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儿科中心静脉通路装置监测与巡查团队的有效性:一项单中心研究。

The Effectiveness of Pediatric Central Venous Access Device Surveillance and Rounding Team: A Single-Center Study.

作者信息

Hanaki Shojiro, Katayama Shuichi, Nakada Soichi

机构信息

Division of Pediatric Surgery, Department of General Surgery, Kurashiki Central Hospital, Kurashiki, JPN.

出版信息

Cureus. 2024 Apr 8;16(4):e57855. doi: 10.7759/cureus.57855. eCollection 2024 Apr.

Abstract

Introduction Central venous access devices (CVADs) are indispensable in the management of pediatric cancer patients, offering vital access to treatment. Yet, complications related to CVADs, such as infections, thrombosis, and dislocations, pose significant risks, potentially leading to prolonged hospitalization, intensive care unit admission, or even mortality. To address these challenges, our hospital established a pediatric CVAD surveillance and rounding team to improve the management and care of pediatric patients with CVADs. Materials and methods This single-center retrospective study evaluated the impact of the pediatric CVAD surveillance and rounding team on the management of pediatric oncology patients with CVADs at Kurashiki Central Hospital, Kurashiki, Japan. We included pediatric cancer patients under 18 years of age who underwent CVAD placement from January 2018 to December 2022. The team conducted weekly rounds focusing on a comprehensive checklist to ensure optimal CVAD care. We compared the incidence of catheter-related complications before and after the establishment of the rounding team using the Student's t-test and Fisher's exact test. Results The study encompassed 28 patients before and 39 after the implementation of the surveillance rounds. Significant reductions were observed in the number of dislocations (from 28.6% to 0%, p = 0.001) and local infections (from 17.9% to 2.6%, p = 0.04). While the decreases in thrombosis, catheter breakage/rupture, and catheter-related bloodstream infections (CRBSIs) did not reach statistical significance, they suggest a favorable trend toward enhanced management of CVADs. Conclusions The establishment of a pediatric CVAD surveillance and rounding team significantly reduced the incidence of dislocations and local infections among pediatric cancer patients with CVADs. This multidisciplinary team approach highlights the importance of continuous surveillance, teamwork, and education in enhancing the quality of CVAD care, contributing to safer patient outcomes and emphasizing the need for continuous improvement in pediatric CVAD management.

摘要

引言

中心静脉通路装置(CVADs)在儿科癌症患者的治疗管理中不可或缺,为治疗提供了至关重要的通路。然而,与CVADs相关的并发症,如感染、血栓形成和脱位,带来了重大风险,可能导致住院时间延长、入住重症监护病房,甚至死亡。为应对这些挑战,我院成立了儿科CVAD监测与查房团队,以改善儿科CVAD患者的管理和护理。

材料与方法

这项单中心回顾性研究评估了日本仓敷中央医院儿科CVAD监测与查房团队对儿科肿瘤CVAD患者管理的影响。我们纳入了2018年1月至2022年12月期间接受CVAD置入的18岁以下儿科癌症患者。该团队每周进行查房,重点关注一份综合检查表,以确保CVAD得到最佳护理。我们使用学生t检验和Fisher精确检验比较了查房团队成立前后导管相关并发症的发生率。

结果

该研究包括实施监测查房前的28例患者和实施后的39例患者。脱位数量(从28.6%降至0%,p = 0.001)和局部感染(从17.9%降至2.6%,p = 0.04)显著减少。虽然血栓形成、导管破裂/断裂和导管相关血流感染(CRBSIs)的减少未达到统计学意义,但它们表明在CVAD管理方面有改善的良好趋势。

结论

儿科CVAD监测与查房团队的成立显著降低了患有CVAD的儿科癌症患者的脱位和局部感染发生率。这种多学科团队方法凸显了持续监测、团队合作和教育在提高CVAD护理质量方面的重要性,有助于实现更安全的患者结局,并强调了儿科CVAD管理持续改进的必要性。

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