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首页> 美国卫生研究院文献>BMJ Open Quality >Reducing Central Venous Catheter Use in Peripheral Blood Stem Cell Donation: Quality Improvement Report
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Reducing Central Venous Catheter Use in Peripheral Blood Stem Cell Donation: Quality Improvement Report

机译：减少外周血干细胞捐献中中央静脉导管的使用：质量改善报告

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Peripheral blood stem cell (PBSC) collection from donors through apheresis has become the main source of stem cells for hematopoietic stem cell transplantation. This procedure requires a high blood flow venous access. A peripheral venous catheter (PVC), compared to a central venous catheter (CVC), is considered to provide safer venous access. However, initially at our institution, King Abdul-Aziz Medical City - Riyadh, a CVC was frequently used (72%). A quality improvement multidisciplinary team has been formed to conduct a systematic quality performance analysis to evaluate the current process of collecting donor PBSCs with the aim to reduce CVC use to less than the international benchmark (20%). A quality improvement methodology, rapid cycles of plan-do-study-act (PDSA), was used to test a set of initiatives. An Intravenous (IV) team assessed the donor's venous access and inserted an appropriate PVC when feasible. This project ran over 16 months with 42 adult donors undergoing PBSC collection. During the first PDSA cycle, 1 CVC was inserted for every 4 donors. In the second PDSA cycle, 1 CVC was inserted for every 8 apheresis donations. In the third PDSA cycle, no CVC was used for 30 apheresis donations. The targeted stem cell dose was collected successfully in one apheresis session in all donors assigned for PVC access with no complications. A significant reduction of CVC use from 72% to 0% was achieved. This quality improvement project demonstrated that a successful apheresis procedure can be achieved easily and safely in the majority of PBSC donors preventing the potential adverse events associated with CVCs. The interdisciplinary collaboration between the IV team, apheresis and clinical hematology teams was paramount to optimize the safe care of donors.
机译：通过单采血液分离术从供体收集的外周血干细胞（PBSC）已成为造血干细胞移植的干细胞的主要来源。此过程需要高血流静脉通路。与中央静脉导管（CVC）相比，外周静脉导管（PVC）被认为可提供更安全的静脉通路。但是，最初在我们机构里阿卜杜勒·阿齐兹国王医疗城-利雅得，经常使用CVC（72％）。已经成立了一个质量改进多学科团队，以进行系统的质量绩效分析，以评估当前收集供体PBSC的过程，旨在将CVC的使用减少到国际基准以下（20％）。一种质量改进方法，即计划研究行为（PDSA）的快速周期，用于测试一系列计划。静脉（IV）小组评估了供体的静脉通路，并在可行时插入了合适的PVC。该项目进行了16个月，共有42位成人捐赠者接受了PBSC收集。在第一个PDSA周期中，每4个捐献者插入1个CVC。在第二个PDSA周期中，每8次血液采血术插入1个CVC。在第三个PDSA周期中，没有CVC用于30项血液采血捐赠。在一次采血过程中成功地收集了分配给PVC通路的所有供体的目标干细胞剂量，无并发症。 CVC使用量从72％显着减少到0％。该质量改进项目证明，在大多数PBSC供体中，可以轻松，安全地实现成功的单采程序，从而避免了与CVC相关的潜在不良事件。静脉输液团队，血液分离和临床血液学团队之间的跨学科合作对于优化捐赠者的安全护理至为重要。

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