Journal of Hematology - Supplements - Haematologica

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Figure 1. Answers to the questionnaires.
Figure 2. Unevaluable questionnaires.
Figure 3. Use of a laminar flow hood.
Figure 4. Use of antibacterial filters.
Figure 5. Change of circuit infusion (in hours).
Figure 6. The measure of prevention for the CVC medication.
because not completed.
The lack of replies could have been caused by
the fact that many centers, in particular those
that deal mainly with adult patients, use CVC
that are not tunneled, while our research covered
only the Broviac, Hickman, Groshong and
Port-a-Cath varieties of CVC.
The answers obtained were varied and of difficult
comparison because the use of the instruments
in the various centrers is different: for
examples the positions of the antibacterial filters
along the line of infusion or use of a laminar
flow hood. We found differences in management
of the protection of the collection
joints which could be loose, wrapped in gauze or
in a system of dried and sterilized disposable
protection or soaked in iodiopovidon.
These instruments and methods are not used
in standardized way in the same patient, but
change according to neutrophil count.Thus the
use of a mask and cap and a longer length of
time between changes of the infusion line are
determined by the patient’s neutrophil count.
The only datum that unites all the centers is
the method of caring for the insertion site of the
CVC (82%). What differentiated was the use of
more anti-infective solutions, the interval
between the medications and the use of topical
therapy even without sign of infection. The
method of infection prevention was considered
good by 86% of the centers, sufficient by 10%
and exagerated by 4%!
Discussion
What seemed to us an efficient and original
idea was demolished by the results obtained,
although this does not mean that we have abandoned
our research for the future.
At this point another questionnaire would have
been useful to evaluate the number of infections
correlated with the CVC, occurring in each center,
but that would have required more commitment
from my colleagues. It seems unlikely that
any survey will be able to demonstrate that in
terms of prevalence of infection one system is
superior to others. Too many factors are involved
in causing infections: conditioning regimen, type
of transplant (allo or auto), previous chemotherapy
and mucosal damages.
The results of the questionnaire have made us
think about some of aspects of CVC handling,
with regards to the antiseptic techniques, used
to prevent infections.
We ask ourselves why so much care is taken of
the insertion point, protected so perfectly with
antiseptic technique, but less attention is dedicated
to the direct handling of the CVC. For
example some colleagues change the infusion
haematologica vol. 85(supplement to n. 11):November 2000