Transition de l’héparine au sérum physiologique pour fermer les cathéters veineux centraux en oncologie : pratique fondée sur la recherche

Terri Jabaley, Niya Xiong, Susanne Conley, Teresa Mazeika, Danielle Johnson, Brenda Biggins, Nancy Hilton, Fangxin Hong

Abstract


Les patients recevant un traitement à long terme contre le cancer doivent très souvent se faire poser un cathéter veineux central (CVC). L’entretien du CVC est donc une compétence fondamentale des infirmières en oncologie. Les pratiques d’irrigation et de fermeture du CVC fondées sur la recherche aident à prévenir l’occlusion intraluminale, une complication fréquente. Les normes recommandent l’utilisation d’un soluté physiologique hépariné pour fermer le CVC; toutefois, selon la recherche, le soluté hépariné n’est pas plus efficace que le seul sérum physiologique. Les objectifs du présent projet de pratique fondée sur la recherche étaient : 1) d’évaluer si la fermeture au sérum physiologique plutôt qu’au soluté hépariné était liée à une différence significative du nombre de cas d’occlusion intraluminale chez les patients suivis en clinique d’oncologie externe; et 2) d’évaluer les effets du mentorat entre pairs sur le point de vue des infirmières et des patients quant au changement de pratique. L’analyse des données a révélé une diminution de l’utilisation d’altéplase après l’adoption du sérum physiologique pour fermer les CVC. Les sondages réalisés auprès des patients et des infirmières montrent que le mentorat entre pairs accroît la confiance des infirmières et des patients, ainsi que l’habileté à procéder au changement de pratique.


Full Text:

PDF

References


Abdullah, G., Rossy, D., Ploeg, J., Davies, B., Higuchi, K., Sikora, L., & Stacey, D. (2014). Measuring the effectiveness of mentoring as a knowledge translation intervention for implementing empirical evidence: A systematic review. Worldviews on Evidence-Based Nursing, 11(5), 284–300. https://doi.org/10.1111/wvn.12060

Akhtar, N., & Lee, L. (2021). Utilization and complications of central venous access devices in oncology patients. Current Oncology, 28(1), 367–377. https://www.mdpi.com/1718-7729/28/1/39

Bertoglio, S., Solari, N., Meszaros, P., Vassallo, F., Bonvento, M., Pastorino, S., & Bruzzi, P. (2012). Efficacy of normal saline versus heparinized saline solution for locking catheters of totally implantable long-term central vascular access devices in adult cancer patients. Cancer Nursing, 35(4), E35–E42. https://doi.org/10.1097/NCC.0b013e31823312b1

Boord, C. (2019). Pulsatile flushing: A review of the literature. Journal of Infusion Nursing, 42(1). https://doi.org/10.1097/NAN.0000000000000311

Boswell, C., Ashcraft, A., Long, J., Cannon, S., DiVito-Thomas, P., & Delaney, T. (2020). Self-efficacy: Changing the tide of evidence-based practice. Worldviews on Evidence-Based Nursing, 17(2), 129–135. https://doi.org/10.1111/wvn.12434

Brito, A. R. O., Nishinari, K., Saad, P. F., Saad, K. R., Pereira, M. A. T., Emidio, S. C. D., … Soares, B. L. F. (2018). Comparison between saline solution containing heparin versus saline solution in the lock of totally implantable catheters. Ann Vasc Surg, 47, 85–89. https://doi.org/10.1016/j.avsg.2017.09.015

Camp-Sorrell, D., & Matey, L. (2017). Access device standards of practice for Oncology Nursing (1st ed.). Oncology Nursing Society.

Chong, L. M., Chow, Y. L., Kong, S. S. C., & Ang, E. (2013). Maintenance of patency of central venous access devices by registered nurses in an acute ambulatory setting: An evidence utilisation project. International Journal of Evidence-Based Healthcare, 11(1), 20–25.

