The long-term use of subcutaneous implanted ports for chemotherapy in cancer patients has been associated with the occurrence of thrombosis and infection. In this study, we compared the safety and efficacy of administration of 1000 U of heparin flushes in prolonged interval (every 6 weeks) with standard dose and schedule (500 U every 4 weeks) for port-related infections and thrombosis during periods of non-use. Data were collected retrospectively from patients treated for various cancer types (matched as 2:1 for age, gender, stage of the disease). Patients who had diseases that could cause thrombosis or bleeding in their past medical history, or were taking oral anticoagulants, or had contraindications for heparin usage were excluded. After completing their chemotherapy, 59 patients received prolonged interval, while 30 patients received standard schedule. All patients were followed for at least 1 year. No clinically documented port-related infection or thrombosis has been found in both groups. Also, none of the devices was removed during this time. Prophylactic flushing of central venous ports with 1000 U of heparin in every 6 weeks might be a safe, easy, cheaper, comfortable and effective alternative to standard dose and schedule for preventing thrombosis and infections.

ICU nurses should be aware of the importance of spiritual care and develop tools for assessing the spiritual needs of patients.

It is recommended that training is provided that includes recognition, assessment and application of appropriate interventions to minimise the incidence of delirium.

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BackgroundWe conducted a survey to find out how patients feel about the care they receive in the outpatient chemotherapy unit of Marmara University Hospital.MethodsThe American College of Physicians Patient Satisfaction survey translated into Turkish was used. A meeting was held with all involved staff, before conducting the survey, to review the purpose and determine the process. The study was conducted with 100 random patients.ResultsConsistent with cancer frequency, most patients had either lung, colorectal or breast cancer. Their insurance was government sponsored in close to 90%. The educational levels were above Turkish median but consistent with the area the hospital is serving. They were coming to the unit on average 8.5 months. The responses were not influenced by the surveyed diagnosis, age, sex or educational status (p > 0,05). Particularly health care team's attention, trust and courtesy came forward as strong points. The weaknesses noted as difficulties in booking an outpatient doctor visit appointment because the phone line was busy or the secretary was not courteous, the excessive amount of time and effort it required to get laboratory and radiology results.ConclusionThe health care system is basically a service based industry and customer satisfaction is at utmost importance just as in other service-oriented sectors. We hope this study will shed light in that area and Turkish health care providers will pay closer attention to how their patients feel about the services that they are getting.

Protracted chemotherapy regimens are new treatment modalities used to treat patients with cancer. These treatments are preferred because of the ease of administration and limited side effects in the outpatient setting. Sixty patients were treated with continuous infusion chemotherapy via implanted infusion ports at Marmara University Hospital Outpatient Chemotherapy Unit in Istanbul, Turkey, from January 2000 to December 2001. Although usage of Huber needles for central venous catheters was limited to between 48 and 72 hours, needles were not removed unless there were signs of inflammatory reaction. The needles remained in place for 28 days (1-49 days) on average. No catheter infections, signs of local irritation, or thrombus formation were observed despite prolonged stay of the Huber needles. Huber needles can be left in place up to several weeks without any untoward effects as long as proper aseptic technique is used.

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Mesane kanseri, yaygın olarak görülen ürogenital bir malignitedir. Tüm mesane kanserlerinin yaklaşık %80'ini, kasa invaziv olmayan mesane kanserleri oluşturmaktadır. Kasa invaziv olmayan mesane kanserinin tedavi yöntemlerinden birisi de intravezikal immünoterapidir. İntravezikal immünoterapi amacıyla Bacille Calmette- Guerin (BCG) kullanılmaktadır ve bu yöntem oldukça etkilidir. BCG, Mycobacterium bovis'in canlı, zayıflatılmış bir formudur. Gerekli koruyucu önlemler alınmadığında, hastalar ve sağlık çalışanları ilacın zararlı etkilerine maruz kalabilmektedirler. İntravezikal BCG uygulaması, hastalarda lokal ve sistemik yan etkiler oluşturabilmektedir. Bu nedenle, hastaların tedavileri ertelenebilmekte veya tamamen kesilebilmektedir. Ayrıca yan etkiler, hastaların yaşam kaliteleri olumsuz etkilemektedir. Tedavinin başarıya ulaşmasında ve yan etkilerinin kontrol altına alınmasında intravezikal BCG uygulama ilkelerine uyulması ve gerekli koruyucu önlemlerin alınması önemlidir. Bu derleme ile, intravezikal BCG uygulama ilkeleri, hastalarda gelişebilecek olası yan etkiler ve bunların önlenmesi, semptom kontrolünün sağlanması, BCG uygulamasının kontrendike olduğu durumlar, BCG uygulama öncesi, sırası ve sonrasında alınması gereken güvenlik önlemleri ve BCG uygulayan hemşirenin sorumlulukları konusunda bilgi vermek amaçlanmaktadır.