. SPONSORING/ MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSORING / MONITORINGAGENCY REPORT NUMBERAFIT/CIWright-Patterson AkFB OH 45433-658311. SUPPLEMENTARY NOTES1 2a. DISTRIBUTION / AVAILABILITY STATEMENT 12b. DISTRIBUTION CODEA pproved for Public Release lAW 190-1 Distributed UnlimitedERNEST A. HAY170OD, 1st Lt, USAFE xecutive Officer13.

3 ABSTRACT (Maximum 200 words)DTIG13 AUG 09 19910 10 3114. SUBJECT TERMS 15. NUMBER OF PAGES10416. PRICE CODE17. SECURITY CLASSIFICATION 18. SECURITY CLASSIFICATION I19. SECURITY CLASSIFICATION 20. LIMITATION OF ABSTRACTOF REPORT OF THIS PAGE OF ABSTRACTNSN S.,ardarcl ;Orm 293 (Rev 2-89)bVcr,- AN5 N Sto 749? -A8U,THE Relationship Between .] Intrinsic AND Extrinsic FACTORSAND CENTRAL VENOUS catheter INFECTIONSIN THE ACUTELY ILL PATIENTFor byL >C Helen Frances l ',r .. :!l dByDC_ t Hb dtIi; IDistA Thesis Submitted to the Faculty of theCOLLEGE OF NURSINGIn Partial Fulfillment of the RequirementsFor the Degree ofMASTER OF SCIENCEIn the Graduate CollegeTHE UNIVERSITY OF ARIZONA1 9 9 13 ACKNOWLEDGMENTSI would like to express my thanks to the people whohelped me complete this thesis.

4 First, my sincere thanks tomy Thesis Chairperson, Dr. Carolyn Murdaugh, for herexpertise, encouragement, patience and support during thistrying time in the life of a Graduate student. I would alsolike to acknowledge Dr. Anne Woodtli and Dr. Leanna Crosbyfor their assistance and support on my thesis committee. Aspecial thanks to Donna Dickinison for getting me involvedin the Central Line Research Committee and helping me find athesis topic. I would also like to express my thanks to themembers of the Central Line Research Committee: , Dr. Crosby, Dr. Connie Glasby, Donna Dickinison,Mary Ann Boher, Katherine Chavez, Carol Rhoades, Eve Roelkerand Lendor Marks for allowing me the opportunity toparticipate in their clinical research would also like to express my appreciation to thecadre of Air Force Nurses who have provided moral supportduring the Graduate program and thesis process -Julia,LaVonne, Paula, and Rhonda.

5 Also, a special thanks to myparents, Don and Judy Edwards, for their long-distancesupport and OF CONTENTS pageLIST OF OF of Venous of Central VenousCatheter Infections ..14 Intrinsic and Extrinsic factors .. CONCEPTUAL Infections ..22 Concept Related Bacteremia..37 Site RESEARCH of Human Subjects ..46 Data Collection Definitions ..49 catheter Related Analysis of Contents -continuedpageChapter4. RESULTS OF DATA ANALYSIS .. 53 Characteristics of the Sample .. 53 Central Venous CatheterCharacteristics .. 59 Definition of Infections .. 59 Research Questions .. 64 Summary .. 675. DISCUSSION AND IMPLICATIONS .. 68 Findings.

6 68 Findings Related to theConceptual Framework .. 69 Serendipitious Findings .. 71 Limitations and Suggestions .. 72 Implications for Nursing Practice .. 74 Implications for Nursing Research .. 76 Summary .. 76 APPENDIX A: HUMAN SUBJECTS APPROVAL .. 78 APPENDIX B: SUBJECT'S CONSENT FORM FORRESEARCH PROJECT .. 80 APPENDIX C: SUBJECT'S CONSENT FORM FORRESEARCH PROJECT -SPANISH .. 84 APPENDIX D: CENTRAL LINE DEMOGRAPHIC DATA .. 88 APPENDIX E: CENTRAL LINE INSERTION INFORMATION 90 APPENDIX F: DAILY PATIENT CHECKLIST .. 93 APPENDIX G: PERMISSION TO USE FIGURES .. 95 REFERENCES .. 996 LIST OF TABLEST able page1 Identification of concepts and conceptualand operational definitions.

7 512 Demographic Characteristics of Sample .. 543 Demographic Characteristics Relatedto Diagnoses/Procedures .. 574 Demographic Characteristics Related toInfections in Sample .. 585 Description of Central Venous Cathetersin the Sample .. 606 Description of Positive Blood Culturesin Sample .. 637 Significant Relationships BetweenExtrinsic factors : Pearson CorrelationCoefficients .. 657 LIST OF ILLUSTRATIONSF igure page1 Multiple lumen central venous catheter ..132 Conceptual framework describing relationshipbetween Intrinsic and Extrinsic factorsand nosocomial infections .. 203 Vascular anatomical structure .. 298 ABSTRACTThe purpose of this study was to describe therelationship Between Intrinsic and Extrinsic factors andcentral venous catheter infections in acutely ill factors (inherent) included sex, age, diagnoses,surgical procedures, and medical history.

8 Extrinsic factors (external) included central venous catheter variables andother invasive medical devices. Nosocomial central venouscatheter infections were categorized as catheter relatedbacteremias and site nonramdonized convenience sample consisted of 30subjects who had central venous catheters in place less than48 hours and who were able to give informed consent. Adescriptive design was used and Pearson CorrelationalCoefficients were computed to examine the relationshipsbetween Intrinsic factors , Extrinsic factors and centralvenous catheter infections. Two cases of catheter relatedbacteremia were identified. No cases of site infection weredocumented. No significant relationships Between intrinsicfactors and central venous catheter infections were Extrinsic factors showed a significant Relationship toredness, a sign of site 1 INTRODUCTIONThe purpose of this research was to describe therelationship Between Intrinsic and Extrinsic factors andcentral venous catheter infections in acutely ill one provides an overview of the problem.

9 Centralvenous catheters are described and the research questionsare stated. The chapter concludes with the proposedsignificance of the of the ProblemNosocomial infections continue to be a major concern ofthe health care industry. Nosocomial infections areinfections produced by microorganisms that the patientacquires during hospitalization (Brachman, 1987). Hospitalacquired infections may be a result of either exogenous( Extrinsic ) or endogenous ( Intrinsic ) factors . Exogenousinfections occur when organisms are transferred to the bodyfrom another source such as contaminated equipment or theenvironment. Endogenous or autogenous infections are causedby the patient's own flora (Jemison-Smith & Gallagher,1985).

10 Nosocomial infections are classified according tothe site of infection: surgical wound, urinary tract,pneumonia or respiratory tract, bacteremia or blood10(Haley & Garner, 1986), wounds other than surgical,intestinal, and burns (Thompson, 1987).Nosocomial bacteremia is defined as "a clinicallyimportant blood culture positive for a bacterium or fungusthat is obtained more than 48 hours followinghospitalization" (Hamory, 1987, p. 283). Primarybacteremias can occur without any recognizable focus ofinfection. If a source of infection is not identified and avenous catheter is in place, the venous catheter becomes thesuspected source of primary bacteremia. Secondarybacteremias show the same organism in the blood culture thatis found at another site in the body.