Asia-Pacific Journal of Oncology Nursing

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 4  |  Issue : 1  |  Page : 61--68

Knowledge level on administration of chemotherapy through peripheral and central venous catheter among oncology nurses


Sevgisun Kapucu1, Ayşe Ozaydın Özkaraman2, Neşe Uysal3, Gulcan Bagcivan4, Ferhan Cetin Şeref5, Aygül Elöz6,  
1 Department of Medical Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
2 Department of Nursing, Faculty of Health Sciences, Eskişehir Osmangazi University, Turkey
3 Department of Nursing, Faculty of Health Sciences, Yıldırım Beyazıt University, Ankara, Turkey
4 Department of Nursing, Gülhane Education and Research Hospital, Ankara, Turkey
5 Oncology Institute, Hacettepe University Hospital, Ankara, Turkey
6 Palliative Care Units, Ankara Oncology Training and Research Hospital, Ankara, Turkey

Correspondence Address:
Sevgisun Kapucu
Associate Professor, Faculty of Nursing, Hacettepe University, Ankara
Turkey

Abstract

Objective: The aim of this study is to determine the knowledge levels of oncology nurses about peripheral and central venous catheter during their chemotherapy administration. Methods: Data collection of this descriptive study was started on April 15, 2015–July 15, 2015. The data presented in this summary belong to 165 nurses. Data were collected with data collection form including questions related to sociodemographic qualifications and knowledge levels of nurses. Data collection forms were E-mailed to the members of Turkish Oncology Nursing Society. Data presented with numbers, percentages, and mean ± standard deviation. Results: The mean age of nurses was 33.60 ± 7.34 years and mean duration for oncology nursing experience was 2.65 ± 0.91 years. Nurses had correct information about the importance of selecting peripheral venous catheter and choosing the placement area for chemotherapy administration (63.6%), control of catheter before the administration (93.9%), influence of chemotherapeutic agent on length of catheter (40.6%), and management of extravasation (75.7%). Nurses also had correct information about the first use of port catheter (67.3%) and checking the catheter whether it is working properly or not (75.8%). Conclusions: In General, nurses' level of knowledge related to catheter is 50% and higher. It is recommended to increase the knowledge of nurses about evidence-based information for catheter care as a step to safe chemotherapy practice.



How to cite this article:
Kapucu S, Özkaraman AO, Uysal N, Bagcivan G, Şeref FC, Elöz A. Knowledge level on administration of chemotherapy through peripheral and central venous catheter among oncology nurses.Asia Pac J Oncol Nurs 2017;4:61-68


How to cite this URL:
Kapucu S, Özkaraman AO, Uysal N, Bagcivan G, Şeref FC, Elöz A. Knowledge level on administration of chemotherapy through peripheral and central venous catheter among oncology nurses. Asia Pac J Oncol Nurs [serial online] 2017 [cited 2019 Oct 16 ];4:61-68
Available from: http://www.apjon.org/text.asp?2017/4/1/61/199081


Full Text

 Introduction



Intravenous (IV) catheterizations are frequently applied in cancer therapy for hydration, nutrition, drug administration, and transfusion of blood and blood products.[1],[2],[3],[4],[5],[6],[7] Oncology nurses are responsible for the safe and timely administration of IV treatments to the patients through peripheral and central venous catheter (CVC) and management of any possible complication.[8],[9],[10],[11],[12]

In recent years, an increased high-dose chemotherapy administration has led to increased use of peripheral venous catheter (PVC) and CVC in the oncology patients.[13] Although several factors such as catheter site, characteristics of the material used, characteristics of the drugs and fluids used, duration, frequency and modality of the treatment, and aseptic techniques employed affect the success of IV chemotherapy, the knowledge level and capability of the nurse play a crucial role.[9],[12],[14],[15]

