- Email: [email protected]
Standardization of central line care
188
Proceedings
of 19th Annual
Conference I
cess; in many of these children, a vascular access device (VAD) is surgically placed to allow ready access to the central venous system without repeated venipunctures.’ Nurses are often responsible for educating parents and young children regarding home care and safety issues for these devices. This poster described the development of a teaching tool, in the form of a storybook for preschool children, (My VAD Book), explaining the routine care and safety issues associated with VADs. The purpose of this tool is to encourage open communication between parent (or caretaker) and child with the goal of helping the child to integrate the experiences associated with a VAD into his day-to-day life. The story (with accompanying pictures) tells about a child with a VAD. Principles related to the preschooler’s cognitive development (eg, egocentricity, concrete thinking, learning through repetition and imitation) are incorporated throughout My VAD Book. The child (referred to as “I” or “me”) explains where he got the VAD (“in the hospital”), what the VAD is for (“getting medicine”), some safety issues (“I never pull on my VAD”), and home care (“mommy puts the medicine in” and “daddy changes my bandage”). Throughout the story, the child’s Teddy is an everpresent companion whose experiences mirror the child’s (“Teddy has a VAD, just like me”) and at the conclusion of the story, the child becomes Teddy’s caretaker (“I put a new bandage on Teddy”). Many teaching tools outlining home care of the VAD are available for parents. At our institution, a developmentally appropriate teaching tool for preschool children with VADs was not available. My VAD Book was developed in response to staff identification of its need. A questionnaire will be given to the first 30 families using the tool to determine its effectiveness. Cooperation of the child with care, child’s knowledge of safety issues, and integration of VAD care into the child’s normal routine will be assessed before introducing the tool to the child and 6 weeks after the tool is introduced. Coping with serious illness can provide an opportunity for growth; when a child devel-
ops feelings of mastery over a situation, a sense of competence and self esteem emerges.2 The use of this teaching tool by pediatric oncology nurses can help to foster learning, growth and understanding for the preschool child with cancer who requires prolonged venous access. Use of this tool may also promote strengthening of the parent-child bond through the shared experiences of day-to-day coping with the child’s VAD.
References 1. Marcoux C, Fisher S, Wong D: Central venous access devices in children. Pediatric Nurs 16: 123- 133, 1990 2. Schuster CS, Ashburn SS: The Process of Human Development: A Holistic Lifespan Approach (ed 3). Philadelphia, PA, Lippincott, 1992
Standardization of Central Line Care Kimberley A. Jenkins-Campbell, RN, MSN, CPON, Pediatric Hematology/ Oncology Clinical Nurse Specialist, Knoxville, TN, Lilian Barroso, RN, MSN, and Caroline Graber, RN, MS, CIC Central lines become an issue for newly diagnosed oncology patients and their families simultaneously with issues such as treatment options and overall prognosis. A successfully maintained central line aids in both the timing of therapy and ease of therapy administration. Infection is a common complication of these devices. Within our institution patients and parents were noticing inconsistencies in dressing change technique among staff. The discrepancy involved both sterile technique and dressing change procedures. A Central Line Committee was formed to address these reports. Verbal surveys of staff were conducted by members of the Central Line Committee. The staff attributed differences in technique and procedure to lack of recent review or update of the institution’s policy and different surgeon’s preference. After thorough review, the Central Line Committee proposed a house-wide change in the institution’s central line dressing change policy. The change included initiating the use of a new product called Biopatch. New dressing change kits were introduced. Lastly, some minor changes such as increasing the length
Proceedings
of 19th Annual
of time between dressing changes were recommended. This house-wide change was approved by all appropriate committees. A proposal was submitted to the Institutional Review Board. The proposal was threefold. (1) A 6-month retrospective and prospective chart review would begin once the new standard of care was introduced. The review would analyze infection rates. Data collection would begin once the new policy was being implemented on the units. (2) A cost analysis will be done reviewing costs to the institution as well as the patient and family. (3) A questionnaire will be distributed to both staff and families familiar with both standards of care. The questionnaire will assess satisfaction with the Biopatch and the new dressing change procedure. The project began April 17, 1995. Data will be collected for 6 months. If infection rates are not significantly different, or if they have improved, the dressing will be changed once every 7 days for the next 6 months. Also, we hope to show decreased cost to both institution and patient. Lastly, it is anticipated that staff consistency and compliance with one house-wide standard of care will be shown.
