الفهرس 
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Abstract
Summary
The central venous catheter is a hollow tube that is
placed in the large venous vessels for administration of the
medications and fluids into the right atrium and measuring
CVP. However, it is a life threatened procedure; it is widely
used in critically ill patients. Dwell time of CVC is the time
from catheter insertion to occurring of complications or
removal (Gavin et al., 2016).
The dwell time or the life utility time of CVC is
ample, limited by the presence of complications like
factors. These factors may be related to the patient,
physician, nurse and environment. Generally, the CVC will
stay in as long as it is needed if not blocked or removed due
to infection and other complications. Once the
complications occur, it will be removed or changed
(Greenberg et al., 2015).
Changing CVC is expensive and has a potential
morbidity and mortality rate in critically ill patients. So, the
most important function of health care providers to long the
CVC’s dwell time as much as possible through preventing
complications which causing the removal of the catheter.
Therefore, it is important to identify the factors that cause
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142
these complications and affect CVC’s dwell time
(Daubenspeck & Kacha, 2019).
Aim of the study:
The aim of the study was to assess the factors
affecting central venous catheter’s dwell time in critically
ill patients with suggested guideline as following:
1. Assessing patient-related factors.
2. Assessing nurse-related factors.
3. Assessing physician-related factors.
4. Assessing environmental-related factors.
5. Developing guideline based on needs assessment for
increasing central venous catheter’s dwell time.
Research question:
The current study answered the following question:
What are the factors affecting central venous catheter’s
dwell time?
Subjects and Methods:
Research Design
The study was conducted through using a descriptive
exploratory design.
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Setting:
This study was conducted at Combined Medical
Intensive Care Unit of Ain Shams University Hospital
affiliated to Ain Shams University.
Subjects: -
The present study consisted of three groups of subjects.
A. A convenient sample of all available nurses working
in the previous mentioned setting (32 nurses).
B. A convenient sample of all available physicians
working in the previous mentioned setting (22
physicians).
C. A convenient sample of 84 patients connected with
CVC in the previous mentioned setting.
Tools of data collection
Data was collected using the following tools:
Human-related factors assessment tools
I. Patient-related factors assessment questionnaire.
II. Nurse-related factors assessment tools.
III. Physician-related factors assessment tools.
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Non-human related factors assessment tool
I. Environmental-related factors assessment tool.
Human-related factors assessment tools
I. Patient-related factors assessment questionnaire
(Appendix I)
It was designed by the researcher to assess patientrelated factors that could affected CVC’s dwell time after
reviewing the related literatures. It included two parts as the
following:
Part 1: It was written in Arabic language and
concerned with the assessment of the demographic
characteristics of patients under the study such as patient’s
age, gender, marital status and educational level.
Part 2: It was written in English language and
concerned with assessment of patients’ clinical data such as
present medical diagnosis, past medical history, recent
surgery less than one month, body mass index and
laboratory investigations.
II. Nurse-related factors assessment tools (Appendix II)
1) Self- administered nurses’ knowledge assessment
questionnaire regarding central venous catheter
care.
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This tool was developed by the researcher in Arabic
language after reviewing the recent related literatures. It
included two parts to assess nurses-related factors that
could affect CVC’s dwell time as the following:
A) Nurses’ demographic characteristics:
It included the demographic characteristics of nurses
such as nurse’s age, gender, qualifications, years of
experience and number of attended training courses about
CVC related protocols and guidelines.
B) Nurses’ knowledge regarding CVC:
It concerned with the assessment of nurses’
knowledge regarding CVC care. It was divided into six
parts as the following:
Part 1: Knowledge regarding CVC.
Part 2: Knowledge regarding insertion procedure and
infection control measures.
Part 3: Knowledge regarding CVP measurement.
Part 4: Knowledge regarding CVC dressing.
Part 5: Knowledge regarding administration of the
medications and fluids.
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Part 6: Knowledge regarding factors affecting dwell
time of CVC.
2) Central venous catheter nursing care observational
checklists.
These checklists were designed by the researcher and
written in English language after reviewing the related
literatures. It used to assess nurses’ practice regarding care
of CVC. It contained 4 parts as the following:
Part 1: Observation of the nurses’ practice before,
during and after insertion of CVC
Part 2: Observation of the nurses’ practice regarding
measurement of CVP.
Part 3: Observation of the nurses’ practice regarding
dressing of CVC.
Part 4: Observation of the nurses’ practice during
administration of the medications and fluids via
CVC.
III. Physician-related factors assessment tool
(Appendix III)
It was designed by the researcher and written in
English language after reviewing the related literatures.
This tool was consisted of three parts as follows:
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Part 1: Included the demographic characteristics of the
physician included in the study.
