Central Venous Catheter Placement: Extending the Role of the Nurse

OBJECTIVE: to improve the quality of the percutaneous tunnelled central venous catheter placement service for patients being treated for malignant disease. DESIGN: a clinical nurse specialist was specially trained to insert percutaneous tunnelled central venous catheters according to predetermined guidelines. Catheters were inserted under local anaesthetic in the outpatient department or the ward. The quality of the service was analysed and compared with the pre-existing service provided by junior medical staff1. SUBJECTS: two hundred adult patients with malignant disease seen between January 1995 and January 1996 at the Christie Hospital Trust. MAIN OUTCOME MEASURES: success of the procedure, insertion-related infection rates and waiting times compared to historical controls. RESULTS: the rate of failed insertions fell from 20% to 3% with a concomitant reduction in surgical referrals; for 97% of patients waiting time was reduced to less than one working day compared with 80% previously. Line-related infection rates in the first thirty days following insertion fell from 10 episodes per 72 lines inserted to two episodes per 200 lines inserted. CONCLUSIONS: training and using a clinical nurse specialist has improved the quality of service and gives junior doctors more opportunity to become competent in the technique of central venous catheter placement. The introduction of guidelines has encouraged a standard approach that facilitates audit.