Occlusion problems in central venous catheters: the child and family perspective.
The use of central venous catheters (CVCs) has revolutionized practice within paediatric oncology settings. However, many children experience problems with occlusion of these devices. When working effectively, CVCs can assist the administration of medication and withdrawal of blood samples and minimize the need for venepuncture, thus considerably easing the trauma of children undergoing treatment for malignant disease. However, when lines are occluded children will be subjected to venepuncture or anaesthetic for line replacement. There are a myriad of factors that may lead to occlusion. A study was undertaken to identify these and explore the effects that occlusion of a CVC can have on the child and family. The research was conducted in two phases. Phase one consisted of a review of case notes of 63 children from which five families were selected for interview. These were undertaken to examine the possible factors that may have precipitated line occlusion and the subsequent effect of this on their lives. The issues arising from the interviews and review of the case notes were used inform phase two, which comprised the development and distribution of a questionnaire in order to investigate key aspects within a larger population of 63 families. This article explores the information gained from children and families about the effect occlusion can have on them and their lives. Overall the findings revealed that parents felt anxious, angry and helpless when faced with occlusion and they described the coping strategies they used when the problem arose. Furthermore, providing information and education to parents regarding the care of the CVC was crucial. Following an analysis of the implications for practice the main recommendations were twofold. First, that structured teaching programmes and shared learning protocols should be developed to ensure that parents are fully conversant with the possible complications associated with the CVC. Second, parents should be provided with the knowledge and skills to feel competent in flushing their child's line when they go home. Both these recommendations have subsequently been introduced within the unit.