Registed Nurses' Association of Ontario

Nursing Leadership and Innovation: Developing a Guideline on the Use of Continuous Low-Dose Heparin Infusions for Central Venous Access Device Patency

Jacqueline Valencia
The Hospital for Sick Children (Sickkids)

Central venous access devices (CVADs) are a favourable option for neonatal and pediatric patients undergoing prolonged intravenous therapy (Doellman, 2011). Nonetheless, one of the biggest challenges related to CVAD maintenance is ensuring patency. Utilization of continuous low-dose heparin infusions is one method that is widely used to prevent occlusions, especially in patients who are fluid restricted and/or receiving continuous infusions of life-saving medications.

Despite the anticipated benefits of continuous low-dose heparin infusions, there have been inconsistencies within and amongst pediatric hospitals worldwide as to what concentration and rate of heparin should be utilized. Through the RNAO Advanced Clinical Practice Fellowship, I was granted the time and resources to lead in developing a departmental guideline that would standardize the use of continuous low-dose heparin infusions on the Cardiology Inpatient Unit at my organization. This kind of guideline would provide clear recommendations for staff while enhancing patient care. By the end of the fellowship, my overall goal was to further develop my leadership skills, and increase my understanding of the qualities required to translate knowledge and implement change in the clinical practice environment.

Before drafting the guideline, I conducted comprehensive literature review to better understand the efficacy of continuous heparin infusions, as well as the benefits and risks involved in their use among pediatric patients. In addition, I developed a benchmarking summary to compare central venous access device maintenance practices among similar pediatric institutions around the world. As well, with my organization’s Quality Management approval, I collected and analyzed data on central venous access device blockages and incidences of Alteplase use on the Cardiology Inpatient Unit based on current practice, to evaluate which what rates of heparin infusions have been most effective in preventing occlusions. Achieving these outcomes laid the groundwork for the guideline’s development, and more importantly, increased my understanding of how current evidence is incorporated to create recommendations and promote best practice.

Integrating stakeholder input was key during the creation of the departmental guideline, to ensure the guideline included sound recommendations and aligned with the organization’s strategic direction. The fellowship provided an opportunity for me to collaborate with multiple interdisciplinary team members throughout the hospital, such as the Staff Cardiologist, Pharmacist, Vascular Access Educator, and Thrombosis team. I was able to build confidence in communicating with colleagues I had never worked with, facilitating meetings to discuss progress in the guideline development, and presenting my fellowship work to various groups and in numerous forums within my organization.

With the help of a thorough literature search on nursing leadership and implementing change effectively in the practice setting, I was able to learn about potential facilitators and barriers to knowledge uptake, and create a multi-faceted implementation plan for the new departmental guideline. Attending the RNAO Best Practice Champion Workshop Level 1 and 2 equipped me with strategies to promote sustainability and carefully evaluate the change. Similarly, attending leadership seminars within my organization allowed me to gain a deeper understanding of my own leadership style and the strengths I possess to spearhead change within my practice setting.

This RNAO fellowship has been such an amazing experience and learning opportunity. I have been able to network with colleagues both inside and outside Sickkids, and learn about the various aspects of guideline development and implementation. More importantly, the fellowship enhanced my confidence and allowed me to develop as a nurse leader in my organization who is able to influence change and patient safety. I would definitely recommend the ACPF fellowship to nursing colleagues who are looking to develop as leaders and change agents in their workplace. Lastly, I would like to thank my mentor team for their endless support over the past few months, and the RNAO for helping me develop such valuable, lifelong skills.