Chopra, V., Govindan, S., Kuhn, L., Ratz, D., Sweis, R. F., Melin, N., … Saint, S. (2014). Do clinicians know which of their patients have central venous catheters? A multicenter observational study. Annals of Internal Medicine, 161(8), 562–567. https://doi.org/https://doi.org/10.7326/M14-0703

da Costa, A. C. C., Ribeiro, J. M., Vasques, C. I., De Luca Canto, G., Porporatti, A. L., & Dos Reis, P. E. D. (2019). Interventions to obstructive long-term central venous catheter in cancer patients: A meta-analysis. Support Care Cancer, 27(2), 407–421. https://doi.org/10.1007/s00520-018-4500-y

Dal Molin, A., Clerico, M., Baccini, M., Guerretta, L., Sartorello, B., & Rasero, L. (2015). Normal saline versus heparin solution to lock totally implanted venous access devices: Results from a multicenter randomized trial. Eur J Oncol Nurs, 19(6), 638–643. https://doi.org/10.1016/j.ejon.2015.04.001

Daraz, L., Morrow, A. S., Ponce, O. J., Beuschel, B., Farah, M. H., Katabi, A., … Seisa, M. O. (2019). Can patients trust online health information? A meta-narrative systematic review addressing the quality of health information on the internet. Journal of General Internal Medicine, 1–8. https://doi.org/10.1007/s11606-019-05109-0

Egnatios, D., & Gloria, C. (2021). Implanted port patency: Comparing heparin and normal saline. Clinical Journal of Oncology Nursing, 25(2), 169–173.

Ferroni, A., Gaudin, F., Guiffant, G., Flaud, P., Durussel, J.-J., Descamps, P., … Merckx, J. (2014). Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices. Medical Devices (Auckland, NZ), 7, 379. https://doi.org/10.2147/MDER.S71217

Fridman, M., & Frederickson, K. (2014). Oncology nurses and the experience of participation in an evidence-based practice project. Paper presented at the Oncology Nursing Forum.

Geerligs, L., Rankin, N. M., Shepherd, H. L., & Butow, P. (2018). Hospital-based interventions: A systematic review of staff-reported barriers and facilitators to implementation processes. Implementation Science, 13(1), 36. https://doi.org/10.1186/s13012-018-0726-9

Gerçeker, G. Ö., Sevgili, S. A., & Yardımcı, F. (2018). Impact of flushing with aseptic non-touch technique using pre-filled flush or manually prepared syringes on central venous catheter occlusion and bloodstream infections in pediatric hemato-oncology patients: A randomized controlled study. European Journal of Oncology Nursing, 33, 78–84. https://doi.org/10.1016/j.ejon.2018.02.002

Ginex, P. K., Dickman, E., Thomas, B., Tucker, S., Guo, J., & Gallagher-Ford, L. (2021). Evidence-based practice in oncology nursing: Oncology Nursing Society Survey Results. Clinical journal of oncology nursing, 25(3), 282–289. https://doi.org/10.1188/21.CJON.282-289

Goossens, G., Jérôme, M., Janssens, C., Peetermans, W., Fieuws, S., Moons, P., … Stas, M. (2013). Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: A randomised, non-inferiority, open trial. Annals of Oncology, 24(7), 1892–1899.

Goossens, G. A. (2015). Flushing and locking of venous catheters: Available evidence and evidence deficit. Nurs Res Pract, 2015, 985686. https://doi.org/10.1155/2015/985686

Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., … Alexander, M. (2021). Infusion therapy standards of practice. Journal of Infusion Nursing, 44(suppl 1), S1–S224. doi:10.1097/NAN.0000000000000396

Klein, J., Jepsen, A., Patterson, A., Reich, R. R., & Mason, T. M. (2018). Heparin versus normal saline: Flushing effectiveness in managing central venous catheters in patients undergoing blood and marrow transplantation. Clinical Journal of Oncology Nursing, 22(2).

