Authors (including presenting author) :
Chan KKS (1), Lo SHO (2), Tang YCF (3), Lee WKM (1), Fong CCA (1), Wong LSJ (1)
Affiliation :
(1) Wound and Stomal Therapy, Department of Surgery, Queen Mary Hospital (2) Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital (3) Department of Surgery, Queen Mary Hospital
Introduction :
Administering parenteral nutrition (PN) through a tunneled central venous catheter (CVC) is regarded as an essential strategy to sustain the nutritional needs for patients suffered from intestinal failure. The duration of PN therapy varied from degree of disease status; in extreme situation, life-long PN support are required. For this reason, optimal CVC nursing care and maintenance is crucial to prevent device-related complication, which may lead to numerous adverse consequences, such as Central Line-Associated Blood Stream Infection (CLABSI), catheter dislodgement, blockage or rupture. Therefore, a structured training program for the patients and/ or their caregivers with home-based long term parenteral nutritional needs was initiated in the author’s premises since 2002.
Objectives :
To ensure a safe and consistent central line care practice among selected patients with home-based parenteral nutritional needs through a structural training programme. Knowledge, skill and ability of caring such patients at their home environment can be mastered and safeguarded.
Methodology :
Patients with home parenteral nutritional support needs are screened for their suitability to receive this training programme. The selected patients and their caregivers will be trained in the aspects of theories, demonstration of psycho-motor skills, supervised practice, intensive coaching, home visit and environmental adjustment according to recommendation; and an ultimate skill performance evaluation by the teaching team and the Chief of colorectal surgery division. Patients' central line care techniques and trouble-shooting will be addressed during their clinical follow-up session. Surveillance on CLABSI and other related complication compared with the pooled mean of CLABSI of National Health Safety Network (NHSN) are regarded as outcome measurement.
Result & Outcome :
A total number of 35 patients/ caregivers were trained for administration of parenteral nutritional at home from 2002 to 2018. In which, 8 completed treatments and no longer required HPN; 17 deceased, 1 suspended because of renal failure, 2 switched to PICC and 7 of them are still actively in used. A total number of 58297 device-utilization-days are measured. CLABSI, site infection, tunnel infection, occlusion, dislodgement and rupture rate were measured: 0.29, 0.03, 0.03, 0.24, 0.03 and 0.07 per 1000 catheter-days respectively. Providing safe, sustainable and optimal home-based CVC care is crucial among this population with specific disease and social needs. With the increase in complexity of patients’ condition and the challenges of facing scarce resources in current public healthcare sector’s situation, the training programme might require evolution in order to adapt the fast-changing healthcare environment in terms of efficiency, effectiveness and quality assurance.
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