Beyond protocols: what are nurses’ lived experiences and perceived systemic barriers in central venous catheter management in a resource-limited tertiary hospital in Ghana? A qualitative study

Abstract

Objective: To explore nurses’ experiences of central venous catheter (CVC) management in a resource-limited tertiary hospital. Design: A qualitative exploratory-descriptive study using in-depth, semistructured interviews. Setting: A low-resource tertiary care facility in Ghana, West Africa. Participants: 13 registered nurses working in intensive and critical care units. Methods: Individual semistructured interviews were conducted and analysed using reflexive thematic analysis. Results: Four (4) main themes and 14 related subthemes were identified. The main themes included (1) system constraints shaping CVC care (supplies, infrastructure and workload); (2) practice and protocol feasibility (infection prevention and workarounds); (3) capability building and support (knowledge/skills, practical training, supervision and mentoring and nurses’ voice) and (4) psychosocial impact (burnout, fear of complications and limited emotional support). Nurses described confidence in routine tasks but reported limited support for managing complications and sustaining protocol adherence. Conclusions: In resource-limited settings, effective CVC management extends beyond individual clinical competence and requires robust institutional support, adequate staffing, ongoing professional development and responsive organisational systems. Addressing these structural and psychosocial factors is essential to improving nursing practice, enhancing patient safety and supporting global infection prevention priorities.