Improving Central Venous Catheter Maintenance in the Home Setting

The use of central venous catheters (CVCs) is pivotal for the delivery of life-saving and life-sustaining medications to patients requiring high-flow therapies or vesicant drugs. As with any vascular access device, the same pathway that is used to deliver these therapies can also introduce pathogens into the bloodstream causing life-threatening infections.

While multiple standards and intervention bundles have been championed to reduce the incidence of these central line associated bloodstream infections (CLABSIs) in inpatient settings, little attention has been paid to the use of CVCs in home-based therapies. The resulting reality is that the 525,000 patients receiving outpatient parenteral antibiotic (OPAT) or home parenteral nutrition (HPN) therapies must perform central line maintenance, a task normally performed by trained medical professionals, by themselves with minimal training and education.

OPAT and HPN patients specifically are at risk for CLABSIs as they tend to have a longer indwelling time for their lines ranging from 20-300 days at a time. Our team is developing solutions to increase compliance with central line maintenance in the home setting by addressing the three major challenges faced by stakeholders: (1) Limited training received by patients prior to expectation to perform maintenance tasks normally done by a professional nurse, (2) inconsistent surveillance of patient central line maintenance compliance to identify and intervene with non-compliant patients before adverse events occur, and (3) Complex and non-standardized maintenance procedures that make it difficult for patients and caregivers to perform consistent and proper maintenance procedures. The team is developing solutions that are addressing these pertinent issues that home infusion patients face, with the goal of keeping discharged patients out of the hospital. There is an increasing push for infusion care to move toward the home setting, and we are designing our solution to improve patient outcomes in a rapidly growing space.