Hematologic Patients' Clinical and Psychosocial Experiences with Implanted Long-term Central Venous Catheter: Self-management versus Professionally Controlled Care

Tom Møller, MPH, RN; Lis Adamsen, MSc Soc, PhD, RN

Disclosures

Cancer Nurs. 2010;33(6):426-435. 

In This Article

Abstract and Introduction

Abstract

Background: A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients.
Objective: This article focuses on patients' clinical and psychosocial experiences with CVC self-care compared with professionally controlled CVC care.
Methods: Eighty-two patients with tunneled CVCs were enrolled in the randomized controlled trial. The intervention group (n = 42) was trained to perform CVC self-care. The control group (n = 40) followed standard CVC procedure provided by nurses. Eighteen patients were selected for semistructured interviews focusing on patients' clinical and psychosocial experiences with CVCs.
Results: Methods of CVC care have different influences on the patients' clinical and psychosocial outcomes, depending on whether they were hospitalized or outpatients. Central venous catheter was viewed as important because it was the main port of treatment toward a cure, although patients constantly fear complications. Central venous catheter self-care increased patients' independence from health professionals and supported perceived self-efficacy and control. Central venous catheters cause psychosocial problems including altered body perception, sexual activity avoidance, and feeling stigmatized.
Conclusions: Patients experience increased perceived self-control and independence when individually supervised and trained in CVC self-management. Assuming ownership of CVC care can encourage patients to feel less inhibited about sexual activity and socialization.
Implications for Practice: Placement of a tunneled CVC should engage nurses to organize individualized structured and supervised patient education. Stigma originating from CVCs should be carefully considered by health professionals when maintaining CVC insertion for longer periods. Central venous catheters should be removed whenever the potential risks exceed the catheter's functional necessity.

Introduction

Treatment of patients with high-grade hematologic malignancies lasts 4 months to half a year. Most patients have a silicone-tunneled central venous catheter (CVC) implanted in the chest and routed to the central bloodstream. A well-functioning CVC is necessary to provide intravenous chemotherapy and medical treatment associated with periodic marrow suppression. Despite its advantages, the CVC frequently causes sepsis and prolonged hospital stays[1–3] and as such increases costs.[1,4] Loss in hygiene quality and consistency with CVC techniques and maintenance are recurring problems when patients are discharged with a CVC.

A randomized controlled trial (RCT) was performed to explore a new clinical intervention in which patients or their relatives were trained to provide CVC self-care, and outcomes were compared with nurse-controlled care. Despite the fact that the intervention was strategically controversial in regard to prevention of CVC line infections, 71% of the background population participated in the trial. The results demonstrated benefits in patient adherence and a 50% reduction in the incidence of catheter-related infections (CRIs) in the trained patient group.[5] It is concluded that a structured and supervised one-on-one patient education program can reduce CRIs.

The need for patient education programs has increased to facilitate a general movement toward less hospitalization and to increase outpatient management, even among patients with acute leukemia at high risk of life-threatening infections.[6–9] Although a recent review concludes that patients with cancer want to be kept fully informed and actively participate in their care,[10] less empirical evidence exists regarding patient experiences with being involved in crucial clinical procedures.

The objective of this study was to explore experiences of patients who were individually trained and assumed self-care responsibility for their CVC compared with patients who remained dependent on controlled CVC care by health professionals.

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