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psnet.ahrq.gov/node/49565/psn-pdf
July 01, 2008 - To provide more nutrition, the physician placed
a central venous line and prescribed intravenous (IV … The LPN on the night shift
mistakenly hooked up the total nutrient fluid prepared for the central line … daughter's concern was
well founded—indeed this total nutrient fluid was to be administered through the central … disconnected the
total nutrient line from the enterostomy tube, and prepared to connect it to the central … daughter (a retired RN) and the RN in charge were present and stopped the LPN from
contaminating the central
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.98_slideshow.ppt
June 01, 2005 - Central venous pressure was 13-17 mm Hg, pulmonary capillary wedge pressure 19 mm Hg, cardiac index ( … The CI and mixed venous oxygen saturation increased to 3.8 L/min/m2 and 75%, respectively, and the SVR … Acute decompensation after removing a central line: practical approaches to increasing safety in the
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psnet.ahrq.gov/issue/systematic-review-evidence-links-between-patient-experience-and-clinical-safety-and
May 01, 2019 - Economic evaluation of quality improvement interventions for bloodstream infections related to central … March 5, 2014
Practices to prevent venous thromboembolism: a brief review.
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psnet.ahrq.gov/issue/rates-patient-safety-indicators-belgian-hospitals-were-low-generally-higher-us-hospitals-2016
September 13, 2023 - More
Related Resources
Improving appropriate use of peripherally inserted central … More About The Topic
Hospitals
Indwelling Tubes and Catheters
Nosocomial Infections
Venous
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psnet.ahrq.gov/web-mm/inadvertent-bolus-norepinephrine
December 04, 2016 - venous catheter to prevent risk of peripheral extravasation and to facilitate rapid, systemic distribution … venous catheter connected to multiple IV infusions. … In these cases, the nurse may decide to keep the IV infusion attached to the central venous catheter … to reduce the risk of central-line-associated blood stream infection (CLABSI). … venous catheter access ports, Limited availability of vascular access coupled with co-administration
-
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0206-technicalspecs.pdf
May 01, 2016 - unspecified site
(includes cavernous malformation)
228.00
Phlebitis/thrombophlebitis of intracranial
venous … Cerebral aneurysm, nonruptured 437.3
Moyamoya disease 437.5
Nonpyogenic thrombosis of intracranial venous … includes anteriovenous malformation)
Cerebrovascular anomalies 747.81
Other (aneurysm) 747.89
Other venous … or aortic 01926
Anesthesia for therapeutic interventional radiological procedures involving the
venous … /lymphatic system (not to include access to the central circulation); intracranial 01933
Ventricular
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/a1a_pdi_pdifactsheet.pdf
October 01, 2015 - PDI 10 Postoperative Sepsis Rate 14.33
PDI 11 Postoperative Wound Dehiscence Rate 1.12
PDI 12 Central … Venous Catheter-Related Blood Stream Infection Rate 0.76
PDI 13 Transfusion Reaction Count N/A*
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/a1c_combo_pdifactsheet.pdf
October 01, 2015 - PDI 10 Postoperative Sepsis Rate 14.33
PDI 11 Postoperative Wound Dehiscence Rate 1.12
PDI 12 Central … Venous Catheter-Related Blood Stream Infection Rate 0.76
PDI 13 Transfusion Reaction Count N/A
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psnet.ahrq.gov/perspective/health-care-acquired-urinary-tract-infection-problem-and-solutions
November 01, 2008 - Venous thromboembolism, ventilator-associated pneumonia, central line–related infection, and urinary … venous catheter kits. … venous catheter kit. … many patient safety problems, that type of applied epidemiological approach is appropriate: falls, venous … September 11, 2023
Strategies to prevent central line-associated bloodstream infections
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/b2b_pdi_ratesgenbywin.pdf
March 01, 2016 - 0.00606061 19.8884023
PDI 11 PDI #11 Postoperative Wound Dehiscence Rate 0 32 0 0.96714253
PDI 12 PDI #12 Central … Venous Catheter-Related Blood Stream
Infection
7 175 0.04 1.00410523
PDI 13 PDI #13 Transfusion … PDI #11 Postoperative Wound
Dehiscence Rate
0 32 0 0.001265 0 0.96714253 0 0.001665
PDI #12 Central … Venous Catheter-
Related Blood Stream Infection Rate
7 175 0 0.001144 0 0.002428 0 0.002309
PDI
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www.ahrq.gov/cpi/about/impact/index.html
