Prevention of Drainage Catheter Related Incidents by Using Three-Points Security Method

Abstract Description

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Authors (including presenting author) :

WONG SWA (1)(2), SUNG Charles (3) LAM YY (2), NG KS (3), TONG MH (4), WONG KW (5), NGAI MY (1), TAM Sammei (1)

Affiliation :

(1) Central Nursing Division (2) Department of Surgery (3) Quality & Safety Department (4) Community Outreach Services Team (5) Department of Radiology, North District Hospital, HKSAR

Introduction :

Subcutaneous drainage procedures including Percutaneous Nephrostomy (PCN), Percutaneous Transhepatic Cholangiography (PTC) and Biliary Drainage (PTBD), abdominal or pleural drainage are commonly performed for patients. However, limit literatures specified the correlation between dressing device and security dressing method for prevention of catheter from dislodgement, broken or twisting. From May to July in 2018, six catheters related incidents were reported shortly in North District Hospital (NDH) which mustered the task group from various specialties such wound specialist, main department representatives, Central Nursing Division and Quality and Safety Department to unite the dressing mechanism for nurses so to prevent the incidents from occurrence.

Objectives :

To introduce a drain securement device with well security dressing mechanism (Three-Point Security Method) to prevent the drain from tearing, kinking or peeling off by movement of patient body, trauma to the patient and keep comfort to the patient. 2) To review the outcome on effectiveness of using this drain securement device by “Three-Point Security Method”.

Methodology :

A prospective pilot study with evaluation on effectiveness of this Three-Point Security Method” after introduction of the nursing educational program was developed. Patient with catheter insertion such as mainly by Percutaneous Nephrostomy (PCN) , Percutaneous Transhepatic Biliary Drainage (PTBD), Percutaneous Transhepatic Cholangiogram (PTC), chest drain and abdominal drain from Radiology Department were monitored for the condition from September to December in 2018, additional correlated parameters such as skin condition, level of comfort perceiving at insertion site were analyzed. Dressing materials for drain securement were mainly including hydrocolloid dressing (DuoDERM) for the three-point security method. Point 1: Wound site. Point 2: Catheter/drain and tubing connection site. Point 3: Distal tubing site.

Result & Outcome :

Zero drainage-catheter related incidents were reported in Advance Incident Reporting System (AIRS) after the pilot of dressing securement with three-point security dressing method in NDH. The total number of incidents (N=6) related to dislodgement of catheters was successfully reduced from 6 to zero during the period from May to December 2018. Total 119 sample cases were reviewed and 100 samples with using hydrocolloid dressing material (DuoDERM) for securement of drain, 93% of patients using this specific dressing method were free from catheter twisting, dislodgment or blockage. However, 7% of patients (N=7) with mild twisting of catheters were reported, inappropriate fixation point was observed after dressing changed and required extra application of fabric dressing/acrylic adhesive dressing materials. Overall, only 2% of patients (N=2) with dressing accidentally peeling off were reported due to patient's vigorous movement during hospitalization. 2% of patients (N=2) with perceiving mild pain at insertion site and 7% patients (N=7) reported mild skin itchiness at day 3 in average after drain securement & hydrocolloid dressing applied. Meanwhile, no skin breakdown case was reported. 95% patients (N=95) tolerated well with the hydrocolloid dressing and free from discomfort. Conclusion: Drain securement device with three-point security method could prevent the drainage catheter from dislodgement, blockage and tube broken effectively. Regarding the use of three-point security method and material, hydrocolloid dressing material could achieve the purpose with low risk on skin problem. Overall, frontline staff are welcome with this new “Three-Point Security Method” for a good securement for the catheter/drain.