减少外周血干细胞捐献中中心静脉导管的使用:质量改进报告。

BMJ quality improvement reports Pub Date : 2017-04-28 eCollection Date: 2017-01-01 DOI:10.1136/bmjquality.u211975.w4817
Samer Ghazi, Ahmed Alaskar, Mohsen Alzahrani, Moussab Damlaj, Khadega A Abuelgasim, Giamal Gmati, Mona Alshami, Salman Alshammary, Khaled Al-Surimi, Hind Salama, Ayman Alhejazi, Abdul-Rahman Jazieh
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引用次数: 2

摘要

外周血干细胞(Peripheral blood stem cell, PBSC)的采集已成为造血干细胞移植的主要干细胞来源。这个手术需要高血流量的静脉通路。与中心静脉导管(CVC)相比,外周静脉导管(PVC)被认为提供更安全的静脉通道。然而,最初在我们的机构,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小组,进行系统的质量绩效分析,以评估目前收集供体PBSCs的过程,目的是将CVC的使用减少到低于国际基准(20%)。一种质量改进方法,即计划-执行-研究-行动(PDSA)的快速循环,被用于测试一系列举措。静脉(IV)小组评估供体静脉通路,并在可行的情况下插入适当的PVC。该项目历时16个月,42名成年捐赠者接受了PBSC采集。在第一个PDSA周期中,每4个献血者插入1个CVC。在第二个PDSA周期中,每8次献血插入1个CVC。在第三个PDSA周期中,30例单采供体未使用CVC。所有供者在一次单采过程中成功收集了目标干细胞剂量,无并发症。CVC的使用从72%显著降低到0%。该质量改进项目表明,在大多数PBSC供体中,可以轻松安全地实现成功的采血操作,防止与cvc相关的潜在不良事件。静脉注射团队、采血和临床血液学团队之间的跨学科合作对于优化献血者的安全护理至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Reducing Central Venous Catheter Use in Peripheral Blood Stem Cell Donation: Quality Improvement Report.

Reducing Central Venous Catheter Use in Peripheral Blood Stem Cell Donation: Quality Improvement Report.

Reducing Central Venous Catheter Use in Peripheral Blood Stem Cell Donation: Quality Improvement Report.

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.

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