Hospice of the Valley (N.S., S.M., S.A.), Phoenix, Arizona, USA.
Center for Pain & Supportive Care (G.P.), Phoenix, Arizona, USA.
J Pain Symptom Manage. 2024 Mar;67(3):e163-e168. doi: 10.1016/j.jpainsymman.2023.11.008. Epub 2023 Nov 20.
The symptoms associated with the excessive fluid accumulation of ascites or pleural effusions can be intractable to medical management and can have a significant negative impact on quality of life of hospice patients. Hospice of the Valley, a community-based, nonprofit hospice agency has historically referred patients to outpatient providers for paracentesis, thoracentesis, and placement of tunneled drainage catheters.
To describe an in-house pilot program of tunneled catheter placement to provide immediate and longer-term symptom relief for selected hospice patients.
The logistics and cost of the pilot program are described. Key data elements, including select demographics, patient eligibility screening, and incidence of procedure-related or late complications are reported.
A total of 135 drainage procedures completed on 127 unique hospice patients over 27 months (2020-2023) were reviewed. The rate of procedure-related complications (<4%) and late complications (<3%) are low. The average cost per procedure ($1030) compares favorably with outpatient providers' fees. The program was well-accepted by the interdisciplinary hospice team, patients, and families.
An in-house program of tunneled catheter placement is a feasible option for hospice providers with low-cost exposure and high potential for improved quality of life and symptom relief for selected patients.
与腹水或胸腔积液过度积聚相关的症状可能难以通过药物治疗控制，并且会对临终关怀患者的生活质量产生重大负面影响。谷 Hospice，一家社区非营利临终关怀机构，历史上一直将患者转介给门诊医生进行腹腔穿刺术、胸腔穿刺术和隧道引流导管放置。
描述一种内部试点计划，即通过放置隧道式导管为选定的临终关怀患者提供即时和更长期的症状缓解。
描述了试点计划的后勤和成本。报告了关键数据要素，包括选择的人口统计学、患者资格筛选以及与程序相关或晚期并发症的发生率。
在 27 个月（2020-2023 年）期间，对 127 名独特的临终关怀患者共完成了 135 次引流程序。程序相关并发症（<4%）和晚期并发症（<3%）的发生率较低。每次手术的平均成本（1030 美元）与门诊医生的费用相比具有优势。该计划得到了多学科临终关怀团队、患者和家属的广泛认可。
对于临终关怀提供者来说，内部隧道式导管放置计划是一种可行的选择，其具有低成本风险和为选定患者提高生活质量和缓解症状的巨大潜力。