Although interventions performed through venous catheterization in oncology clinics provide many advantages for the patient and health professionals, they may cause problems such as phlebitis, extravasation, thrombophlebitis, air embolism, circulatory overload, bleeding, hematoma, and infection, unless they are performed and monitored properly.[7],[16],[17],[18],[19],[20],[21],[22] Therefore, to achieve a successful management of IV chemotherapy administration, to prevent complications, and to extend the life of catheters, nurses should have adequate knowledge on the field and should refer to evidence-based recommendations and guidelines in their practices.[23],[24],[25],[26] Although studies assessing the knowledge level and attitudes of nurses on the administration of chemotherapy are available in Turkey and worldwide, the number of studies addressing the knowledge levels of oncology nurses on chemotherapy applications with PVC and CVC in Turkey is limited.[27] This study aims to evaluate the knowledge level on chemotherapy administration through PVC and CVCs among Turkish nurses.

 Methods



Study design and sample

This study is a descriptive type of study. The study population included 568 nurses employed in oncology services/outpatient clinics, whose E-mail addresses were registered in the Turkish Oncology Nursing Society. Data were collected from 165 (29%) nurses who agreed to participate in the study.

Measures

In this study, data were collected through a web-based and in-print questionnaire. The first of the two-part questionnaire contained six questions of sociodemographic characteristics and 11 questions of chemotherapy applications. The second questionnaire, in turn, included twenty questions of chemotherapy applications performed with peripheral and central venous catheterization. Each question had a single correct answer and the answer choice “I do not know” was given in each question to avoid speculation. Internal consistency coefficient of the questionnaire was 0.654.

Having received the expert opinion of two oncology nurses and five academicians on items and answer formats included in the questionnaire, which was developed according to the literature data, questionnaires were designed in a manner which allowed participants to fill them on a webpage.[4],[14],[15],[17],[25],[28],[29],[30] Five nurses filled out the questionnaires as part of the preliminary survey of the study. During the preliminary survey, the cognitive penetrability and the convenience of filling out the questionnaire were evaluated. Data obtained from preliminary survey were excluded from the study. The web-based questionnaire was printed out and used as hard copy.

Procedures

This study was conducted between April 15, 2015, and July 15, 2015 through E-mail and face-to-face interview method. Researchers sent information forms and web-based questionnaires to the participants through E-mail. The nurses who read the information form and agreed to participate in the study filled out the web-based questionnaires and sent them back to researchers through E-mail (100 questionnaires). Printed questionnaires were handed out to the oncology nurses directly and filled out during face-to-face interviews (65 questionnaires). The study protocol was approved by the local Ethics Committee of the Association of Oncology Nurses (No: 604.01.02) and written informed consent was obtained from each participant.

Statistical analysis

Statistical analysis was performed using the SPSS version 17.0 software (SPSS Inc., Chicago, IL, USA). Descriptive data were given in percentage and mean values. One of the answer choices given in questions in the questionnaire on chemotherapy administration through peripheral and CVC was correct, two choices were incorrect, and the other choice was “I do not know”. While evaluating nurses' answers to questions in the questionnaire, frequencies and percentage values of correct, incorrect, and “I do not know” answers were calculated. Continuous variables were expressed as mean ± standard deviation, and categorical variables were expressed as numbers and percentages. Pearson's Chi-square (χ2) test was performed to analyze the differences among categorical variables (answers of the nurses regarding administration of chemotherapy through peripheral/CVC and characteristics of the nurses). P < 0.05 was considered statistically significant.

 Results



The descriptive characteristics of nurses who participated in the study are presented in [Table 1]. A total of 70.9% of nurses reported that a safety chemotherapy protocol existed in the institutions which they worked, while 56.1% reported that extravasation record forms were available. The mean number of insertion of peripheral catheters and port needles was 12.28 ± 18.81 and 4.64 ± 6.95 on a daily practice of nurses, respectively. They also carried out the maintenance of 3.70 ± 4.45 port catheters and 1.75 ± 2.15 central catheters on average per day.{Table 1}