Educating the School Nurse: An Important Link for the Child With Cancer Angela Atkinson Ethier, RN, MSN, CPON, CPN, Clinical Nurse Specialist, Texas Children’s Hospital, Sugar Land, TX, and Kimberly Hillman, RN, BSN School nurses are an important link for the child with cancer’s school reentry. A survey of area school nurses located in a major city in the Southwestern United States revealed a
Conference
189
need for childhood cancer information including disease, treatment side effects, and prognosis. School nurses also indicated difficulty identifying a contact person at the child’s treatment center. A collaborative effort between inpatient and outpatient nursing developed a letter and childhood cancer information sheet for the school nurse as part of our School Intervention Program for children treated for cancer at our institution. The purpose of the letter and information sheet is to provide a contact person and general information about childhood cancer, respectively. The letter addressed to the school nurse identifies the student being treated for cancer and their diagnosis. A clinical nurse specialist and the child’s pediatric nurse practitioner are identified including name and phone number as contacts for the school nurse. The overview, “Information for the School Nurse About Childhood Cancer” briefly addresses 11 topics. Topics include comparison of adult and childhood cancer, epidemiology, prognosis, types of childhood cancer, age/gender/race, treatment modalities, side effects, disease information, immunizations, chicken pox, and psychosocial needs. Both the letter and overview promote communication between the hospital nurse and school nurse of the child being treated for cancer. We anticipate that these tools will dispel myths about childhood cancer and alleviate fears by providing basic information and a link that previously was missing between the hospital nurse and school nurse. Early response to the letter and overview has been positive. Ongoing evaluation continues.
Proceedings
of 19th Annual
Conference I
cess; in many of these children, a vascular access device (VAD) is surgically placed to allow ready access to the central venous system without repeated venipunctures.’ Nurses are often responsible for educating parents and young children regarding home care and safety issues for these devices. This poster described the development of a teaching tool, in the form of a storybook for preschool children, (My VAD Book), explaining the routine care and safety issues associated with VADs. The purpose of this tool is to encourage open communication between parent (or caretaker) and child with the goal of helping the child to integrate the experiences associated with a VAD into his day-to-day life. The story (with accompanying pictures) tells about a child with a VAD. Principles related to the preschooler’s cognitive development (eg, egocentricity, concrete thinking, learning through repetition and imitation) are incorporated throughout My VAD Book. The child (referred to as “I” or “me”) explains where he got the VAD (“in the hospital”), what the VAD is for (“getting medicine”), some safety issues (“I never pull on my VAD”), and home care (“mommy puts the medicine in” and “daddy changes my bandage”). Throughout the story, the child’s Teddy is an everpresent companion whose experiences mirror the child’s (“Teddy has a VAD, just like me”) and at the conclusion of the story, the child becomes Teddy’s caretaker (“I put a new bandage on Teddy”). Many teaching tools outlining home care of the VAD are available for parents. At our institution, a developmentally appropriate teaching tool for preschool children with VADs was not available. My VAD Book was developed in response to staff identification of its need. A questionnaire will be given to the first 30 families using the tool to determine its effectiveness. Cooperation of the child with care, child’s knowledge of safety issues, and integration of VAD care into the child’s normal routine will be assessed before introducing the tool to the child and 6 weeks after the tool is introduced. Coping with serious illness can provide an opportunity for growth; when a child devel-
ops feelings of mastery over a situation, a sense of competence and self esteem emerges.2 The use of this teaching tool by pediatric oncology nurses can help to foster learning, growth and understanding for the preschool child with cancer who requires prolonged venous access. Use of this tool may also promote strengthening of the parent-child bond through the shared experiences of day-to-day coping with the child’s VAD.
