Central line practice in Canadian blood and marrow transplant

Melanie Keeler

Abstract


More than 800 blood cell and bone marrow transplants are performed annually in Canada to treat fatal cancers and rare blood disorders. Central vascular access is fundamental in blood and marrow transplant nursing to facilitate chemotherapy and blood product infusions. A tunnelled Central Venous Catheter (CVC) is the vascular access device-of-choice in the cell and marrow transplant population. Several practice guidelines direct nursing policy and procedure for CVC management and care. CVC insertion and removal guidelines are increasingly relevant given the widening scope of advanced practice nursing. Unresolved issues are noted among the most heavily cited CVC practice recommendations accessible via the Centers for Disease Control and Prevention (CDC). A descriptive survey based on the CDC guidelines was conducted to identify potential variability in CVC strategies in Canadian blood and marrow transplant nursing. Survey results indicate nationwide differences in catheter site selection, educational strategies, dressing strategies, delegation of dressing changes, and volumes of flushing and locking solutions used to manage catheter patency. Variability in practice coincides with gaps in the evidence identified in practice recommendations. Future studies comparing specific care approaches to device-associated complications are needed to resolve issues and strengthen practice guidelines.

Key words: central venous catheter, blood and marrow transplant, practice, Canada


Full Text:

PDF

References


Baird, S.F., Taori, S.K., Dane, J., Willoeles, L.J., Roddie, H., & Hanson, M. (2011). Cluster of non-tuburculous mycbbactaraemia

associated with water supply in haemo-oncology unit. Journal of

Hospital Infection, 79, 339–343.

Boersma, R.S., & Schouten, H.C. (2010). Clinical practices concerning

central venous catheters in haematological patients. European

Journal of Oncology Nursing, 14, 200–214.

Camp-Sorrell, D. (2010). State of the science of oncology vascular

access devices. Seminars in Oncology Nursing, 26(2), 80–87.

Canadian Blood and Marrow Transplant Group. (2013). Canada

transplant statistics. Retrieved from http://www.cbmtg.org/

index.cfm?act=stats&do=getStats&prov=0&year=2010

Dibb, M., Carlson, G., Abraham, A., Shaffer, J., Teubner, A., & Lal,

S. (2012). OC-034 salvage of central venous catheters in HPN

catheter-related blood stream infections is safe and effective: 18

years of experience from a national centre. GUT, 61, A14–A15.

Faruqi, A., Medefindt, J., Dutta, G., Philip, S.A., Tompkins, D.,

& Carey, J. (2012). Effect of a multidisciplinary intervention

on central line utilization in an acute care hospital. American

Journal of Infection Control, 40, e211–215.

Ge, X., Cavallazzi, R., Li., C., Pan, S.M., Wang, Y.W., & Wang, F.L.

(2012). Central venous access sites for the prevention of venous

thrombosis, stenosis, and infection. Cochrane Database of

Systematic Reviews, 3, doi:10.1002/1461858.CD004084.pub.3

Gillies, W.J., O’Riordan, E., Sheriff, K.L., & Rickard, C.M. (2011).

Gauze and tape and transparent polyurethane dressings for

central venous catheters. Cochrane Database of Systematic

Reviews, 3. doi:10. 1002/14651858.CD003827.pub2

Hitz, F., Kingbiel, D., Omlin, A., Rinike, S., Zerz, A., & Cerny, T.

(2012). Athrombogenic coating of long-term venous catheter for

cancer patients: A prospective, randomized, double-blind trial.

Annals of Hematology, 91(4), 613–620.

Infusion Nurses Society. (2011). Policies and procedures for infusing

nursing (4th ed.). Philadelphia: Lippincott, Williams & Wilkins.

Kim, E.J., Kim, H.J., Kim, K.H., Kim, S.H., Lee, S.C., Bae, S.B., …

Hong, D.S. (2010). Retrospective analysis for complications of

the central venous catheter in patients with cancer at a single

center in Korea. Korean Journal of Hospital Palliative Care, 13(1),

–31.

Levi, M., van der Poll, T., & Schultz, M. (2012). Infection and

inflammation as risk factors for thrombosis and atherosclerosis.

Seminars in Thrombosis and Hemostasis, 38(5), 506–514.

Mathers, D. (2011). Evidence-based practice: Improving outcomes

for patients with a central venous access device. Journal of the

Association for Vascular Access, 16(2), 64–72.

Møller, T., & Adamsen, L. (2010). Hematologic patients’ clinical

and psychosocial experiences with implanted long-term central

venous catheter: Self-management versus professionally

controlled care. Cancer Nursing, 33(6), 426–435.

Moreau, N. (2009). Are your skin-prep and catheter techniques up to

date? Nursing, 39(5), 15–16.

O’Grady, N.P., Alexander, M., Burns, L.A., Patchen Dellinger, E.,

Garland, J., O’Heard, S., … Saint, S. (2011). Guidelines for the

prevention of intravascular catheter-related infections. American

Journal of Infection Control, 39, S1–34.

Rosenthal, V.D. (2009). Central line-associated blood stream

infections in limited resource countries: A review of the

literature. Healthcare Epidemiology, 49, 199–1907.

Rowan, C.M., Miller, K.E., Beardsley, A.L., Ahmed, S.S., Rojas,

L.A., Hedlund, T. L., … Nitu, M.E. (2013). Alteplase use for

malfunctioning central venous catheters correlates with

catheter-associated bloodstream infections. Pediatric Critical

Care Medicine, 14(3), 306–309.

Scales, K. (2010). Central venous access devices part 1: Devices for

acute care. British Journal of Oncology Nursing, 19(2), 88–92.

Scales, K. (2011). Reducing infection associated with central venous

access devices. Nursing Standard, 25(36), 49–56.

Shekelle, P.G., Wachter, R.M., Pronovost, P.J., Schoelles, K., Mcdonald, K.M., Dy, S.M., … Winters, B.D. (2013). Making health care safer II: An updated critical analysis of the evidence for patient safety practice. Comparative Effectiveness Review No. 211. (Prepared by the Southern California-RAND Evidence-based Practice Center under

Contract No. 290-2007-10062-I.) AHRQ Publication No. 13-E001-EF.

Rockville, MD: Agency for Healthcare Research and Quality.

Tomblyn, M., Chiller, T., Einsele, H, Gress, R., Sepkowitz, K., Storek,

J., … Boeckh, M.A. (2009). Guidelines for preventing infectious

complications among hematapoietic cell transplant recipients:

A global perspective. Biology Blood Marrow Transplant, 15,

–1238.

Toscano, C.M., Bell, M., Zukerman, C., Sheltor, W., Novicki, T.J.,

Nichols, W.G., … Jarvis, W.R. (2009). Gram-negative blood stream

infections in hematapoietic stem cell transplant patients: The

roles of needleless device use, bathing practices, and catheter

care. American Journal of Infection Control, 37, 327–334.


Refbacks

  • There are currently no refbacks.


Bookmark and Share