Authors (including presenting author) :
Chan HY (1), Lee KY (1), Karn KY(2)
Affiliation :
(1) Community Nursing Service, United Christian Hospital (2) Nursing Service Department, United Christian Hospital
Introduction :
Exit site granuloma (ESG) is the common complication associated with catheter such as percutaneous endoscopic gastrostomy catheter, Super pubic urinary catheter, percutaneous transhepatic biliary drainage and pigtail drainage, etc. it has significant consequences with increased infection, pain and skin erosion. Furthermore, the frequency home visit for the exit site care represent a significant burden in our service, as well as increase in healthcare cost. Therefore, a bundle of care for the prevention of exit site granuloma were implement at early 2019. Through the collaboration with wound team, an innovative program with the aim to provide a bundle of care on exit site granuloma by using 2% Aqueous Chlorhexidine (CHG) and patient empowerment had been commenced in early 2019.
Objectives :
1.To develop a care bundle for the prevention of ESG 2. To explore the effectiveness of using 2% CHG on treating the ESG and infection in community. 3.To reduce the frequency of home visit. 4.To empower patient and caregiver on exit site and catheter care
Methodology :
To developing the new care bundle wherein evidence-based practice on using of skin infectants, catheter dressings and patient education should be stipulated. An appropriate clinical protocol has been drawn up after the extensive literature searches in these 3 areas have been performed. A training session for CNs on the exit-site granuloma care management and the dressing method with 2% CHG swab stick was conducted before the care bundle program had been launched at February 2019. CNs assessed the patient’s exit site condition and empowered the patient / relatives on catheter care management during home visit. With the collaboration of wound team, patient who were suffering from the exit-site granuloma would be referred to wound team for comprehensive assessment. 2% CHG swab stick would be prescribed if deem necessary.
Result & Outcome :
Totally 10 patients were recruited and dropped out rate was 1% (n=1) due to the admission of chest infection. The exit site granulomas were 100% subsided after recruited in the program. As a result, the frequency of home visit were reduced to alternate day or twice per week instead of daily home visit and home visits decreased from 459 to 127 (72%) dramatically. In conclusion, the implementation the care bundle has effectively reduced exit site granuloma. The encouraging result of the program recognized that an early intervention on exit site care was important. 2% CHG swab stick was effectively on treating exit site granuloma and reduced the patient on suffering from pain and skin erosion by silver nitrate treatment. Moreover, it reduced the frequency of CN home visit. It provided a Win-Win benefit for both patient and health care services.
