To understand the vulnerability of patients with cancer to central line-associated bloodstream infections related to tunneled central venous catheters (CVCs), patients were asked to describe their line care at home and in clinic and to characterize their knowledge and experience managing CVCs. Forty-five adult patients with cancer were recruited to participate. Patients were interviewed about the type of line, duration of use, and observations of variations in line care. They also were asked about differences between line care at home and in the clinic, precautions taken when bathing, and their education regarding line care. Demographic information and primary cancer diagnosis were taken from the patients' medical records. Patients with hematologic and gastrointestinal malignancies were heavily represented. The majority had tunneled catheters with subcutaneous implanted ports. Participants identified variations in practice among nurses who cared for them. Although many participants expressed confidence in their knowledge of line care, some were uncertain about what to do if the dressing became loose or wet, or how to recognize an infection. Patients seemed to be astute observers of their own care and offered insights into practice variation. Their observations show that CVC care practices should be standardized, and educational interventions should be created to address patients' knowledge deficits.
Affordable Care Act; PPS-Exempt Cancer Hospital Quality Reporting Program, 78 Fed. Reg. 50837 (August 19, 2013) (to be codified at 42 C.F.R. pts. 412, 413, 414, et al.).
Centers for Disease Control and Prevention. (2011). Vital signs: Central line-associated blood stream infections—United States, 2001, 2008, and 2009. <i>Morbidity and Mortality Weekly Report, 60</i>, 243-248.
Laura, R., Degl'Innocenti, M., Mocali, M., Alberani, F., Boschi, S., Giraudi, A., … Peron, G. (2000). Comparison of two different time interval protocols for central venous catheter dressing in bone marrow transplant patients: Results of a randomized, multicenter study. The Italian Nurse Bone Marrow Transplant Group (GITMO). <i>Haematologica, 85</i>, 275-279.
Mermel, L.A., Allon, M., Bouza, E., Craven, D.E., Flynn, P., O'Grady, N.P., … Warren, D.K. (2009). Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. <i>Clinical Infectious Diseases, 49</i>, 1-45. doi:10.1086/599376
Mollee, P., Jones, M., Stackelroth, J., van Kuilenburg, R., Joubert, W., Faoagali, J., … Clements, A. (2011). Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: A prospective cohort study. <i>Journal of Hospital Infection, 78</i>, 26-30.
Moller, T., Borregaard, N., Tvede, M., & Adamsen, L. (2005). Patient education—A strategy for prevention of infections caused by permanent central venous catheters in patients with haematological malignancies: A randomized clinical trial. <i>Journal of Hospital Infection, 61</i>, 330-341. doi:10.1016/j.jhin.2005.01.031
O'Grady, N.P., Alexander, M., Burns, L.A., Dellinger, E.P., Garland, J., Heard, S.O., … Saint, S. (2011). Guidelines for the prevention of intravascular catheter-related infections. <i>American Journal of Infection Control, 39</i> (Suppl. 1), S1-S34.
Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., … Goeschel, C. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. <i>New England Journal of Medicine, 355</i>, 2725-2732.
Pronovost, P.J., Goeschel, C.A., Colantuoni, E., Watson, S., Lubomski, L.H., Berenholtz, S.M., … Needham, D. (2010). Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: Observational study. <i>BMJ, 340</i>, c309.
Rinke, M.L., Chen, A.R., Bundy, D.G., Colantuoni, E., Fratino, L., Drucis, K.M., … Miller, M.R. (2012). Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients. <i>Pediatrics, 130</i>, E996-E1004.
Scott, D.R. (2009). <i>The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention.</i> Retrieved from http://1.usa.gov/RUbCoo <a target="_blank" href='http://1.usa.gov/RUbCoo'>http://1.usa.gov/RUbCoo</a>
Schiffer, C.A., Mangu, P.B., Wade, J.C., Camp-Sorrell, D., Cope, D.G., El-Rayes, B.F., … Levine, M. (2013). Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. <i>Journal of Clinical Oncology, 31</i>, 1357-1370. doi:10.1200/JCO.2012.45.5733
Tomlinson, D., Mermel, L.A., Ethier, M.C., Matlow, A., Gillmeister, B., & Sung, L. (2011). Defining bloodstream infections related to central venous catheters in patients with cancer: A systematic review. <i>Clinical Infectious Diseases, 53</i>, 697-710. doi:10.1093/cid/cir523
Wolf, H.H., Leithäuser, M., Maschmeyer, G., Salwender, H., Klein, U., Chaberny, I., … Mousset, S. (2008). Central venous catheter-related infections in hematology and oncology: Guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Oncology. <i>Annals of Hematology, 87</i>, 863-876.