CENTRAL VENOUS CATHETER PLACEMENT - EXTENDING THE ROLE OF THE NURSE

Objective: to improve the quality of the percutaneous tunnelled centra l venous catheter placement service for patients being treated for mal ignant disease. Design: a clinical nurse specialist was specially trai ned to insert percutaneous tunnelled central venous catheters accordin g to predetermined guidelines. Catheters were inserted under local ana esthetic in the outpatient department or the ward. The quality of the service was analysed and compared with the pre-existing service provid ed by junior medical staff(1). Subjects: two hundred adult patients wi th malignant disease seen between January 1995 and January 1996 at the Christie Hospital Trust. Main Outcome Measures: success of the proced ure, insertion-related infection rates and waiting times compared to h istorical controls. Results: the rate of failed insertions fell from 2 0% to 3% with a concomitant reduction in surgical referrals; for 97% o f patients waiting time was reduced to less than one working day compa red with 80% previously. Line-related infection rates in the first thi rty days following insertion fell from 10 episodes per 72 lines insert ed to two episodes per 200 lines inserted. Conclusions: training and u sing a clinical nurse specialist has improved the quality of service a nd gives junior doctors more opportunity to become competent in the te chnique of central venous catheter placement. The introduction of guid elines has encouraged a standard approach that facilitates audit.