The responses of nurses who participated in the study on chemotherapy administration through PVC are shown in [Table 2]. Of the nurses, 57.6% answered the questions on PVC selection correctly, 63.6% answered the questions on the selection of the region where catheter should be inserted correctly, 93.9% answered the questions on catheter control correctly, 53.3% answered the questions on the properties of liquids administered through PVC correctly, 59.4% answered the questions on the administration ways of chemotherapy medication to be infused for more than 6 days correctly, and 75.8% answered the questions on actions to be taken in case extravasation occurs correctly. Nearly 69.1% of nurses gave incorrect answers to questions on the frequency of changing infusion sets [Table 2].{Table 2}

The distribution of nurses' responses who participated in the study to chemotherapy administration through CVC and port catheter is presented in [Table 3]. Of them, 67.3% responded correctly to questions on administration of first chemotherapy following the insertion of port catheter, 75.8% responded correctly to questions on the necessity to control catheters before administration of chemotherapy through port/central catheters, 61.2% responded correctly to questions on the termination of the procedure after chemotherapy through port catheters, 69.1% responded correctly to questions on the frequency of heparin administration through port catheters besides chemotherapy application, 70.3% responded correctly to questions on actions to be taken in case extravasation develops during administration of chemotherapy through CVC, and 80.6% responded correctly to questions on the content of the training to be provided to patients who received treatment through port catheterization. On the other hand, 76.4% of nurses responded correctly to questions on the application of antiseptic hand sanitation procedure before and after the administration of chemotherapy through CVC, and 89.6% of nurses responded incorrectly to questions on the selection of port needle gauge according to the treatment to be administered saying that the port needle gauge should not be changed according to treatment; 89.7% of nurses responded incorrectly to questions on the adjustment and monitoring of infusion rate during chemotherapy infusion saying that the infusion rate was set by the pump device [Table 2] and [Table 3].{Table 3}

Although not shown in [Table 3], it was found that giving the correct answer regarding frequency of changing infusion sets during administration (χ2 = 6.597, P = 0.010) and single/multiple chemotherapy administration through CVC was more within the nurses who had prior training on safety chemotherapy administration (χ2 = 8.319, P = 0.004) than who did not. Giving the correct answer regarding points to consider in PVC selection during administration was less among the nurses who have bachelor's degree than others (χ2 = 8.075, P = 0.044), and giving the correct answer regarding whether chemotherapy medications have any impact on the changes that occur in the tissue in case of extravasation was more within the nurses who have bachelor's degree than others (χ2 = 7.885, P = 0.048). And also, giving the correct answer regarding termination of the procedure when chemotherapy administered through port catheter is finished was more within the nurses who had the training on safety chemotherapy administration 2 years ago or more than others (χ2 = 9.076, P = 0.028).

 Discussion



In this study, we found that 65.5% of oncology nurses had already trained about safety chemotherapy administration. The literature on the field also reveals that not all oncology nurses participate in chemotherapy training programs.[31],[32] The national and international oncology organizations recommend that the treatment of patients who receive chemotherapy due to cancer diagnosis should be provided by expert oncology nurses in a patient-centered, safety, timely, and reliable manner using accurate methods.[31],[33] Several studies have shown that the proportion of nurses who trained about safety chemotherapy administration before starting to work in the field where they will administer chemotherapy is low, whereas most of them complete these trainings while working at the chemotherapy centers. It has also been demonstrated that nurses experience distress, irritability, and fear during chemotherapy application, which is due to lack of prior training on the subject.[31],[32] It was reported that untrained oncology nurses did not adopt a positive attitude toward preparation and administration of chemotherapy and adverse effect and emergency management, implying the necessity of training seminars to improve nurses' knowledge level and attitudes.[34] It was also addressed in the literature that seemingly insignificant negligence and errors during IV administration of chemotherapy might cause adverse outcomes such as extravasation, thrombophlebitis, bleeding, hematoma, and infection, suggesting that nurses with inadequate level of knowledge posed a risk to patients' well-being.[17],[19],[25],[26],[28],[35] Therefore, to provide more comfort to patients and to minimize potential complications, it is of utmost importance that all nurses who administer chemotherapy should complete training programs based on the current clinical guidelines and evidence-based studies and improve their clinical skills through these trainings.

