Application and effect evaluation of multidisciplinary team management model: On central venous access device associated skin impairment based on Delphi method

Abstract

Objective:

To establish a multidisciplinary management model based on Delphi method to guide nursing practice and reduce the incidence of CVAD-associated Skin Impairment (CASI) in tumor patients.

Methods:

On the basis of literature review and focus group interview, the initial item pool of CASI management model for cancer patients was determined. The Delphi method was used to conduct two rounds of letter consultation with 36 authoritative and representative experts to determine the content and weight of indicators of CASI multidisciplinary management model for cancer patients.

Results:

Most of the research group were experts with bachelor degree or above. More than 90% of experts have worked for more than 10 years; Areas of expertise include oncology care, venous therapy, wound stomatology, and dermatology. The recovery rate of the two rounds of expert correspondence questionnaire was 100%. The authority coefficient of experts was 0.898, indicating a good degree of authority. Kendall’s harmony coefficients were 0.193 and 0.250, with statistically significant differences (p < 0.001). After two rounds of expert letter consultation, a multidisciplinary management model of CASI for cancer patients was initially formed, which included 15 first-level prevention indexes and 38 second-level prevention indexes of CASI for cancer patients. There were 9 first-level indexes and 16 second-level indexes of CASI treatment in tumor patients.

Conclusion:

Cancer patients based on Delphi method to construct CASI multidisciplinary management model has high reliability and scientificity, multidisciplinary management model in the management of patients with tumor CASI exploration will provide new methods for central venous catheter nursing and the new way of thinking, will also be intravenous fluids will provide a scientific basis for professional development and quality improvement and practical experience.

Keywords

Central venous access device (CVAD)CVAD-associated skin impairment (CASI)multidisciplinary team management model Delphi method nursing

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References

Gorski

Hadaway

Hagle

, et al. Infusion therapy standards of practice, 8th edition. J Infus Nurs 2021; 44(1S): S1–S224.

Martincich

Cini

Lapkin

, et al. Central venous access device complications in patients receiving parenteral nutrition in general Ward settings: a retrospective analysis. J Parenter Enteral Nutr 2020; 44: 1104–1111.

Broadhurst

Moureau

Ullman

. Management of central venous access device-associated skin impairment: an evidence-based algorithm. J Wound Ostomy Continence Nurs 2017; 44(3): 211–220.

Curto-García

García-Suárez

Callejas Chavarria

, et al. A team-based multidisciplinary approach to managing peripherally inserted central catheter complications in high-risk haematological patients: a prospective study. Support Care Cancer 2016; 24(1): 93–101.

Ullman

Mihala

O’Leary

, et al. Skin complications associated with vascular access devices: a secondary analysis of 13 studies involving 10,859 devices. Int J Nurs Stud 2019; 91: 6–13.

Zhao

Wei

, et al. Medical adhesive-related skin injury prevalence at the peripherally inserted Central catheter insertion site: a cross-sectional, multiple-center study. J Wound Ostomy Continence Nurs 2018; 45(1): 22–25.

Serra

Ielapi

Barbetta

, et al. Skin tears and risk factors assessment: a systematic review on evidence-based medicine. Int Wound J 2018; 15(1): 38–42.

Liu

. Nursing progress of skin allergy at PICC catheterization in cancer chemotherapy patients. China Matern Child Health Res 2017; S2(28): 214–215.

Wei

Zhang

Bai

. Research progress of skin allergy related to peripherally inserted central venous catheter. Nurs Manage China 2017; 17(01): 124–127.

10.

Liu

Wang

. Meta analysis of the effects of two kinds of films on local skin allergy in patients with PICC catheterization. Evid Based Nurs 2017; 3(04): 289–292.

11.

Broadhurst

Moureau

Ullman

. Central venous access devices site care practices: an international survey of 34 countries. J Vasc Access 2016; 17(1): 78–86.

12.

Mimoz

Lucet

Kerforne

, et al. Skin antisepsis with chlorhexidine–alcohol versus povidone iodine–alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet 2015; 386: 2069–2077.

13.

Laurie

Carolyn

Rosen

. Medical adhesives and patient safety: state of the science: consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. Orthop Nurs 2013; 32(5): 365–380.

14.

Jia

Huang

Cao

. Nursing care of local skin contact dermatitis after PICC catheterization. Chin Clin Res 2012; 25(08): 815.

15.

Yuan

. Discussion on the relationship between dressing replacement time of PICC puncture site and infection. Nurs J 2010; 17(18): 66–67.

16.

Mermel

Allon

Bouza

, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49(1): 1–45.

17.

Ciałkowska

Adamowski

Piotrowski

, et al. What is the Delphi method? Strengths and shortcomings. Psychiatr Pol 2008; 42(1): 5–15.

18.

Chen

. Application status of Delphi method in nursing management. Nurs Res 2018; 32(21): 3339–3341.

19.

Guo

. Medical field investigation technology and statistical analysis. Beijing: People’s Health Publishing, 2009.

20.

Attinger

Hoang

Steinberg

, et al. How to make a hospital-based wound center financially viable: the Georgetown University Hospital model. Gynecol Oncol 2008; 111(2): S92–S97.

21.

Zhang

Gao

. Construction of health education path table for PICC patients based on Delphi method. J Nantong Univ (Med Ed) 2020; 40(06): 53.