3

Average: 3 (1 vote)

Journal Club
Open Access Article

Central Venous Access Devices: An Investigation of Oncology Nurses' Troubleshooting Techniques

Tina M. Mason
Sheila M. Ferrall
Alice R. Boyington
Richard R. Reich
CJON 2014, 18(4), 421-425 DOI: 10.1188/14.CJON.421-425

Experienced oncology nurses use different troubleshooting techniques for clearing occluded central venous access devices (CVADs) with varying degrees of success. The purpose of this study was to explore troubleshooting techniques used for clearing occluded CVADs by experienced oncology RNs and identify the perceived effectiveness of each technique. An invitation for a web-based survey was sent to select RN members of the Oncology Nursing Society. All nurses (N = 224) reported asking patients to raise and/or move their arm. Most nurses asked patients to lie down, cough, and take deep breaths. Respondents considered instilling a thrombolytic agent to be the most effective technique. No associations were found between techniques and respondents' years in oncology nursing, work setting, certification, or academic degree. The findings contribute to knowledge about care of patients with occluded devices and will help formulate direction for additional investigation of CVADs. Establishing the appropriateness of practice-related troubleshooting techniques may eliminate unnecessary steps and save nursing time. Educating nurses on the topic will also help reduce techniques that are not expected to yield results or are contraindicated.

References 

Camp-Sorrell, D. (2010). State of the science on oncology vascular access devices. <i>Seminars in Oncology Nursing, 26</i>, 80-87. doi:10.1016/j.soncn.2010.02.001

Camp-Sorrell, D. (2011a). <i>Access device guidelines: Recommendations for nursing practice and education</i> (3rd ed.). Pittsburgh, PA: Oncology Nursing Society.

Camp-Sorrell, D. (2011b). Troubleshooting complications of vascular access devices. <i>Oncology Nurse Advisor, 2</i>(6), 20-25.

Cummings-Winfield, C., & Mushani-Kanji, T. (2008). Restoring patency to central venous access devices. <i>Clinical Journal of Oncology Nursing, 12</i>, 925-934. doi:10.1188/08.CJON.925-934

Dillman, D.A. (2000). <i>Mail and internet surveys: The tailored design method</i> (2nd ed.). New York, NY: John Wiley and Sons.

Gorski, L.A. (2003a). Central venous access device occlusions: Part 1: Thrombotic causes and treatment. <i>Home Healthcare Nurse, 21</i>, 115-121.

Gorski, L.A. (2003b). Central venous access device occlusions: Part 2: Nonthrombotic causes and treatment. <i>Home Healthcare Nurse, 21</i>, 168-171.

Hadaway, L.C. (2005). Reopen the pipeline for I.V. therapy. <i>Nursing, 35</i>(8), 54-61.

Hamilton, H. (2006). Complications associated with venous access devices: Part two. <i>Nursing Standard, 20</i>(27), 59-65.

Infusion Nurses Society. (2011). <i>Policies and procedures for infusion nursing</i> (4th ed.). Norwood MA: Author.

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

Miller, P.A. (2006). Central venous access devices. <i>Radiologic Technology, 77</i>, 297-308.

National Comprehensive Cancer Network. (2014). <i>NCCN Clinical Practice Guidelines in Oncology: Venous thromboembolic disease</i> [v.2.2014]. Retrieved from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/pdf/vte.pdf'>http://www....

Nirenberg, A., Reame, N.K., Cato, K.D., & Larson, E.L. (2010). Oncology nurses' use of National Comprehensive Cancer Network clinical practice guidelines for chemotherapy-induced and febrile neutropenia. <i>Oncology Nursing Forum, 37</i>, 765-773.

Rawson, K.M., & Newburn-Cook, C.V. (2007). The use of low-dose warfarin as prophylaxis for central venous catheter thrombosis in patients with cancer: A meta-analysis. <i>Oncology Nursing Forum, 34</i>, 1037-1043.

Schulmeister, L., & Camp-Sorrell, D. (2000). Chemotherapy extravasation from implanted ports. <i>Oncology Nursing Forum, 27</i>, 531-538.

Svoboda, P., Barton, R.P., Barbarash, O.L., Butylin, A.A., Jacobs, B.R., Lata, J., … El-Shahawy, M.A. (2004). Recombinant urokinase is safe and effective in restoring patency to occluded central venous access devices: A multiple-center, international trial. <i>Critical Care Medicine, 32</i>, 1990-1996. doi:10.1097/01.CCM.0000142706.01717.EB

Vescia, S., Baumgärtner, A.K., Jacobs, V.R., Kiechle-Bahat, M., Rody, A., Loibl, S., & Harbeck, N. (2008). Management of venous port systems in oncology: A review of current evidence. <i>Annals of Oncology, 19</i>, 9-15. doi:10.1093/annonc/mdm272