The majority of the nurses who participated in this study responded incorrectly to the questions on the frequency of changing infusion sets and antiseptic hand sanitation procedures. According to the conducted studies and guidelines, types of catheters used in chemotherapy, infusion times, and changing and maintenance of catheters not only reduce the risk of complications but also have a considerable effect on the success of treatment.[2],[14],[15],[35],[36],[37],[38] While Alkubati et al.[30] showed that 10% of nurses were aware of the correct frequency of changing the clothing on the catheter, 31.3% were aware of accurate skin antisepsis and 54% implemented CVC care accurately. Cicolini et al.[25] also found that nurses most frequently responded incorrectly to the question on antiseptic hand sanitation before inserting PVC (73.7%), 54.6% were aware that PVC should be changed every 96 h, while 55.2% were aware that antiseptic techniques should be used while changing the infusion sets. In another study, Maki et al. reported that the ratio of catheter-related infections was 3% in CVC and 0.1% in peripheral venous catheterizations. Vidal et al. also reported the ratio of total implant venous port-related infections to be 84.5% whereas Shah et al. reported the same ratio to be 3.6%.[38],[39],[40] The guidelines developed by O'Grady et al., on the other hand, highlighted the importance of antiseptic technique in preventing IV catheter-borne infections.[15] Based on these results, it can be suggested that oncology nurses should update their information by following the developments in current guidelines and evidence-based practices on the prevention of infections occurring during the IV catheterization procedures.

In this study, while most of the nurses responded correctly to questions on catheter control before chemotherapy administration, a majority of nurses responded incorrectly to questions on the selection of needle gauge to be inserted in the port catheter according to the treatment to be administered and the adjustment of the rate of liquids to be infused with peripheral IV catheters. Furthermore, the ratio of correct answers regarding PVC selection, designation of the region where PVC will be inserted, and the duration of PVC was low. This outcome might be a result of the fact that not all nurses received training. Moreover, it was an interesting finding of our study that most of the nurses who were aware of the actions to be taken in case of extravasation did not know the procedures to prevent extravasation. In the prevention of extravasation, which is defined as “a terrible complication” and “an avoidable disaster,” risks aggravate unless necessary precautions are taken.[35] Therefore, the patient's veins should be assessed; veins at flexion point should be avoided during applications; pH value and osmolarity of the medication administered, drug infusion rate, duration of the treatment, and appropriate catheter diameter for the width of the vein should be known; and catheter aperture should be checked.[2],[14],[35],[36],[37] In their study, Verity et al.[31] showed that oncology nurses were well informed on the development of extravasation, which a similar finding is found in this study. Another study revealed that almost half of the oncology nurses, who had a mean chemotherapy knowledge level score of 79.4 ± 9.82 over 100, were preparing and administering chemotherapeutics four or more times a day.[41] We believe that on-the-job training programs and courses on catheters and their maintenance would be helpful to raise the awareness of oncology nurses.

Furthermore, this study showed that 47.3% and 61.2% of participant nurses washed CVC and implanted venous port catheter, respectively, with 10 ml 0.09% NaCl and heparinized solution before closing the catheters. Similarly, Keogh et al.[42] reported that 61% and 57% of nurses and midwives washed CVC and PIVC, respectively, with 10 ml 0.09% NaCl.[43] On the other hand, Hadaway suggested that catheters should be washed with at least 10 ml 0.09% NaCl to reduce vein damage and to extend the catheter's life, while Infusion Nurses Society stated that 1–3 ml and 5–10 ml of 0.09% NaCl would be sufficient to wash PVC and CVC, respectively.[4],[14]

Previous studies showed nurses' knowledge influenced by professional education and training.[43],[44] Our study nurses who had prior training on safety chemotherapy administration more correct answer chemotherapy administration. Gibson et al.[32] showed that there were significant correlations between time working in oncology and the number of years administering chemotherapy and the worry domains and attitude to chemotherapy. Our study giving the correct answer regarding termination of the procedure when chemotherapy administered through port catheter is finished was more within the nurses who had the training on safety chemotherapy administration 2 years ago or more than others.

