Standardizing Central Venous Catheter Care by Using Observations From Patients With Cancer

Abstract

To understand the vulnerability of patients with cancer to central line-associated bloodstream infections related to tunneled central venous catheters (CVCs), patients were asked to describe their line care at home and in clinic and to characterize their knowledge and experience managing CVCs. Forty-five adult patients with cancer were recruited to participate. Patients were interviewed about the type of line, duration of use, and observations of variations in line care. They also were asked about differences between line care at home and in the clinic, precautions taken when bathing, and their education regarding line care. Demographic information and primary cancer diagnosis were taken from the patients' medical records. Patients with hematologic and gastrointestinal malignancies were heavily represented. The majority had tunneled catheters with subcutaneous implanted ports. Participants identified variations in practice among nurses who cared for them. Although many participants expressed confidence in their knowledge of line care, some were uncertain about what to do if the dressing became loose or wet, or how to recognize an infection. Patients seemed to be astute observers of their own care and offered insights into practice variation. Their observations show that CVC care practices should be standardized, and educational interventions should be created to address patients' knowledge deficits.

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

“…4,7,8,15,16 Similar to the findings of the current study, a survey of adult patient central line care also demonstrated practice variation and patient uncertainty over appropriate central line maintenance care techniques. 11 As 34% of respondents in the current survey reported that they touch or access their child’s central line, and 8% reported that another adult in the household touches or accesses their child’s central line, this study suggests the need for effective educational interventions and auditing of home caregiver central line practices. Our institutional experience suggests auditing and observations of family line care is feasible, can be positively received by families, and can be associated with reduced CLABSIs, 4 although it clearly needs to be augmented to achieve consistent central line care.…”

“…10 A different group of adult oncology patients identified appreciable differences in clinic nurse central line care practices, and these patients reported variations in central line maintenance practices in their home setting. 11 It is unclear if results for adults can be translated to the unique setting presented by pediatric oncology patients, where an adult caregiver and the patient together often provide central line care, and multiple stressors contribute to quality of life. 12 …”

Implanted vascular access device options: a focused review on safety and outcomes

“…In a 2014 survey of 47 patients at a specialized cancer center, seven of 20 respondents reported never receiving education on home management of their device, and 29% of 44 respondents did not know which symptoms would be concerning for an infection in the device. Interestingly, patients were closely observant of the protocols followed by health care personnel and were able to actively correct mistakes, such as missed flushes, short cleaning times, etc …”

“…Interestingly, patients were closely observant of the protocols followed by health care personnel and were able to actively correct mistakes, such as missed flushes, short cleaning times, etc. 45…”

Improving cancer patients’ knowledge about totally implantable access port: a randomized controlled trial

“…Patients with TIAP, compared to patients with CVC, reported less restriction in daily activities and spent less time thinking that they had a CVAD [23]. However, regarding CVAD, cancer patients feel very cautious and insecure [24]. Maybe, they recognize that CVADs like TIAP require utmost care to minimize not only infection risk [25] but also other complications like catheter malfunction or catheter-related thromboembolism [26][27][28].…”