Incidence of Thrombus with Central Venous Catheterization (CVC)

In the United States millions of central venous catheters are inserted annually with the well-known complication of thrombus occurring between 33% and 59% of these placements. Studies show that the role of nurse practitioner in practice has proven to be safe and efficacious, yet barriers and questions of boundary continue to exist and limit advanced practice nursing. Central venous catheter access is a field which has tremendous potential for advanced practice nursing development and leadership. Using critical skills of assessment of patient access needs would lead to proper line placement in the proper site. Having a dedicated Advanced Practice Nurse-Led central venous catheter placement team would increase the skill set and competency of those placing these catheters which would decrease complications. A review of the literature shows that the role of nurse practitioner practice has proven to be safe and efficacious but barriers remain which limit practice and question boundaries of the role of nurse practitioner and limit advanced nursing practice. The roles of Advanced Practice Nurses are expanding with broader scope of practice which, in some instances, includes the performance of advanced procedures. Central venous catheter access is a field which has tremendous potential for advanced practice nursing development and leadership. This project seeks to quantify the incidence of central venous catheter (CVC) related thrombus at a metropolitan Level II Trauma Center and to lay the foundation for the formation of an Advanced Practice Nurse-Led CVC placement team which would be responsible for the placement and continued management of these central venous catheters. Implementation of this project comprised a review of medical records of all patients who received a central venous catheter in 2012 for evidence of CVC-related thrombus and quantifying the incidence of thrombus at this facility from that data. This metropolitan Level II Trauma Center has thrombus levels well below the national average. They also have a dedicated team trained in the placement of internal jugular catheter placement. This team is an RN-Interventional Radiology team which, while successful with CVC placement, does not institute any type of line follow-up or data collection. This is where Advanced Practice leadership would be able to institute monitoring guidelines and parameters to include follow-up assessments, tracking of complications and ensure timely line removal.