 Conclusion



This study found that more than half of oncology nurses were accurately informed on the peripheral and CVC and chemotherapy administration. However, believing in a “zero-error” practice in patient care, this observation may be considered unfavorable for oncology nurses. To provide the necessary benefit on behalf of the patient and to carry out the practice effectively, institutions should regularly develop chemotherapy training programs and ensure oncology nurses to participate in these programs, which would not only improve the knowledge levels of nurses but also induce positive changes in their attitudes and behaviors. Based on the results of this study, we recommend nurses working in this field to be supported with relevant on-the-job training programs and courses to improve the knowledge level concerning catheter care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Elshamy KF, Mesbah MR. Effect of peer education intervention and procalcitonin detection on peripheral intravenous catheter-related blood stream infections and associated complications among selected patients at Mansoura University Hospitals. J Am Sci 2011;7:362-73.
2McCallum L, Higgins D. Care of peripheral venous cannula sites. Nurs Times 2012;108:12, 14-5.
3Rickard CM, McCann D, Munnings J, McGrail MR. Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: A randomised controlled trial. BMC Med 2010;8:53.
4Gorski LA. Infusion nursing standards of practice. J Infus Nurs 2007;30:20-1.
5Fink RM, Hjort E, Wenger B, Cook PF, Cunningham M, Orf A, et al. The impact of dry versus moist heat on peripheral IV catheter insertion in a hematology-oncology outpatient population. Oncol Nurs Forum 2009;36:E198-204.
6Taşoğlu İ, Özgül H, İmren Y, Gökgöz L. A rare complication after central venous catheterization: A retained guide wire in the subclavian vein. Turkish Journal of Thoracic and Cardiovascular Surgery 2007;15:174-5.
7Anıl AB, Anıl M, Kanar B, Yavaşcan Ö, Bal A, Albudak E, et al. The evaluation of central venous catheterization complications in a pediatric intensive care unit. Turkish Archives of Pediatrics 2011;46:215-9.
8Turkish Ministry of Health Directive about the making changes in Nursind regulations 2012. Available from: http://www.resmigazete.gov.tr/eskiler/2011/04/20110419-5.htm. [Last accessed on 2012 Nov 28].
9Ay FA. Drug aplications. İstanbul: İstanbul Medical Publishing 2007. p. 348-62.
10Infusion Nurses Society. Infusion Nursing Standards of Practice. Cambridge, MA: INS and Becton Dickinson; 2006.
11Kelseka E, Güldoğuş F. Venous port implantation: retrospective evaluation. İnt J Hematol Oncol 2005;15:195-8.
12Jacobson AF, Winslow EH. Variables influencing intravenous catheter insertion difficulty and failure: An analysis of 339 intravenous catheter insertions. Heart Lung 2005;34:345-59.
13Güleser GN, Taşçı S. Central venous catheters which are frequently used in oncology and care. F.Ü. Journal of Health Science Medical 2009;23:4-51.
14Hadaway L. Technology of flushing vascular access devices. J Infus Nurs 2006;29:137-45.
15O'Grady NP, Alexander M, Burns LA, Dellinger P, Garland J, O'Heard S; The Healthcare Infection Control Practices Advisory Committee. Central of Disease Control Guidelines for the Prevention of Intravascular Catheter-related Infections. U.S.A.: U.S. Department of Health and Human Services; 2011. p. 20-6.
16Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F; ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Ann Oncol 2012;23 Suppl 7:vii167-73.
17Çelik Z, Anıl C. Intravenous application complications. Current Gastroenterology 2004;8:158-65.
18Karagözoğlu Ş. Nursing care and place of hot and cold application in thrombophlebitis as a complication of intravenous liquid treatment. Cumhuriyet University Journal of Nursing Highschool 2001;5:18-26.
19Waitt C, Waitt P, Pirmohamed M. Intravenous therapy. Postgrad Med J 2004;80:1-6.
