Can someone revise or rewrite my paper?

To prepare:

Review the information in Figure 6–2 in Nursing Informatics and the Foundation of Knowledge.
Develop a clinical question related to your area of practice that you would like to explore.
Consider what you currently know about this topic. What additional information would you need to answer the question?
Using the continuum of data, information, knowledge, and wisdom, determine how you would go about researching your question.
Explore the available databases in the Walden Library. Identify which of these databases you would use to find the information or data you need.
Once you have identified useful databases, how would you go about finding the most relevant articles and information?
Consider how you would extract the relevant information from the articles.
How would you take the information and organize it in a way that was useful? How could you take the step from simply having useful knowledge to gaining wisdom?

By Day 7 of Week 4

Write a 3- to 4-page paper that addresses the following:

Summarize the question you developed, and then relate how you would work through the four steps of the data, information, knowledge, wisdom continuum. Be specific.
Identify the databases and search words you would use.
Relate how you would take the information gleaned and turn it into useable knowledge.
Can informatics be used to gain wisdom? Describe how you would progress from simply having useful knowledge to the wisdom to make decisions about the information you have found during your database search.

Your paper must also include a title page, an introduction, a summary, and a reference page.

Central Venous Catheter Usage

Synethia Harris

Walden University

NURS 5051A

Dr. Debbie Beck

December 25, 2017

Informatics has been identified as one of the core competencies for nurses at all levels of practice. Nurses and computer documentation of patients with chronic kidney disease can significantly improve the quality of patient care and treatment. Healthy kidneys regulate the body’s levels of water and mineral and removes waste. I would find the most relevant information through searching the database on issues topicing or having a relationship with dialysis access. I would use search for words such as “dialysis access”, “problems with central venous catheters”, and “femoral venous access”. I would also trace illustrations in books and journals that touch on central venous catheters highlighting femoral access. The kidneys also secrete certain products that are important in metabolism. People with failed or damaged kidneys may have difficulty eliminating waste and unwanted water from the blood. (Fresenius, 2006). The cause might be a chronic, or long-term condition, or an acute problem, such as an injury or a short-term illness that affects the kidneys. Dialysis is an artificial way of carrying out this process. Dialysis substitutes the natural work of the kidneys. It is also known as renal replacement therapy (RRT).

Hemodialysis requires access to blood vessels capable of providing rapid extracorporeal blood flow. Immediate hemodialysis access should be straightforward, available for immediate use, and have minimal complications. That is where tunneled central venous catheters (CVCs) come in to play. I am aware of central venous catheters being used as a quicker method of access. During my research, said that femoral sites are associated with high risks of catheter-related bloodstream infections (CRBIs). During hemodialysis, the access site is the patient’s lifeline (Fresenius, 2006). So why is the femoral vein a considered site for surgeons?

The use of invasive monitoring technologies and aggressive hemodynamic resuscitation protocols has increased. Therefore, the ability to gain rapid and accurate vascular access has become a skill that is imperative for critical and emergency care physicians to possess. The predictable anatomic locations of the dialysis central venous catheter are the internal jugular, subclavian, and femoral vein. In the last ten years, tunneled central venous catheters (CVCs) have been increasingly utilized in chronic hemodialysis patients, sometimes in the place of fistulas. They have gained popularity for their unquestioned advantages, such as the possibility for immediate use. However, several problems have emerged following their diffusion. Infections, thrombosis and dysfunctions are the most important catheter-related complications. Infections may occur with and without symptoms of systemic illness. Early diagnosis and appropriate antibiotic treatment are essential for saving the catheter. The pathogenesis of infections and strategies for prevention are many. Thrombosis and stenosis are well known complications of subclavian and jugular catheterization. In uremic patients, for temporary use, the use of the femoral vein is a suggested location site. Protocols for application of thrombolytic agents in CVCs are considered. Dysfunction, defined as the failure to maintain a blood flow of at least two hundred and fifty milliters per minute, remains the Achilles’ heel of the system. Adequate look therapy and tip position are only two basic aspects.

All routes of central venous access are associated with complications and possible failure. The less than ideal conditions under which such access is established also contribute to the incidence of complications. The technique of accurately placing a femoral vein catheter depends on appropriate patient selection and a sound knowledge of anatomy. A couple of the generally accepted indications for femoral venous catheter placement are urgent or emergency hemodialysis access and hemoperfusion access in patients with severe drug overdose.

In 2012, a task force of the American Society of Anesthesiologists published a set of practice guidelines for central venous access. Absolute contraindications for femoral central line placement for patients with venous injury at the level of the femoral veins or proximally, suspected thrombosis of the femoral veins on the proposed side of venous cannulation, and ambulatory patients, because ambulation increases the risk of catheter fracture and migration.

Other contraindications for femoral central venous access are the presence of bleeding disorders,

distortion of anatomy due to deformity, previous long-term venous catherization, absence of a

clearly palpable femoral artery, history of vasculitis, and history of radiation therapy

In conclusion, informatics can be used to gain wisdom. A pessimistic outlook on the matter could lead us to consider that the advantages of catheter use are far outweighed by the disadvantages. However, we cannot avoid using central venous catheters in our dialysis units and a great challenge awaits both physicians and manufactures in the coming years.

References

American Nurses Association. Nursing Informatics: Scope and Standards of Practice. Silver Spring, MD: nursesbooks.org; 2008.

Cheesbrough, J, Finch, R, Burden, R. (1968). A prospective study of the mechanisms of infection associated with hemodialysis catheters. Infectious Disease:154-156

Fresenius Medical Care. (2006). Retrieved from: FMC4me.com

Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical approaches to the nursing informatics data-information- knowledge-wisdom framework. Advances in Nursing Science, 34(1), 6-18.

McGonigle, D., & Mastrian, K. (2011). Nursing informatics and the foundation of knowledge Jones & Bartlett Learning.

National Kidney Foundation. KDOQI Clinical Practice Guidelines for Hemodialysis Adequacy, 2000. Am J Kidney Dis 2001; 37 (suppl 1):S7-S64.

O’Grady, N, Alexander M, Burns, L. (2011). Guideline for the prevention of intravascular catheter-related infections .162-193.

Ponikyar, R. (2005). Temporary hemodialysis catheters as a long-term vascular access in chronic hemodialysis patients