MAINTENANCE OF THE IMPLANTED CENTRAL VENOUS PORT: USING EVIDENCE BASED PRACTICE TO REDIEFINE THE NURSING POLICY

2.50
Hdl Handle:
http://hdl.handle.net/10755/165238
Category:
Abstract
Type:
Presentation
Title:
MAINTENANCE OF THE IMPLANTED CENTRAL VENOUS PORT: USING EVIDENCE BASED PRACTICE TO REDIEFINE THE NURSING POLICY
Author(s):
Flaherty, Annemarie; Houlihan, Nancy; Mertens, Kim; Sweeney Gornell, Suzanne; Taylor, Joanne; Leonhart, Nicole
Author Details:
Annemarie Flaherty, RN MS AOCNS CNSC, Clinical Nurse Specialist, Memorial Sloan Kettering Cancer Center, New York, New York, USA, email: brammco@msn.com; Nancy Houlihan, RN, MA, AOCN; Kim Mertens, RN, MSN, AOCNS; Suzanne Sweeney Gornell, RN, BSN, OCN; Joanne Taylor, RN, MA, AOCN; Nicole Leonhart, RN, MS, ANP
Abstract:
Implanted central venous catheters (I-CVCs) play a major role in oncology care but are associated with long term risks of infection, thrombosis, and catheter malfunction. Despite routine flushing, 41% of I-CVCs result in thrombosis of the vessel, which increases the risk of infection. With the growing use of oral agents and successive chemotherapy regimens, I-CVCs are increasingly unused for extended intervals. Patient visits for flushing may create nuisance and non-reimbursable expense, and compliance can be problematic. Yet, complications may be greater beyond a 4-6 week flushing schedule. Review of nursing policy at this institution revealed a lack of evidence- based (EB) guidelines for long term I-CVC maintenance. The Evidence Based Practice subcommittee identified this lack of clear practice standards as a dilemma in caring for long term patients. We applied an EB approach to investigate a specific time interval for flushing an I-CVC when not in routine use. A comprehensive review of the evidence included: review of the published literature, guidelines, and manufacturer recommendations and consultation with identified experts. In analyzing institutional complications, we performed a retrospective chart review of patients treated with Alteplase«. Data was collected about complications and risk factors. We found limited information in our review to support a specific time frame for flushing unused I-CVCs and validation from expert opinion of the universal need to set practice standards. Our chart review was inconclusive because of inconsistent documentation. Outcome variables included type of infusion, efficacy of flush, and overall catheter functioning. Based on this review current nursing policy is under revision to clarify long term I-CVC maintenance and related documentation, with a plan for re-education of staff. Application of an evidence based methodology to solve a clinical question guides quality care initiatives. We learned that long term I-CVC maintenance is an under-studied practice issue. Lack of randomized clinical trials creates a dilemma for best practice recommendations. This presentation, which will describe our EB process and the results of the evidence and complication data, can guide other nurses in addressing clinical questions as well as raise clinical implications for further study.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2007
Conference Name:
32nd Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Las Vegas, Nevada, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleMAINTENANCE OF THE IMPLANTED CENTRAL VENOUS PORT: USING EVIDENCE BASED PRACTICE TO REDIEFINE THE NURSING POLICYen_GB
dc.contributor.authorFlaherty, Annemarieen_US
dc.contributor.authorHoulihan, Nancyen_US
dc.contributor.authorMertens, Kimen_US
dc.contributor.authorSweeney Gornell, Suzanneen_US
dc.contributor.authorTaylor, Joanneen_US
dc.contributor.authorLeonhart, Nicoleen_US
dc.author.detailsAnnemarie Flaherty, RN MS AOCNS CNSC, Clinical Nurse Specialist, Memorial Sloan Kettering Cancer Center, New York, New York, USA, email: brammco@msn.com; Nancy Houlihan, RN, MA, AOCN; Kim Mertens, RN, MSN, AOCNS; Suzanne Sweeney Gornell, RN, BSN, OCN; Joanne Taylor, RN, MA, AOCN; Nicole Leonhart, RN, MS, ANPen_US
dc.identifier.urihttp://hdl.handle.net/10755/165238-
dc.description.abstractImplanted central venous catheters (I-CVCs) play a major role in oncology care but are associated with long term risks of infection, thrombosis, and catheter malfunction. Despite routine flushing, 41% of I-CVCs result in thrombosis of the vessel, which increases the risk of infection. With the growing use of oral agents and successive chemotherapy regimens, I-CVCs are increasingly unused for extended intervals. Patient visits for flushing may create nuisance and non-reimbursable expense, and compliance can be problematic. Yet, complications may be greater beyond a 4-6 week flushing schedule. Review of nursing policy at this institution revealed a lack of evidence- based (EB) guidelines for long term I-CVC maintenance. The Evidence Based Practice subcommittee identified this lack of clear practice standards as a dilemma in caring for long term patients. We applied an EB approach to investigate a specific time interval for flushing an I-CVC when not in routine use. A comprehensive review of the evidence included: review of the published literature, guidelines, and manufacturer recommendations and consultation with identified experts. In analyzing institutional complications, we performed a retrospective chart review of patients treated with Alteplase«. Data was collected about complications and risk factors. We found limited information in our review to support a specific time frame for flushing unused I-CVCs and validation from expert opinion of the universal need to set practice standards. Our chart review was inconclusive because of inconsistent documentation. Outcome variables included type of infusion, efficacy of flush, and overall catheter functioning. Based on this review current nursing policy is under revision to clarify long term I-CVC maintenance and related documentation, with a plan for re-education of staff. Application of an evidence based methodology to solve a clinical question guides quality care initiatives. We learned that long term I-CVC maintenance is an under-studied practice issue. Lack of randomized clinical trials creates a dilemma for best practice recommendations. This presentation, which will describe our EB process and the results of the evidence and complication data, can guide other nurses in addressing clinical questions as well as raise clinical implications for further study.en_GB
dc.date.available2011-10-27T12:14:58Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:14:58Z-
dc.conference.date2007en_US
dc.conference.name32nd Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationLas Vegas, Nevada, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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