References 1. Marcoux C, Fisher S, Wong D: Central venous access devices in children. Pediatric Nurs 16: 123- 133, 1990 2. Schuster CS, Ashburn SS: The Process of Human Development: A Holistic Lifespan Approach (ed 3). Philadelphia, PA, Lippincott, 1992
Standardization of Central Line Care Kimberley A. Jenkins-Campbell, RN, MSN, CPON, Pediatric Hematology/ Oncology Clinical Nurse Specialist, Knoxville, TN, Lilian Barroso, RN, MSN, and Caroline Graber, RN, MS, CIC Central lines become an issue for newly diagnosed oncology patients and their families simultaneously with issues such as treatment options and overall prognosis. A successfully maintained central line aids in both the timing of therapy and ease of therapy administration. Infection is a common complication of these devices. Within our institution patients and parents were noticing inconsistencies in dressing change technique among staff. The discrepancy involved both sterile technique and dressing change procedures. A Central Line Committee was formed to address these reports. Verbal surveys of staff were conducted by members of the Central Line Committee. The staff attributed differences in technique and procedure to lack of recent review or update of the institution’s policy and different surgeon’s preference. After thorough review, the Central Line Committee proposed a house-wide change in the institution’s central line dressing change policy. The change included initiating the use of a new product called Biopatch. New dressing change kits were introduced. Lastly, some minor changes such as increasing the length
Proceedings
of 19th Annual
of time between dressing changes were recommended. This house-wide change was approved by all appropriate committees. A proposal was submitted to the Institutional Review Board. The proposal was threefold. (1) A 6-month retrospective and prospective chart review would begin once the new standard of care was introduced. The review would analyze infection rates. Data collection would begin once the new policy was being implemented on the units. (2) A cost analysis will be done reviewing costs to the institution as well as the patient and family. (3) A questionnaire will be distributed to both staff and families familiar with both standards of care. The questionnaire will assess satisfaction with the Biopatch and the new dressing change procedure. The project began April 17, 1995. Data will be collected for 6 months. If infection rates are not significantly different, or if they have improved, the dressing will be changed once every 7 days for the next 6 months. Also, we hope to show decreased cost to both institution and patient. Lastly, it is anticipated that staff consistency and compliance with one house-wide standard of care will be shown.
Educating the School Nurse: An Important Link for the Child With Cancer Angela Atkinson Ethier, RN, MSN, CPON, CPN, Clinical Nurse Specialist, Texas Children’s Hospital, Sugar Land, TX, and Kimberly Hillman, RN, BSN School nurses are an important link for the child with cancer’s school reentry. A survey of area school nurses located in a major city in the Southwestern United States revealed a
Conference
189
need for childhood cancer information including disease, treatment side effects, and prognosis. School nurses also indicated difficulty identifying a contact person at the child’s treatment center. A collaborative effort between inpatient and outpatient nursing developed a letter and childhood cancer information sheet for the school nurse as part of our School Intervention Program for children treated for cancer at our institution. The purpose of the letter and information sheet is to provide a contact person and general information about childhood cancer, respectively. The letter addressed to the school nurse identifies the student being treated for cancer and their diagnosis. A clinical nurse specialist and the child’s pediatric nurse practitioner are identified including name and phone number as contacts for the school nurse. The overview, “Information for the School Nurse About Childhood Cancer” briefly addresses 11 topics. Topics include comparison of adult and childhood cancer, epidemiology, prognosis, types of childhood cancer, age/gender/race, treatment modalities, side effects, disease information, immunizations, chicken pox, and psychosocial needs. Both the letter and overview promote communication between the hospital nurse and school nurse of the child being treated for cancer. We anticipate that these tools will dispel myths about childhood cancer and alleviate fears by providing basic information and a link that previously was missing between the hospital nurse and school nurse. Early response to the letter and overview has been positive. Ongoing evaluation continues.