Part 2: Central venous catheter insertion observational
checklist for physician that concerned with
assessing physician’s practice regarding
insertion of CVC.
This tool contained steps related guide-wire exchange,
duration of the procedure, numbers of puncture and number
of needle passes.
Part 3: Data related catheter assessment. It was
concerned with assessing clinical data regarding
CVC; its dwell time and cause of removal, site
of insertion and side of insertion. Also, blood
culture, medications given in case of CVC
infection and its effect and type of CVC
dressing.
Non-human related factors assessment tool
I. Environmental-related factors assessment tool
(Appendix IV)
This tool was designed by the researcher after
reviewing the related literatures. It was written in English
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language. It was carried out once to assess the
environmental factors that affect CVC’s dwell time such as:
Human resources and structure.
Antibiotic policy
Training program
Infection control system
Sterilization and care of equipment and instruments
Documentation system.
Results
- The results revealed that, 35.7% of the studied patients
were from 35>50years old, 54.8% of them were male,
64.3% of them were married and 38.1% of them had a
secondary education.
- 21.4% of the studied patients had neurological
disorders, 25% of them had history of kidney disorders,
40.5% were overweight and 11.9% had A-V fistula as a
recent surgery.
- 59.5% of the studied patients had abnormal level of CReactive Protein, 78.6% of them normal virology
profile.
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- Also, the results showed, 59.4% of the nurses had age
ranged from 25 to less than 35years old, and 62.5% of
them were females, 53.1% studied at nursing institute,
56.2% of the nurses had 5>10 years of experience and
62.5% of them hadn’t got previous training courses
regarding CVC care.
- 71.9% of the nurses under study ad unsatisfactory level
of total knowledge regarding central venous catheter
care and 56.3% had satisfactory level of practice
regarding care of CVC
- It was revealed that, 59% of the studied physicians had
age 25>30 years old, 54.5% of them were male. While
59.1% of them had bachelor in medicine. 45.4% of that
physicians had less than 5 years of experience and
majority of them 90.9% had previous training courses
regarding CVC care.
- 77.3% of physicians had satisfactory level of practice
regarding insertion of CVC.
- It was revealed tat, 34.5% of CVCs had dwell time
from 4>5 weeks, and 95.2 % of them were inserted in
ICU, 92.9 % of them planned for removal. 51.2 % were
removed related to occlusion of CVC, 76.2% inserted in
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jugular veins and 78.6 % of them connected to the
dominant side of patient.
- Also, the resuts showed that, only 63% of
environmental-related factors that require for CVC
insertion and care are present.
- There were statistically significant relations between
CVC’s dwell time and the studied patients’ education,
present and past diagnosis, BMI, recent surgery and
most of laboratory investigation.
- There were statistically significant relations between
CVC’s dwell time and the studied nurses’ education,
years of experience, training courses, level of total of
knowledge and practice.
- There were statistically significant relations between
CVC’s dwell time and the studied physicians’ education,
experience and practice.
- There were positive statistically significant correlations
between the CVC’s dwell time and patients’ level of
education, nurses’ experience, level of total knowledge
and practice and physicians’ experience and level of
total practice.
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Conclusion
The results of this study concluded that:
The factors that affecting CVC’s dwell time are;
patient-related factors including patients’ level of
education, present medical diagnosis, past medical history,
BMI, recent surgery and laboratory investigations. Also,
the factors including nurse-related factors as nurses’ level of
educational, years of experience, attendance of training
courses, their level of total knowledge and practice. As well
also there are physician-related factors involving physicians’
level of education, experience and total level of practice.
So, based on the previous factors the suggested
guideline was developed (Appendix IX).
Recommendations
Based on the results of the present study the following
recommendations are suggested:
Recommendation related to patients
Establish simplified and illustrated educational
booklet for the conscious patients connected with
CVC about basic information of CVC.
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Recommendations related to nurses
Establish periodical in-services program to improve
nurses’ knowledge regarding care of CVC.
Develop procedure book for nurses regarding CVC
related procedure in ICU as a guidance for all nurses.
Recommendation related to physicians
All physicians should attend training courses
regarding CVC insertion prior to work in ICU. As in
the study setting, majority of the physicians had
attended training courses regarding CVC insertion.
Recommendation related to environment
Developing CVC car that contain all necessary
supplies for CVC insertion and procedures.
Developing policy for the frequency of dressing
change and frequency of skin cleansing ranged from
48 hours for adhesive tapes and 7 days for
transparent dressing.
Recommendation related to research
Future researches are recommended to examine
factors affecting CVC’s dwell time before and after
using transparent dressing and chlorohexidine.
The study should be replicated on larger probability
samples in order to generalize the results.