Evidence-based Protocol for Malfunctioning Totally Implanted Venous Access Devices

Abstract

Background: Fundamental to chemotherapy infusion, all venous access lines must always produce brisk blood return before treatment may begin. Occlusions occur in 14-67% of central venous catheters, including totally implanted vascular access devices. There are mechanisms that nurses use to manage care when a totally implanted vascular access device is appropriately accessed but does not produce a blood return, and there is evidence regarding which of these mechanisms are likely to prove successful. Local Problem: To implement a novel evidence-based protocol for appropriately accessed totally implanted vascular access devices without blood return in an ambulatory outpatient oncology clinic within a community hospital setting. Interventions: This Institutional Review Board approved 14-week project began in September 2018. Totally implanted vascular access device and alteplase instillation competencies were completed and audited to ensure current knowledge of oncology registered nurses. Electronic health record reports of documentation of the standardized totally implanted vascular access device protocol, alteplase use, and delay of chemotherapy >24hrs were monitored. A system usability scale questionnaire was also administered to unit registered nurses. The system usability scale measures post outcome for satisfaction and sustainability. Satisfaction and sustainability are defined as scoring as acceptable above 70, marginal below 69-50, and not acceptable below 50.

Results: Eighty-five percent (N=28/33) of registered nurses completed both competencies. There were two instances of alteplase use during the study period due to lack of blood return with one documented use of the standardized protocol, both without delay of greater than 24hrs. Fiftyeight percent (N=19/33) of registered nurses completed the system usability scale with 79% (n=15/19) judging it to be acceptable, 16% (n=3/19) as marginal, and 5% (n=1/19) as not acceptable. Conclusions: A standardized algorithm for totally implanted vascular access devices benefits patients and registered nurses by providing consistent care for malfunctioning totally implanted vascular access devices, and may reduce time to receive scheduled chemotherapy and cost. registered nurses experience less stress and more satisfaction with a standardized protocol and have a clear path when a totally implanted vascular access device is malfunctioning.