A nurse-led paediatric oncology fast-track clinic proves a successful ambulatory intervention for patients.

AIM: To assess the impact of a pilot nurse-led paediatric oncology fast-track clinic (OFTC) for complications and side effects following chemotherapy within a paediatric tertiary hospital. METHODS: Prospective clinical data from the first 100 patients seen in the OFTC were compared with retrospective data of oncology patient presentations to the emergency department (ED) (over a 1-year period, n = 196) who would have been eligible for review in the OFTC. Parent and patient satisfaction of clinical care were also assessed via surveys pre- and post-OFTC implementation. RESULTS: Analysis which achieved statistical difference was a reduction in the number of blood tubes taken in OFTC (average 1.9 for those discharged from clinic, 2.9 for those admitted from clinic) in comparison to those seen in the ED (average 3.2) (p = 0.0027). The average number of interventions per patient seen in the ED were 2.1 (standard deviation 1.64) compared with 1.7 (standard deviation 1.55) interventions per patient seen in the OFTC, and who were not admitted following review. This result approached statistical significance with p = 0.0963. Other results which did not meet statistical significance included a reduction in treatment times, hospital admissions and medical oncology reviews. CONCLUSION: Our pilot study implementing an OFTC for the triage and assessment of chemotherapy-related complications has proven successful from an operational and consumer perspective. The clinic improved care by ensuring expedited review, more streamlined interventions, and less overall hospital admissions. The improvements in efficiency were also mirrored by increased parent and patient satisfaction.

Neonatal percutaneous central venous lines: fit to burst.

OBJECTIVE: To examine pressure changes in neonatal percutaneous central venous catheters under varying laboratory conditions and to quantify the risks of rupture in clinical practice. DESIGN: We tested 27-gauge polyurethane Premicath and 24-gauge silicone ECC (both Vygon, Norristown, PA) catheters. Burst pressures were determined by applying a slowly ramped pressure to catheters that were occluded at the tip. Flow-pressure relationships were defined by increasing flow rates through patent catheters from 5 to 499 ml/h. Pressure changes during the manual flushing of catheters were determined for patent and occluded catheters and with different syringe sizes. RESULTS: The mean burst pressure for polyurethane catheters (1730.8 kPa, 95% CI 1634.7 to 1826.8) was higher than for silicone catheters (275.6 kPa, 95% CI 240.4 to 310.8). Polyurethane catheters demonstrated an approximately fivefold greater margin of safety above manufacturer recommended operating pressures before burst compared to silicone catheters. Pressures remained at safe levels in both catheters over the range of flows generally used in neonatal practice. Hand-flushing of obstructed silicone catheters caused rupture in 5/6 silicone catheters tested, in comparison to 0/16 polyurethane catheters. CONCLUSIONS: Polyurethane central venous catheters have a greater pressure tolerance than silicone catheters and are less likely to rupture under experimental conditions. Obstructed silicone catheters rupture easily when flushed. Catheters were not tested in human infants.