ABSTRACT
Tunneled right atrial catheters have allowed more patients to benefit from intensive intravenous therapy regimens. The enthusiasm for increased therapeutic protocols and the benefit in quality of life for patients using these catheters must be tempered by a sincere respect for the many serious complications that can occur. Careful attention to aseptic technique and the use of a protocol to evaluate problems increase the benefits to the patient while decreasing the risk of serious complications.
Subject(s)
Catheterization, Central Venous/nursing , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/methods , Catheters, Indwelling/adverse effects , Equipment Failure , HumansABSTRACT
Patients undergoing bone marrow transplant (BMT) are at great risk of infection and sepsis. Long-term central catheters (LTCCs), required for IV therapy, can be a portal of entry for infectious agents. This randomized, prospective study compared two types of catheter dressings in 98 patients undergoing BMT: a dry sterile gauze dressing (DSGD) changed daily and a transparent adherent dressing (TAD) changed every four days. Study outcomes included incidence and severity of local and systemic complications, patient assessment of comfort, and calculation of nursing time. One case of catheter-related infection occurred during the study. No significant differences existed between the two dressings in the incidence of positive skin cultures or local complications with the exception of skin irritation. The TAD caused less skin irritation, was preferred by patients, cost less, and required less nursing time. The findings indicate that TADs provide a safe, comfortable, and cost-effective alternative to DSGDs for patients undergoing BMT and receiving antibiotic support during aplasia.
Subject(s)
Bandages , Bone Marrow Transplantation , Catheterization, Central Venous , Occlusive Dressings , Adolescent , Adult , Bandages/economics , Bandages/standards , Bone Marrow Transplantation/nursing , Catheterization, Central Venous/nursing , Catheters, Indwelling , Child , Child, Preschool , Costs and Cost Analysis , Female , Humans , Male , Middle Aged , Occlusive Dressings/economics , Occlusive Dressings/standards , Patient Satisfaction , Prospective Studies , Skin/microbiologyABSTRACT
Many problems associated with the use of vascular access devices (VADs) can be circumvented with an organized, systematic approach to management. This paper describes an approach that includes several key components: 1) A nurse coordinator of parenteral therapy (CPT) follows all patients with a VAD; records demographic and clinical data on an ongoing basis; monitors complications and outcomes; serves as a consultant for VAD-related questions; develops policies, procedures, and guidelines for catheter care; and oversees inservice nursing and basic patient education. 2) A data coordinator enters all data into a data base management system, compiles complication and other statistics on a periodic basis, and retrieves selected data for specific purposes. 3) A VAD Committee, composed of the above two individuals, a nurse epidemiologist, and physicians representing medical oncology, hematology, transplantation, pediatrics, and surgery, meets monthly to collectively evaluate and assign cause for complications, consider new products, and discuss policy changes regarding VADs. As a result of this multidisciplinary process, responsibility and accountability for VAD insertion and care are appropriately placed, statistics on complications are compiled, and treatment and policy decisions are made. These outcomes have resulted in a significant reduction in complications, an increase in average catheter life, enhancement of quality assurance, and overall improved patient care.
