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Nurse Accountability of Using Maximum Sterile Barriers While Placing Central Venous Lines and Arterial Lines

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As a professional nurse, I am accountable for maintaining a safe environment for my patients. A healthcare team consists of multiple players including doctors, nurses, nurse aids, respiratory therapists, physical and occupational therapists, dieticians, etc. It is my duty to ensure that all components of the healthcare team preserve the patient’s best interest, and if they do not, intervene to the limit of my scope of practice, and utilize my chain of command. In accordance with my duty to maintain a safe environment, the use of maximum sterile barriers while placing central venous lines (CVL) and arterial lines to prevent infections will be exercised.
Approximately 3 months ago, I was involved in a patient care situation that exemplified the need for accountability from professional nurses. A four year old boy came in with a ventriculoperitoneal (VP) shunt malfunction. He presented to the children’s emergency room with decreased level of consciousness, nausea, vomiting, and headache for two days. He rapidly worsened; by the time he was admitted to my unit, he was intubated, hypothermic, and hypotensive. He needed a VP shunt revision, but would have a lower chance of survival if he was not first stabilized. He came over with one peripheral IV, but it was not sufficient for the multiple boluses and vasopressors that were needed to sustain his rapidly dropping blood pressure. We needed more lines, immediately. The intensivist ordered insertion of a femoral CVL for fluids and medications and an arterial line for continuous monitoring of his blood pressure and blood draws. According to hospital policy, under patient care procedure 15.09.04, insertion of a CVL requires use of sterile technique. Statistically, femoral-placed lines come with the highest risk of infection (Henry, Jimenez, Lorente, Martin, & Mora, 2005). As the team began preparing the

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