Lange, L., Peikert, M. L., Bleich, C., & Schulz, H. (2019). The extent to which cancer patients trust in cancer-related online information: A systematic review. PeerJ, 7, e7634. https://doi.org/10.7717/peerj.7634

López-Briz, E., Ruiz Garcia, V., Cabello, J. B., Bort-Martí, S., Carbonell Sanchis, R., & Burls, A. (2018). Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults. Cochrane Database of Systematic Reviews, 7(7). https://doi.org/10.1002/14651858.CD008462.pub3

Melnyk, B. M., Gallagher-Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2018). The first US study on nurses’ evidence-based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence-Based Nursing, 15(1), 16–25. https://doi.org/10.1111/wvn.12269

Middlebrooks, R., Carter-Templeton, H., & Mund, A. R. (2016). Effect of Evidence-Based Practice Programs on individual barriers of workforce nurses: An integrative review. The Journal of Continuing Education in Nursing, 47(9), 398–406.

Royon, L., Durussel, J., Merckx, J., Flaud, P., Vigier, J., & Guiffant, G. (2012). The fouling and cleaning of venous catheters: A possible optimization of the process using intermittent flushing. Chemical Engineering Research and Design, 90(6), 803–807. https://doi.org/https://doi.org/10.1016/j.cherd.2011.10.004

Schiffer, C. A., Mangu, P. B., Wade, J. C., Camp-Sorrell, D., Cope, D. G., El-Rayes, B. F., … Levine, M. (2013). Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol, 31(10), 1357–1370. https://doi.org/10.1200/JCO.2012.45.5733

Sharma, A. E., Rivadeneira, N. A., Barr-Walker, J., Stern, R. J., Johnson, A. K., & Sarkar, U. (2018). Patient engagement in health care safety: An overview of mixed-quality evidence. Health Affairs (Project Hope), 37(11), 1813–1820. https://doi.org/10.1377/hlthaff.2018.0716

Sharma, S. K., Mudgal, S. K., Gaur, R., Sharma, R., Sharma, M., & Thakur, K. (2019). Heparin flush vs. normal saline flush to maintain the patency of central venous catheter among adult patients: A systematic review and meta-analysis. Journal of Family Medicine and Primary Care, 8(9), 2779–2792. https://doi.org/10.4103/jfmpc.jfmpc_669_19

Shay, L. A., & Lafata, J. E. (2015). Where is the evidence? A systematic review of shared decision making and patient outcomes. Medical Decision Making, 35(1), 114–131. https://doi.org/10.1177%2F0272989X14551638

Spiva, L., Hart, P. L., Patrick, S., Waggoner, J., Jackson, C., & Threatt, J. L. (2017). Effectiveness of an evidence-based practice nurse mentor training program. Worldviews Evid Based Nurs, 14(3), 183–191. https://doi.org/10.1111/wvn.12219

Ullman, A. J., Marsh, N., Mihala, G., Cooke, M., & Rickard, C. M. (2015). Complications of central venous access devices: A systematic review. Pediatrics, 136(5), e1331–e1344. https://doi.org/10.1542/peds.2015-1507

Van Norman, G. A. (2016). Drugs and devices: Comparison of European and US approval processes. JACC: Basic to Translational Science, 1(5), 399–412. https://doi.org/10.1016/j.jacbts.2016.06.003

Vigier, J., Merckx, J., Coquin, J., Flaud, P., & Guiffant, G. (2005). The use of a hydrodynamic bench for experimental simulation of flushing venous catheters: Impact on the technique. Itbm-Rbm, 26(2), 147–149. https://doi.org/10.1016/j.rbmret.2005.03.001

Wallen, G. R. (2014). Innovations that INSPIRE. Nursing Management, 45(9), 23.

Williams, B., Perillo, S., & Brown, T. (2015). What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurse Education Today, 35(2), e34–e41. https://doi.org/10.1016/j.nedt.2014.11.012

Zhong, L., Wang, H. L., Xu, B., Yuan, Y., Wang, X., Zhang, Y. Y., … Hu, Z. S. (2017). Normal saline versus heparin for patency of central venous catheters in adult patients—A systematic review and meta-analysis. Crit Care, 21(1), 5. https://doi.org/10.1186/s13054-016-1585-x


Refbacks

  • There are currently no refbacks.