Abordaje del acceso vascular por equipo de terapia infusional: seguridad y calidad asistencial / Approach to vascular access by infusion therapy team: safety and quality of care

Objetivo: describir la evolución del modelo de atención del acceso vascular por un equipo de terapia infusional enfermero referente (ETI) y sus resultados en la seguridad vinculados al acceso vascular central de inserción periférica (PICC) en pacientes oncohematológicos. Métodos: estudio observacional en una cohorte retrospectiva de 3.423 pacientes oncohematológicos a los cuales se les indicó un PICC ambulatoriamente durante 2012-2021. Variables: modelo de atención, motivo de la indicación, método de comprobación de la colocación del acceso, complicaciones del acceso vascular. Recogida de información mediante datos primarios del registro de acceso vascular y registro clínico de la historia informatizada ESPOQ2©. Análisis descriptivo paquete estadístico IBM SPSS® V.23.0 . Resultados: la creación de un equipo referente de terapia infusional incrementó la capacidad de colocación de catéteres, pasando de 98 (2013) a 768 (2021). La indicación del PICC pasó del 45,80% por instauración de quimioterapia mediante bomba de infusión domiciliaria (2016) al 93,70% por indicación por fármaco irritante o vesicante (2021) (p< 0,001). La introducción de la técnica ecoguiada y método electro-intracavitario de control de punta disminuyeron las complicaciones por flebitis mecánicas y la radiación por comprobación de catéter (p< 0,001). Conclusiones: los modelos de atención con equipos de terapia infusional referentes consolidados incrementan la seguridad del paciente oncológico portador de acceso vascular PICC.(AU)

Objective: to describe the evolution of the vascular access care model led by a nurse infusion therapy (ETI) team and its safety results associated with peripherally inserted central vascular access (PICC) in oncohematology patients. Methods: descriptive observational study in a retrospective cohort in 3,423 oncohaematological patients who were indicated for a PICC on an outpatient basis during 2012 to 2021. Variables: Care model, reason for the indication, access placement verification method, vascular access complications. Data collection using primary data from the vascular access registry and clinical registry of the ESPOQ2© computerized history. Descriptive analysis using IBM® SPSS® Statistics V.23.0. Results: infusional teams' reference increased the capacity to place catheters, going from 98 (2013) to 768 (2021). The indication for the PICC went from 45.80% due to initiation of chemotherapy home infusion (2016) to 93.70% due to an indication for an irritant or vesicant drug (2021) (p< 0.001). The introduction of the ultrasound-guided technique and electro-intracavitary method of tip control decreased complications due to mechanical phlebitis and radiation due to catheter verification (p< 0.001). Conclusions: care models with consolidated reference infusion therapy teams increase the safety of cancer patients with PICC vascular access.(AU)

Evidence on port-locking with heparin versus saline in patients with cancer not receiving chemotherapy: A randomized clinical trial.

Objective: To assess the safety and efficacy of port-locking with heparin every 2 months vs. every 4 months and vs. saline solution every 2 months in patients with cancer not receiving active chemotherapy. The hypothesis stated that locking with heparin at four-month intervals and saline at two-month intervals would not increment > 10% of port obstructions. Methods: Multicentre, phase IV parallel, post-test control group study took place at the two chemotherapy units of oncology hospitals. Included patients with cancer with ports that completed the chemotherapy treatment but still having port maintenance care or blood samples taken up to four months. A sample of 126 patients with cancer in three arms was needed to detect a maximum difference of 10% for bioequivalence on the locking methods. Consecutive cases non-probabilistic sampling and randomized to one of the three groups; group A: received heparin 60 IU/mL every two months (control) vs. group B heparin every four months and vs. saline every two months in group C. Primary variables were the type of locking regimen, port obstruction, and absence of blood return, port-related infection, or venous thrombosis during the study period. Clinical and sociodemographic variables were also collected. Results: A total of 143 patients were randomly assigned; group A, 47 patients with heparin every 2 months, group B, 51 patients with heparin 4 months, and group C, 45 patients with saline every 2 months. All participants presented an adequate blood return and no obstructions, until the month of the 10th, when one participant in the group A receiving was withdrawn due to an absence of blood flow (P â€‹= â€‹0.587). Conclusions: Port locks with heparin every 4 months or saline every 2 months did not show differences in safety maintenance, infection, or thrombosis compared to heparin every 2 months.