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AOSTCACT TRANSVERSAL THEMES
SOCIÉTÉ INTERNATIONALE D'ONCOLOGIE PÉHATRIQUE
SIOP ASIA CONGRESS
NURSING
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ABSTRACT NO.: 0-140
The usage of central venous access devices to improve the quality care in children,
treated with intensive chemotherapy
A.V. Petrichenko, I. Logachova, K.F. Savlaev, A.V. Zabrodnaya
Applied Research Center for Specialized Medical Care of Children named after V.F. Voyno-Yasenetsky, Russia
Key words: central venous access devices, pediatric oncology
Introduction. The requirements for the qualifications of the nursing staff of modern pediatric oncological department are extremely high. It is currently impossible to achieve best results of treatment of children with solid tumors, without the usage of modern treatment protocols. The treatment plan for patients with solid tumors included innovative methods of anticancer therapy, supportive treatment and high quality of nursing care Aim. Optimization of medical care for children treated from solid tumors.
Materials and methods. The data were collected from patients who received the treatment for solid tumors at pediatric oncological department during 2013-2015 years. A central venous access device plays an important role in the management of cancer patients. They serve not only for safe administration of chemotherapy, but also for prolonged administration of fluids, blood and blood products, antibiotics, parenteral nutrition, and frequent blood sampling. Different types of central venous access devices are associated with different patterns of complications. There are different types of venous access devices, but totally implantable venous access ports (TIVAP) are now used most commonly because of their safety, cosmetics, low infection rates, ease of implantation, and usage. A proper TIVAP not only provides secure vascular access for all patients' therapeutic needs, but can also reduce the frequency of venipuncture for the purposes of native vessel protection. In this study, 75 patients at the age from 9 months till 18 years received port implantations. Results. However, the procedure and its subsequent maintenance are not free of side effects -14 (27 %) TIVAP were removed prematurely due to complications. We had observed complications associated with TIVAP, such as thrombosis and blockage at 11 patients (21 % cases), embolization at 2 patients (4 % cases), and catheter fracture at 1 patients (2 % cases). We do not observed important complications, such as infections, pneumothorax, hematoma.
Conclusion. Intravenous ports are very important for children with solid tumors. The complication rate has decreased not only with improved techniques and material, but also high quality of nursing care. With increasing experience and knowledge about TIVAP care, we hope the associated complications will decrease, resulting in improved patient safety and compliance with the device.
May 2016, Moscow, Russia
OF PEDIATRIC HEMATOLOGY and ONCOLOGY
ABSTRACT NO.: OP-141
How to organize the best nurses care of venous catheter
D.Sh. Bikkulova
Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Moscow, Russia Key words: hand skills, training dummy, commitment to the protocol
Introduction. Federal Research Centre of Pediatric Hematology, Oncology and Immunology began accept of patients in a new building in January, 2012. The medical staff had experience, skills and knowledge in different areas of medicine, not only hematology and oncology. Hematology and oncology patients have certain specifics: need CVC, receive chemotherapy and steroid therapy. As a result patients have immunosuppression, metabolic disorders, fragile skin. These patients have a high risk of developing the catheter-related infections of bloodstream. Nurses has to have additional knowledge in the area of hematology/oncology, good hand skills to support aseptic conditions. Aim. It was important to define uniform maintenance and care of central venous catheters (CVC).
Materials and methods. The solution of CVC problems is possible if the hospital have Internal protocols of venous access, Clinical recommendations of vascular access, full course of lectures about catheters, a training class for nurses. CVC checklist is also needed.
Training component: nurses study to master hand skills, to remember the protocol, to know complications and prevent them, maintenance and care of CVC. Newly employed staff is allowed to start work after mastering hand skills on the silicon dummy.
Task force were created in for preparation and adjusting protocols for our local needs. Task force consists of reputable employees: vice-chief of the hospital, anesthesiologists, hematologists, epidemiologists from the Department of Infection Control, nurses. Discussions about measures on prevention the central line-associated bloodstream infections (CLABSI) was especially difficult and long. The market offers a big set of dressing for catheters fixation. It is important to define what dressing to apply on the catheter area. It is necessary that all members of the task force would agree with offered solution. Some members of the task force were not satisfied with scientific publications only. Several points of the CVC protocol were accepted after additional tests or clinical trials conducted in our Hospital.
Results. We have protocols : No. 1 - the intraosseous vascular access, No. 2 - the Short peripheral catheter, No. 3 - Short-term CVC, No. 4 Long-term tunnelled CVC, No. 5 Long-term implanted CVC, No 6 PICC-line. Adoption of protocols in medical center is long and laborious process. Staff has various experience in the medical area and habits in their clinical practice. Agreement on certain opinion among the staff is easier to achieve through increasing level of knowledge, additional trial and search of compromises. Conclusion. It is very important to have training class with tailor's dummy for to master hand skills, CVC protocols, commitment to the protocol for the best nurses care and maintenance CVC.
ABSTRACT NO.: O-189
The usage of innovative methods of sanitary disposal of the surgical unit
A.V. Petrichenko, I. Ozhogina, K.F. Savlaev, A.V. Zabrodnaya
Applied Research Center for Specialized Medical Care of Children named after V.F. Voyno-Yasenetsky, Russia
Key words: surgical unit, cleanings, disinfections
Introduction. The timeliness of the problem is based on the necessity of reduction of the use of cleaning and disinfecting agents, water consumption, and decrease of pressure on medical stuff by using ergonomical inventory and scientifically based organization of cleaning process with the application of innovative technologies. Aim. Prevention of post-surgery complications and hospital infection.
Materials and methods. From 2013 till the December of 2015 the system of harmless cleaning is applied in the surgical unit, it is used for all the cleanings and disinfections. The inventory is made of polymeric materials, it can stand the use of disinfecting agents and autoclaving and has color coding. Previously dampen expendable cotton materials are used on the strictly defined area, it keeps the constant concentration of disinfection solution what leads to the prevention of cross contamination and also to the prevention of splash of contaminated liquids. As cleaning is over the inventory needs sanitary disposal for its future use. The system can be used with any means which are appropriate for the cleaning of operation unit.
Results. 153 deep cleanings and 2 964 ordinary cleanings are made. The use of the system allowed to reduce the stuff by 67 % and to reduce the time of cleaning for 2.6 times. Duly made washouts and inoculations showed negative result in all cases. The quantity of sanitary indicator microorganisms using all the methods of cleaning amounted to 0 % whereas
the norm before the start of the work is 200 CFU/cm and the norm during the work is 500 CFU/cm. Performed 497 operations in 460 children with solid tumors, from 2013 till 2015 Co
years. Early postoperative complications caused by an infectious process were observed in 7 (1.5 %) cases. 3
Conclusion. The innovative system of harmless cleaning is aimed to the prevention of cross contamination, the spread of hospital infection and infectious post-surgery complications. It allows to optimize the stuff and the time of cleaning, reduce the terms of preparation for cleaning and it can significantly improve the epidemiological conditions of the operation unit.
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