Literature Evaluation table

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Central venous catheters (CVC) remain as a prevailing modality of vascular access in the medicine. Central lines are used extensively for drug administration, rapid fluid resuscitation, parenteral nutrition and the administration of dialysis. Often, the use of central line is very important to the enhancement of the health quality in critically ill patients.
In spite of the fact that the application of CVC is very important, this pervasive procedure has a number of related complications, which result in increased healthcare cost, morbidity and even mortality. The essence of the clinical problem lies in different forms of complications that can occur during the central catheter placement. These complications encompass bleeding, venous or arterial injury, hematoma, staphylococcus etc. (Kombrau, Lee, & Firstenberg, 2015). During the dialysis, CVC vascular erosion may also happen. In the course of the provision of nursing care, the incorporation of mechanisms, measures and diagnosis that inhibit and reduce the number of complications is very significant. Recognition and management of such complex situations are of utmost importance as they can rapidly become hazardous (Balasubramanian, S.Gupta, & P.Laboi, 2014).
The clinical setting in which the problems arise is very complex. Nurses use dialysis catheters in urgent emergencies, such as acute kidney injury, fluid overload, severe sepsis, blood filtration and septic shock. The emergence of the CVC related complications further perplexes the process of treatment and creates impediments for health improvement. The condition of patients is aggravated, morbidity and mortality rates are increased as well as workload and received stress in the working environment. Consequently, these factors significantly affect the quality of work (Patel, Patel, Singh, & Khawaja, 2019).
There are various ways to avoid complications during central line placement. One solution can be the avoidance of CVC placements, if possible. On the other hand, ultrasound-guided PIV placement can be used as an alternative for CVC. More specifically, the application of ultrasound-guided cannulation during the dialysis to avoid the risks of CVC complications during renal problems is a helpful evidence-based solution for the discussed problem. Guidance of the CVC placement with ultrasound and the application of landmark method prevents the occurrence of complications that may bring hazardous consequences (Kamata & Iehara, 2016).
Second way that reduces the cases of CVC related problems is the utilization of CVC insertion checklist. Localized and proper implementation of the afore-mentioned checklist protocol is highly recommended by the UK’s NHS and World Health Organization. Maximization of the sterile barriers, usage of the hand hygiene and the selection of the optimal insertion site also minimizes the chance of complications. Furthermore, in the clinical setting, nurses should remove unnecessary central lines immediately. Adherence to aseptic techniques also reduces problems – performance of skin antisepsis, cleansing of the port and replacement of compromised and soiled dressings (Haddad, Cleef, & Agarwal, 2012).
PICOT statement can be formalized in a following fashion: In patients with renal problems, who necessitate dialysis (P), will the application (intervention) of ultrasound-guided cannulation (CVC placement with ultrasound) and the proper utilization of CVC insertion checklist (I) compared to the common application of CVC (C) reduce or eliminate the complications arose from the use of central catheters (O) in period of 6 weeks (T). Question regarding the issue of therapy is raised to investigate the effect of ultrasound-guided cannulation on patients compared to ordinary application of CVC.
Dialysis therapy could not be accomplished without the cannulation of vascular entrée. Therefore, the creation of useful and productive vascular access is imperative. Statement related to the diagnosis of the accuracy of chosen intervention (Ultrasound-guided approaches) compared to the common intervention must also be examined. Increase in the recent report for ultrasound-guided techniques and the received profitable outcomes may be a proof of the accuracy of chosen intervention (Kamata & Iehara, 2016)
One of the best and the most acknowledged method of vascular access in order to perform dialysis is autologous arteriovenous fistulae (AVF). The application of AVF requires precise two-needle cannulation to assist the progress of dialysis. A huge volume of evidence and facts mentioned in a scientific literature supports the usage of ultrasound (US) guidance during dialysis and confirms the decrease in complications in central venous access (Eves, Leung, & Chetter, 2019).
The issue regarding the prediction of prognosis can also be reviewed in a literature. Superior patient outcomes are guaranteed in case of successful cannulation of the arteriovenous access for patients with the last stage kidney failure and with catheter-free dialysis. The real application of such methods can be performed under ultrasound-guided cannulation. This method targets to improve the rate of first time successful cannulations and critically reduce the complications during CAC, whether it will be staphylococcus, blood infiltration or the formation of hematoma. The potential of the ultrasound-guided cannulation lies not only in the advancement of patient experience but also in the decrease of morbidity that is linked with complications and potential healthcare losses. Complication-free and precise initiation of dialysis is very significant for the self-cannulation and longevity of technique safety in hemodialysis patients that receive treatment in home (Ward & McQuillan, 2017).

 
References
Balasubramanian, S., S.Gupta, & P.Laboi, M. &. (2014). Rare Complication of Dialysis Catheter Insertion. Clinical Kidney Journal, 194-196.
Eves, J., Leung, C., & Chetter, G. S. (2019). Ultrasound Guided Cannulation of Difficult Fistulae for Dialysis – A RCT. European Journal of Vascular & Endovascular Surgery, 94-95.
Haddad, V., Cleef, S., & Agarwal, A. (2012). Central Venous Catheters in Dialysis: The Good, The Bad and the Ugly. The Open Urology & Nephrology Journal, 12-18.
Kamata, T., & Iehara, M. T. (2016). Ultrasound-Guided Cannulation of Hemodialysis Access. Renal Replacement Therapy.
Kombrau, C., Lee, K., & Firstenberg, G. H. (2015). Central Line Complications. International Journal of Critical Illness & Injury Science, 170-178.
Patel, A., Patel, A., Singh, S., & Khawaja, S. S. (2019). Central Line Catheters and Associated Complications: A Review. Cureus.
Ward, F., & McQuillan, R. F. (2017). Ultrasound-Guided Cannulation of the Hemodialysis Arteriovenous Access. Seminars in Dialysis, 319-325.