Evidence-based Practice For Maintenance Of Implantable Venous Access Port In Adult Patients

BackgroundTotally implantable venous access ports(TIVPs),is a long term used venous catheters comprised of a port and central venous pipe.The extensive use not only simplifies the infusion of chemotherapeutic drugs,total parenteral nutrition,but also have no restriction of daily activities.It drastically improve the level of lives in some degree.But there are complications including catheter-related infections,occlusion during the application that can cause catheter removal and prolong the time of hospitalization.Studies have found that the ability of medical staff is closely related to the rate of TIVPs' complications.The aim of this study is to summarize the best evidence of maintenance of TIVPs,and then put it into practice.ObjectivesTo enhance the quality of clinical nursing practice,and develop a China-style norm of TIVPs' maintenance on the basis of currently best evidences and its practice.Material and MethodsWe searched the BMJ(best practice),Cochrane Library,JBI Library,Registered Nurses Association of Ontario(RNAO),National Guideline Clearinghouse(NGC),Scottish Intercollegiate Guideline(SIGN),The National Institute for Health and Care Excellence(NICE),Medline,CNKI,Weipu Database,Wanfang Database and CBM to collect literatures including guidelines,evidence summary,systematic review and consensus.Level of evidences,recommendations of best evidence and its' standards were formulated following by standards of JBI,combination with expert discussion.Then we launched the evidence-based practice in a three armour hospital affiliated tonanjing medical university.Results1.Result of the evidence summaryA total of 10 studies cover seven guidelines,two evidence summaries and a expert consensus were included.The content of best evidences are aspects of the nurses' qualifications(CDC,2011;NICE,2014;JBI,2015;ESMO,2015),hand hygiene(CDC,2011;NGC,2012;NICE,2014 JBI,2015;INS,2016),pain assessment before access(JBI,2015),the smallest needles and its bevel direction(JBI,2015;INS,2016),the disinfection of skin and needless connectors(RNAO,2008;CDC,2011;NICE,2014;SHEA/IDSA,2014;ESMO,2015 JBI,2015;JBI,2016;INS,2016),dressing exchange(INS,2016;RNAO,2008;NGC,2012;NICE,2014;JBI,2015),flushing and locking(RNAO,2008;NGC,2012;JBI,2015;INS,2016),position of patients while accessing(NGC,2012).2.Result of evidence-based practiceAfter carry out the program,The compiance of hand hygiene changed from 9%to 73.56%,daily evaluate and record changed from 28.30% to 75.22%,dry on time of skin disinfectant changed from 27.50% to 100%,the disinfectant solution of needless connector changed from 17.30% to 100%.Only pulse flushing still got a low score(17.86%).Moreover,nurses' professional knowledge such as skin disinfectant solution and its' dry time changed from18.18% and 27.27% to 100% respectively,the score of patients' self-management knowledgement had also increased.ConclusionAfter implemented the evidence-based practice of Totally implantable venous access ports' maintenance,it advanced the quality of vascular catheters,perfect the management of ports' supervision,improve self-nursing ability.