April 01, 2017 - Hospital-acquired conditions have relatively high mortality risk and include central line-associated … blood stream infections, ventilator-associated pneumonia, and post-operative venous thromboembolism. … Comprehensive Unit-based Safety Program, or CUSP, at The Johns Hopkins Hospital, he nearly eliminated central … , process improvement, and teamwork, to more than 1,100 intensive care units nationwide and reduced central … AHRQ’s and other HHS investments have led to central line-associated blood stream infections declining
-
www.ahrq.gov/news/blog/ahrqviews/womens-health-week-2023.html
May 01, 2023 - rising rates of severe maternal morbidity, eclampsia/preeclampsia, severe postpartum hemorrhage, and venous … most convenient to patients, and using “pop-up clinics” rather than expecting patients to travel to central
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.127_slideshow.ppt
May 01, 2006 - Examples:
pneumothorax from central venous catheter placement
anaphylaxis to penicillin
postoperative … Thus, pneumothorax from central venous catheter placement counts as an adverse event regardless of insertion
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www.ahrq.gov/patient-safety/settings/hospital/vtguide/guide4.html
October 01, 2022 - Preventing Hospital-Associated Venous Thromboembolism
Chapter 4. … risk factors identified were known thrombophilia, hospital stay ≥6 days, inflammatory bowel disease, central … venous catheter placement, and cancer (among adults <65 years). … Age ≥85 years, hepatic failure with an INR >1.5, GFR <30mL/min/m 2 , ICU or CCU admission, central venous … A validation of a retrospective venous thromboembolism risk scoring method.
-
www.ahrq.gov/es/patient-safety/settings/hospital/vtguide/guide4.html
October 01, 2022 - Preventing Hospital-Associated Venous Thromboembolism
Chapter 4. … risk factors identified were known thrombophilia, hospital stay ≥6 days, inflammatory bowel disease, central … venous catheter placement, and cancer (among adults <65 years). … Age ≥85 years, hepatic failure with an INR >1.5, GFR <30mL/min/m 2 , ICU or CCU admission, central venous … A validation of a retrospective venous thromboembolism risk scoring method.
-
psnet.ahrq.gov/node/49483/psn-pdf
June 01, 2005 - initial numbers were—surprisingly—more consistent with cardiogenic shock than
septic shock, with a central … venous pressure of 13-17 mm Hg, pulmonary capillary wedge pressure of 19
mm Hg, cardiac index (CI) … The CI and mixed venous oxygen saturation
increased to 3.8 L/min/m2 and 75%, respectively, and the SVR … While many ICUs have developed processes and protocols related to high-risk procedures such as
central … Acute decompensation after removing a central line: practical
approaches to increasing safety in the
-
www.ahrq.gov/sites/default/files/publications/files/simulation-brief.pdf
February 01, 2015 - venous access line. … Likewise,
procedural skills that are found in surgery or in placing a central line require
a unique … venous catheter insertion skills.16 Mastery learning represents a different
way of thinking about … Representative of the diversity were awards that focused on
central venous catheter insertion, diagnosis … Long-term retention of central
venous catheter insertion skills after simulation-based mastery learning
-
www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/impact/ahrq-works.pdf
April 01, 2017 - Hospital-acquired
conditions have relatively high
mortality risk and include
central line-associated … blood
stream infections,
ventilator-associated
pneumonia, and post-
operative venous thromboembolism … Preventing central line-
associated blood stream infections, the top-ranked
mortality risk among all … process improvement, and teamwork,
to more than 1,100 intensive care units nationwide and
reduced central … AHRQ’s and other HHS investments
have led to central line-associated blood stream infections
declining
-
psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.140_slideshow.ppt
December 01, 2006 - baseline
Timing: within 5-10 days of heparin exposure
Thrombosis: up to half of patients will develop venous … thrombosis—risk of thrombosis persists for at least 30 days, with up to 50% of patients developing venous … NS for patency of peripheral or central catheters
Heparin still used routinely for flushing dialysis … Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of … of heparin
Clinical presentation of HIT can include isolated thrombocytopenia, isolated arterial or venous
-
psnet.ahrq.gov/web-mm/around-block
March 04, 2020 - therapy is increasingly utilized in the inpatient setting to reduce the incidence of hospital-acquired venous … neuraxial methods result in fewer postoperative cardiac events, pulmonary complications, and cases of venous … Take-Home Points Pharmacologic prophylaxis for venous thromboembolism and neuraxial anesthesia are … Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic … Cases
Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central