Journal of Hematology - Supplements - Haematologica

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64 7 10 8 11 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
65 References 1. Clarke DE, Raffin TA. Infectious complications of indwelling long-term central venous catheters. Chest 1990; 97:966-72. 2. Goldmann DA, Pier GB Pathogenesis of infection related to intravascular catheterization. Clin Microbiol Rev 1993; 6:176-92. 3. Maki DG Pathogenesis, prevention, and management of infections due to intravascular devices used for infusion therapy. In Bisno AL, Waldvogel FA (Eds): Infections associated with indwelling medical devices. Washington, DC. American Society for Microbiology 1989; pp:161-77. 4. Linee guida per la prevenzione delle infezioni associate a dispositivi intravascolari: Centers for Disease Control and Prevention. Giornale Italiano delle Infezioni Ospedaliere, vol. 4,n.1, Gennaio-Marzo 1997. 5. Daghistani D, Horn M, Rodriguez Z, Schoenike S, Toledano S. Prevention of Indwelling Central Venous Catheter Sepsis. Med Pediatr Oncol 1996; 26:405-8. haematologica vol. 85(supplement to n. 11):November 2000
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