Bringing Central Line–Associated Bloodstream Infection Prevention Home: Catheter Maintenance Practices and Beliefs of Pediatric Oncology Patients and Families

Abstract

Background A study was conducted to investigate (1) the extent to which best-practice central line maintenance practices were employed in the homes of pediatric oncology patients and by whom, (2) caregiver beliefs about central line care and central line–associated blood stream infection (CLABSI) risk, (3) barriers to optimal central line care by families, and (4) educational experiences and preferences regarding central line care. Methods Researchers administered a survey to patients and families in a tertiary care pediatric oncology clinic that engaged in rigorous ambulatory and inpatient CLABSI prevention efforts. Results Of 110 invited patients and caregivers, 105 participated (95% response rate) in the survey (March–May 2012). Of the 50 respondents reporting that they or another caregiver change central line dressings, 48% changed a dressing whenever it was soiled as per protocol (many who did not change dressings per protocol also never personally changed dressings); 67% reported the oncology clinic primarily cares for their child’s central line, while 29% reported that an adult caregiver or the patient primarily cares for the central line. Eight patients performed their own line care “always” or “most of the time.” Some 13% of respondents believed that it was “slightly likely” or “not at all likely” that their child will get an infection if caregivers do not perform line care practices perfectly every time. Dressing change practices were the most difficult to comply with at home. Some 18% of respondents wished they learned more about line care, and 12% received contradictory training. Respondents cited a variety of preferences regarding line care teaching, although the majority looked to clinic nurses for modeling line care. Conclusions Interventions aimed at reducing ambulatory CLABSIs should target appropriate educational experiences for adult caregivers and patients and identify ways to improve compliance with best-practice care.

Decreasing Central Line–Associated Bloodstream Infections Acquired in the Home Setting Among Pediatric Oncology Patients

“…As the majority of these patients are discharged home with their CVC in place, it is imperative to determine evidence-based interventions to decrease their risk of CLABSI. Rinke et al (2015) associated nonadherence to the CVC maintenance bundle with acquisition of CLABSI in the home setting, suggesting that caregivers require consistent training and education regarding evidence-based bundles and specific catheter care skills. In an interrupted time-series study, in-depth caregiver training that included quarterly caregiver assessments and redemonstrations significantly reduced ambulatory CLABSI (p = .005; .…”

Manuseio do cateter central de inserção periférica (PICC) pelo enfermeiro em pediatria / Handling the central peripheral insertion catheter (PICC) by nurses in pediatrics

“…Portanto, a presente pesquisa ratifica a necessidade de análise e estudo do prontuário do paciente, uma vez que, observado problemas cardíacos, cuidados como o uso da heparina devem ser agregados à assistência com a finalidade de prevenir complicações. Rinke et al (2015) em sua pesquisa com 110 pessoas as quais eram pacientes e cuidadores observou a necessidade de orientar a pacientes e familiares para colaborar no cuidado, tendo em vista efetivamente a necessidade de prevenir complicações no uso do PICC no setor pediátrico oncológico, uma vez que, os tratamentos voltadas a neoplasia são longos tornando necessário que a assistência possa garantir a segurança do paciente. Neste contexto, o estudo observou que em 67% dos casos os enfermeiros realizavam a troca de curativos, enquanto, 29% era realizado por um adulto (familiar/acompanhante).…”

Reduced central line infection rates in children with leukemia following caregiver training

“…[21,22] Although we did not specifically assess caregivers’ compliance to the training, most families demonstrated dedication and accountability to the process (data not shown). The effect of our training on CLABSI rate further supports its efficacy.…”

“…The high degree of interest in the didactic educational sessions, and our overall rate reduction, further support that basic education of caregivers on infection risk and CL management may be helpful for all families of children with leukemia. [22] …”