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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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 ORIGINAL ARTICLE
Year : 2022  |  Volume : 27  |  Issue : 5  |  Page : 600-604

Improvement in care and maintenance of Port-A-Cath following the introduction of care” bundle


1 Department of Pediatric Hematology and Oncology, KMC Hospital B R Ambedkar Circle, Mangalore, India
2 Department of Cardiothoracic and Vascular Surgery, KMC Hospital B R Ambedkar Circle, Mangalore, India
3 Department of Medical Oncology, KMC Hospital B R Ambedkar Circle, Manipal, Karnataka, India
4 Department of Radiodiagnosis, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
5 Division of Pediatric Hematology and Oncology, Department of Pediatrics, Kasturba Medical College, Mangalore; Manipal Academy of Higher Education, Manipal, Karnataka, India

Correspondence Address:
Harsha Prasada Lashakri
Division of Pediatric Hematology and Oncology, Department of Pediatrics, Kasturba Medical College, Mangalore 575 001;, Manipal Academy of Higher Education, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.jiaps_254_21

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Background: Port-a-cath is a type of indwelling central venous catheter used to manage pediatric patients who require long-term intravenous therapy. Objectives: The objective of this study was to improve the care and maintenance of port-a-cath among the nursing staff by introducing a care bundle. Materials and Methods: Pretraining and posttraining designs using PDSA (Plan, Do, Study, Act.) model were followed. We observed two sets of 30 procedures for accessing of port-a-cath by the nursing staff. Following the initial 30 observations of port-a-cath handling, a “care bundle” was designed as per the set standards of the maintenance of port-a-cath. It involved education and training and live audio-visual sessions. Two months after the initiation of the care bundle, the second set of 30 procedures was observed. Results: Following the introduction of the care bundle, the observed efficacy on obtaining verbal consent improved to 100% from 83%, arrangement of drugs and instruments before insertion to 100% from 90%, not touching the needle while inserting from 60%, administration of adequate amount saline flush from 83.3% (25/30), heparin administration from 71.1%, and looking out for signs of extravasation to 100% from 80%. Two nursing staff involvement improved from 23% to 63%. A 100% efficacy in the management of nonbleeding back scenarios was observed. The cross-checking of drug expiry improved from an initial 26.6% to 89.3%. The port-a-cath infections have significantly come down (3 vs. 0) (P < 0.05). Conclusion: Implementation of a “care bundle” has significantly improved the quality of handling of port-a-cath and reduction in infections.






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