Central line practice in Canadian blood and marrow transplant

More than 800 blood cell and bone marrow transplants are performed annually in Canada to treat fatal cancers and rare blood disorders. Central vascular access is fundamental in blood and marrow transplant nursing to facilitate chemotherapy and blood product infusions. A tunnelled Central Venous Catheter (CVC) is the vascular access device-of-choice in the cell and marrow transplant population. Several practice guidelines direct nursing policy and procedure for CVC management and care. CVC insertion and removal guidelines are increasingly relevant given the widening scope of advanced practice nursing. Unresolved issues are noted among the most heavily cited CVC practice recommendations accessible via the Centers for Disease Control and Prevention (CDC). A descriptive survey based on the CDC guidelines was conducted to identify potential variability in CVC strategies in Canadian blood and marrow transplant nursing. Survey results indicate nationwide differences in catheter site selection, educational strategies, dressing strategies, delegation of dressing changes, and volumes of flushing and locking solutions used to manage catheter patency. Variability in practice coincides with gaps in the evidence identified in practice recommendations. Future studies comparing specific care approaches to device-associated complications are needed to resolve issues and strengthen practice guidelines.