20Royal King College of Nursing Standards for Infusion Therapy. 3rd ed. London: Royal College of Nursing 2010. p. 7-20, 60-5.
21Ingram P, Lavery I. Peripheral ıntravenous cannulation: Safe ınsertion and removal technique. Art Sci Clin Skills 2007;22:44-9.
22Schulmeister LC. Extravasation. In: Olver IN, editor. The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer US: 2011.
23Oran NT. Port Catheter: How can we maintain venous access? Maltepe Univ J Nurs Sci Art 2009;3:136-42.
24Özkaraman A, Yeşilbalkan Ö. Nursing management in peripheral intravenous chemotherapy. Osmangazi Med J 2014;36.
25Cicolini G, Simonetti V, Comparcini D, Labeau S, Blot S, Pelusi G, et al. Nurses' knowledge of evidence-based guidelines on the prevention of peripheral venous catheter-related infections: A multicentre survey. J Clin Nurs 2014;23:2578-88.
26Freytes CO. Indications and complications of intravenous devices for chemotherapy. Curr Opin Oncol 2000;12:303-7.
27Pınar R. Nurses' attitudes towards protecting the environment, themselves and their patients during chemotherapy preparation and administration. Atatürk Univ J Nurs Highschool. 2003;145-5.
28Labeau S, Vereecke A, Vandijck DM, Claes B, Blot SI; Executive Board of the Flemish Society for Critical Care Nurses. Critical care nurses' knowledge of evidence-based guidelines for preventing infections associated with central venous catheters: An evaluation questionnaire. Am J Crit Care 2008;17:65-71.
29Guideline for Peripheral Intravenous Catheters. Centre for Healthcare Related Infection Surveillance & Prevention and Tuberculosis Control; 2013. p. 1-14.
30Alkubati SA, Ahmed NT, Mohamed ON, Fayed AM, Asfour HI. Health care workers' knowledge and practices regarding the prevention of central venous catheter-related infection. Am J Infect Control 2015;43:26-30.
31Verity R, Wiseman T, Ream E, Teasdale E, Richardson A. Exploring the work of nurses who administer chemotherapy. Eur J Oncol Nurs 2008;12:244-52.
32Gibson F, Shipway L, Aldiss S, Hawkins J, King W, Parr M, et al. Exploring the work of nurses who administer chemotherapy to children and young people. Eur J Oncol Nurs 2013;17:59-69.
33Chemotherapy Services in England: Ensuring Quality and Safety. National Chemotherapy Advisory Group 2009. p. 11-20.
34Shokier ME, Shaban FM, Gadiry SH, Seif Eldin IA. Quality ambulatory oncology nursing practice for chemotherapeutic patients. J Am Sci 2012;8:469-82.
35Schulmeister L. Preventing and managing vesicant chemotherapy extravasations. J Support Oncol 2010;8:212-5.
36WOSCAN Chemotherapy Extravasation Guideline. Chemotherapy Extravasation in Practice. WOSCAN Cancer Nursing and Pharmacy Group; 2009. p. 1-24.
37Hadaway LC. Preventing and managing peripheral extravasation. Nursing 2009;39:26-7.
38Gallieni M, Pittiruti M, Biffi R. Vascular access in oncology patients. CA Cancer J Clin 2008;58:323-46.
39Shah H, Bosch W, Thompson KM, Hellinger WC. Intravascular catheter-related bloodstream infection. Neurohospitalist 2013;3:144-51.
40Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: A systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159-71.
41Kyprianou M, Kapsou M, Raftopoulos V, Soteriades ES. Knowledge, attitudes and beliefs of Cypriot nurses on the handling of antineoplastic agents. Eur J Oncol Nurs 2010;14:278-82.
42Keogh S, Flynn J, Marsh N, Higgins N, Davies K, Rickard CM. Nursing and midwifery practice for maintenance of vascular access device patency. A cross-sectional survey. Int J Nurs Stud 2015;52:1678-85.
43Deshmukh M, Shinde M. Impact of structured education on knowledge and practice regarding venous access device care among nurses. Int J Sci Res 2014;3:895-901.
44ShresthaR. Impact of educational interventions on nurses' knowledge regarding care of the patient with central venous line. J Kathmandu Med Coll2013;2:2263-2281.