Nurse-Initiated Protocol for Central Venous Catheter (CVC) Selection for Blood and Marrow Transplant (BMT) Recipients

Topic Significance & Study Purpose/Background/Rationale

Advances in the design of CVCs has led to a variety of features that increase the functionality of CVCs used in the care of BMT patients. Examples of these features include: power injection of contrast media, central venous pressure (CVP) monitoring, apheresis procedures including stem cell collection, plasma exchange and extracorporeal photopheresis. However, matching the right CVC with the individual treatment requirements for BMT patients can be a challenge. For example, CVC’s composed of polyurethane are not recommended for infusion containing high concentrations of alcohol (e.g. undiluted etoposide). At our institution, an opportunity for improvement was identified due to an increase in occurrences of inappropriate CVC selection.  The decision to develop a nurse-initiated protocol was based on the knowledge of infusion therapy.

Methods, Intervention, & Analysis

In order to optimize the best outcome of selection and placement of the right CVC for BMT recipients, a nurse-initiated protocol for CVC selection was developed. CVC options and patient risk factors that nurses utilize in the care and maintenance of CVCs. The CVC selection protocol is based on the specific requirements of the patient’s road map for transplant. Application of manufacturer’s guidelines for each device and collaboration by a multidisciplinary team were used to identify the best CVC choice for the patient with reference to the patients planned therapies.  For example:

Autologous BMT Patient Criteria	CVC Type
Standard mobilization and collection No undiluted etoposide	High flow temporary CVC for mobilization/collection Double lumen power injectable peripherally inserted central catheter (PICC)

To implement the protocol, the BMT RN Coordinator starts with a review of the patient’s road map for transplant in collaboration with the BMT pharmacist. After the review the RN selects the appropriate CVC based on the protocol table that pairs the correct CVC with patient criteria. Once the selection is made the BMT RN Coordinator enters the order for the CVC type into the electronic medical record. The order is then accessed by the surgeon, interventional radiologist and/or nurse placing the CVC.

Findings & Interpretation   

N/A

Discussion & Implications

The goal of this quality improvement project is to eliminate occurrences of inappropriate CVC placement in autologous and allogeneic transplant recipients.