Journal of Hematology - Supplements - Haematologica

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10
8
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Figure 10. Elaboration of protocol.
Figure 11. The knowledge of doctors on the methods and
handling of CVC.
9
Figure 7. Efficiency of working method.
Figure 8. Protection at collection points of CVC and derivations.
Figure 9. Reutilization of the protective points of the joints
and derivations.
lines without sterilized gloves and use the derivation
circuit to administer therapy without any
protection.
From what do we deduce that for one operation
we need to apply all the rules of antiseptic
care, and for another it is sufficient to wash our
hands ? Why does a CVC need more care
because the patient is neutropenic, when there
are no guarancies that the neutropenia will manifest
again? In our opinion it is a curious attitude
that makes one act with extreme caution
on an area of insertion which is cicatrized, one
in which one or more mechanical barriers (cuffs
in Dacron) are present and yet not worry to the
same degree when connecting or injecting
directly into the blood circulation interposing,
only hand washing as an infection barrier.
We ask ourselves whether this difference is reasonable.
Maybe the same importance given to
the maintenance of an intravenous short-term
catheter is widened to a CVC, forgetting that the
tunneled CVC was designed to remain in place
for long periods of time, and for this reason
should be protected from possible infections.
Or maybe the patient submitted to BMT has
been compared to the one in intensive care,
undervaluing the diversity of immune system
function in these two groups of patients, disregarding
that, even when there is a recovery from
neutropenia, the immune system in the BMT
patient remains extremely oversensitive to infective
agents.
Not by chance the majority of protocols in use
in some centers were produced together with
anesthetists, heart surgeons, or surgeons who
use an indwelling CVC, who have many years of
experience in the use of CVC but not in the specific
context of BMT.
We think it is proper to consider the experience
of others but that the choice of a technical
model of assistance is based on the demand that
a pathology requires, and must be discussed
with the experts who know the consequences of
an infection of the CVC.
One item of the questionnaire addressed the
knowledge of the method in use by doctors of
the BMT centers: only 23% gave an affirmative
answer.
The good result of a BMT is not exclusively
linked to the efficiency of the therapeutic protocol,
but also to the prevention of infections, a
sphere in which nurses assume a significant role.
haematologica vol. 85(supplement to n. 11):November 2000