UNCOVERING PRACTICE DIFFERENCES RELATED TO THE CARE OF INDWELLING AND EXTERNAL TUNNELED CATHETERS ACROSS PRACTICE SETTINGS IN A LARGE ACADEMIC MEDICAL CENTER.

Tunneled catheters place the client at risk for complications such as infection, occlusion and extravasations. Inappropriate care of these devices can result in persistent disability or even early death. The overall complication rate involving tunneled catheters is reported between 1.4% and 14.4 % (Dicarlo, et al. 2001). Evidenced-based guidelines identified that education and training of health care providers who insert and maintain these catheters is one of the most important strategies for the prevention of catheter-related infections (Ogrady, et al. 2002). The MGH nursing policy and procedure manual clearly delineates the care for these catheters. Despite this, members of the Cancer Nursing Practice Committee (CNPC) at the Massachusetts General Hospital (MGH), representing oncology nurses in both adult and pediatric ambulatory and inpatient areas, identified that there is variation in the nursing care of these catheters across care units. In an effort to identify care actually being delivered to this population, members of the CNPC have developed an electronic survey to be administered across the oncology nursing clinical areas. The goals are to identify current practice, and develop an educational program that will promote consistency of care across practice settings. The objective of the Survey is to describe actual nursing management of Port-a-Caths and Hickman/Broviac catheters in the different inpatient units and outpatient treatment areas. An ongoing review of the literature will be conducted to evaluate practice at MGH, as compared to evidence-based best practices. The survey data will be used to inform the CNPC current nursing practice and serve as a guide for an education curriculum to assure consistency with evidence-based practice Analysis of the survey as well as example of the education plan will be presented. Engaging the staff nurses in this process and providing the time and leadership support required has proven to be an effective means of engaging the staff nurse in the process of shaping evidence based practice and critical peer review of oncology nursing care. [ABSTRACT FROM AUTHOR]