A National Survey on Peri-interventional Management of Percutaneous Transhepatic Biliary Drainage.

PURPOSE: The purpose of this study is to evaluate knowledge about management of percutaneous transhepatic biliary drainage (PTBD) catheters among nurses taking care of hepato-pancreato-biliary (HPB) patients. METHODS: Six HPB nurses from the Dutch national HPB association created a questionnaire that was complemented by 2 HPB surgeons, 3 HPB interventional radiologists, and a methodologist. Registered nurses working at the department of gastroenterology or gastrointestinal surgery and familiar with the care for HPB patients were invited to complete the questionnaire. RESULTS: In total 120 completed questionnaires from Dutch nurses were returned. The responders were working in 38 of 64 different hospitals. About half of the respondents considered their own knowledge insufficient, which was reflected in the response to the specific questions concerning the PTBD procedure, and 70% rated the knowledge of their immediate nursing colleagues as insufficient. Less than 50% of the respondents knew whether antibiotic-prophylaxis or "pain medication" was required before PTBD procedure. Only a few respondents were aware of the existence of a hospital protocol for PTBD management and its content. CONCLUSIONS: Nursing care for biliary catheters is not standardized nationwide, and consensus on management is lacking. An evidence-based guideline for PTBD management is advised for nursing care of patients with HPB diseases.

Vía Clínica. Tratamiento Del Hepatocarcinoma / The clinical pathway of treatment of hepatocellular carcinoma

Introducción: la práctica clínica habitual nos muestra la gran variabilidad presente en la atención médica en pacientes con una misma patología. Las vías clínicas son planes asistenciales integrados y sistematizados para determinados procesos. El desarrollo del proceso asistencial del tratamiento del hepatocarcinoma (HCC) se encuentra dentro del marco asistencial de los departamentos del Área de Tumores HPB (Hepatobiliopancreática), Hepatología y Cirugía General de la Clínica Universidad de Navarra (CUN). Objetivos: elaborar una vía clínica capaz de organizar, homogeneizar y estandarizar la atención de los pacientes diagnosticados de HCC y que se pueda aplicar desde el inicio hasta el final en el transcurso de esta enfermedad. Metodología: se ha definido el conjunto de actos asistenciales necesarios para atender de la mejor forma posible a un paciente que acuda a la Clínica para ser tratado de hepatocarcinoma. El ámbito del estudio se encuentra en la CUN, clínica privada que forma parte de la Universidad de Navarra. Resultado: se ha desarrollado la vía clínica del tratamiento del hepatocarcinoma, centrada en el tratamiento quirúrgico y el trasplante hepático. Conclusiones: las vías clínicas suponen una disminución de la variabilidad y un control de calidad en la práctica clínica, permitiendo analizar la información que nos proporcionan los indicadores, las encuestas de satisfacción y el registro informático de los datos(AU)

Introduction: The regular clinical practise slows a wide variability present in medical care in patients with the same pathology. The clinical pathways are integrated and systematized care plans for certain processes. The development of the hepatocarcinoma's (HCC) health care treatment is within the care frame of Tumoral Area's departments, Hepatology and General Surgery in the Clinic University Of Navarra (CUN). Objectives: To conduct a clinical pathway able to organize, homogenize and standardize the care of patients diagnosed with hepatocarcinoma and that could be applied from the beginning to the end of the course of this disease. Methodology: The identification of the set of care procedures wich would be necessary to achieve the best possible result in a patient who comes to the clinic to be treated for an hepatocarcinoma. The study' scope has taken place at the CUN, a private clinic that is a part of the University of Navarra. Result: The clinical pathway of the hepatocarcinoma's treatment has been developed centered on the surgical treatment and the hepatic transplant. Conclusion: The clinical pathways represents a decrease in variability and quality control in clinical practice, and the ability to analyze the information that indicators provide us, the satisfaction surveys and the computerized registration of electronic data(AU)