Soins Infirmiers Généraux
par Edgar Ortiz | San Lorenzo, Paraguay
Objectif: Improve the processes for vascular access, improving quality of life in children’s with cancer
The gross national income per capita in Paraguay is US$ 4040 which is lower than that of other countries in Latin America and the Caribbean. It has a population of 6.783.374 (D.G.E.E.C 2013) and 32% of them are less than 15 years (2.187.812). Mortality rate, under-5 (per 1,000 live births) is 22/1000 live birth 23% of the population are living below the national poverty line 30% has no access to healthcare. The estimated yearly incidence of childhood cancer is 7.5 cases per 100,000 children aged 0 to 14 years, and cancer is the second-leading cause of death in children aged 1 to 19 years. The Department of Pediatric Hematology-Oncology is one of the centers of reference of childhood cancer in Paraguay; it is embedded at the School of Medicine which depends on the National University of Asuncion. From its beginnings in 1987 it was the first center in the country that treated children with hematology and oncology problems both benign and malignant. Until 2012 was dependent on the service of Pediatrics of the school of Medicine from both resource and budgetary point of view. Annually receives 100-120 new cases of pediatric cancer, approximately 40% of cases expected at country level. The ReNACI network was conceived and built by Department of Pediatric Hematology-Oncology of the Clinical Hospital with the goal of establishing and sustaining regional pediatric clinics for early cancer detection, referral, social assistance, and follow-up to prevent treatment abandonment. In the last three years the number of nurses working in the Department of Pediatric Hematology-Oncology and the ReNACI network increased significantly from 12 to 62 professionals. The nursing staff is not specialized in pediatrics or pediatric oncology, it is common to multiple jobs working in other hospitals usually in different areas to pediatric oncology, with different management systems of patients, and we considered the standardization of all the processes of nursing staff. The Department of Nursing has a continuous training program within the Department of Pediatric Hematology-Oncology and a staff dedicated to preventing infection but does not have a protocol for managing vascular access, or a program to improve the quality of life of the children admitted to the department. Repeated requiring venipuncture these patients for the treatment, come to damage the peripheral vascular access sites Therefore, treatment can be performed with catheters extended stay, reducing complications, promotes patient comfort and reduces costs, so they are widely accepted for use in central vascular access. Among the factors that influence the choice of the catheter or the type of vascular access we can include: Need to access, type of illness and treatment (vesicant and irritating drug), scheduled time for permanence, the general condition of the patient, the state General veins, socio-economic and cultural conditions Vascular accesses in service of pediatric hematology-oncology are currently peripherals in 90% of cases, short-term central catheters in 8% of cases and long-lived plants (prot-a-cath) in 2% of the cases Within the set of actions that involves the vascular access, nursing professionals assume an important role in the process. Interesting to note what is done through peripheral venous vessels, as the most used for its versatility, pose less serious complications and be less invasive than other alternatives as may be made through central venous or arterial vessels, developing nurses intense activity around it. Although complications usually associated with peripheral venous access (AVP) not involve a very high morbidity and mortality, it is true that any complication for patients, however slight, they supposed discomfort, changes in the location of the catheter, limitation of movement, disturbances in therapy, etc. and when these become serious complications associated with considerable morbidity due to its high frequency of use. In the few cases in which catheters long stay settled in the department infectious complications are mostly presented by inadequate management, while in some cases patients with long term catheters underwent peripheral venous access because nurses was not trained to use. This certainly affects the quality of life of pediatric cancer patients, as these vascular accesses aim to provide pediatric cancer patients an ideal venous access for administering treatment, intravenous therapy without interruption, decreasing need for venipuncture and complications, improving the quality of life of these children The advantages of long-standing central catheters in children with cancer include: less venipunctures eliminating pain, reducing the stress level of the patient, the family and nurses during the administration of medications given, immediate availability of a venous access, safe administration of chemotherapy and other solutions, repeated blood sampling, simultaneous administration of different solutions and medications, reduced risk of infection compared with peripheral venous access. Many centers set up teams dedicated to appropriate management of standardized vascular access and use certain forms of surveillance were significantly reduced rates of severe phlebitis, and program participants expressed satisfaction with the peripheral program. The interest of developing a directory of care is also to establish appropriate and necessary conditions that favor a uniform and standardized clinical practice, allowing nurses provide excellent care in the establishment, maintenance and removal of peripheral and central venous access peripherally inserted It is a necessity and an obligation to face to conform to the quality standards required today, develop a guide procedures with a view of nursing, with the participation of professionals that in their clinical practice they are related to care in the peripheral and central venous access Through the project, we aim to reduce the rates of severe phlebitis and other infections, improve the quality of life of cancer patients admitted to the Department of Hematology-Oncology at the Clinical Hospital and the National Network for Childhood Cancer In addition increased use of central venous catheters long tenure, training nurses in their management.