Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Debbie Hampton

Clinical Mentor

Pam Isaacs

Committee Member

Vicki Montgomery

Committee Member

Dr. Michelle Pendleton


Background: Central venous line (CVL) maintenance “bundles” have been developed and implemented at Norton Healthcare to decrease central line-associated bloodstream infections. While maintenance bundle audits are performed and compliance scores are reported to frontline providers and institutional leaders, the traditional audit process does not capture the factors underlying noncompliance.

Methods: A retrospective evaluation of the implementation of the Kamishibai Card process for CVL maintenance bundle compliance in the NCH PICU was performed using a pre- and post-test design. Pre-implementation and post-implementation data was compared to assess the change in compliance with the individual CVL maintenance bundle components as well as the composite compliance score. K-Card data results were categorized according to frequency of identification and results were analyzed to assess for trends.

Results: Statistically significant change was noted in one element of the CVL maintenance bundle, tubing timed and dated (P=0.05) comparing the pre-implementation to the post implementation time period. The most frequent cause for non-compliance with the CVL maintenance bundle was incomplete communication during hand-off (92) followed by device associated (47). The most frequent follow-up action was nurse educated in the moment (103) followed by issue immediately resolved (94).

Conclusions: The information gathered from this only was found to be statistically significant in the bundle element, “tubing dated and timed,” improvements occurred in all bundle elements. Overall the K-Card process had a positive impact on CLABSI in the PICU.

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