Authors: (including presenting author): :
Chang CM (1), Cheng KY (1), Chan MH (1), Ng KY (1)
Affiliation: :
(1) Pain Management Unit, Anaesthesia and Operating Theatre, New Territories West Cluster
Introduction: :
Continuous PNB is an important modality of postoperative analgesia. Complications such as catheter dislodgement and infusate leakage can happen and these would interrupt the therapeutic effect and increase the infection risk (i). According to the NTWC statistics in 2019, mild oozing happened in nearly all PNB dressings, about 40% of which encountered CDRPs, especially catheter dislodgement, infusate leakage and dressing detachment. Therefore, we conducted this project to sort out the causes and solutions by using Johns Hopkins Nursing's EBP. It was found the underlying causes were related to the catheter-through-needle system and a lack of standardized dressing method in PNB. Based on the findings from our EBP appraisal, we suggested to use a catheter-over-needle system which is better fit on the skin, thus lowering the risk of leakage and dislodgement(ii). The use of Integrated Securement and Dressing (ISD) can further reduce dressing edge lifting and enhance catheter fixation(iii).
Objectives: :
To reduce PNB catheter- and dressing- related problems through adopting the Johns Hopkins Nursing's Evidence-based Practices (JHN's EBP)recommendations by 1) replacing the current catheter-through-needle (CTN) system to a catheter-over-needle (CON) system , 2) standardizing the PNB dressing method, and 3) standardizing the dressing material to ISD.
Methodology: :
1) Internal audit to understand the current situation of PNB catheter and dressing related problems 2) Use JHN's EBP model to develop recommendations based on the evidence synthesis. Starting from 17/11/20, NTWC Pain Team ran a trial of using the new CON catheter (PAJUNK E-Cath acc. Tsui 18G) with the new ISD (3M Tegaderm I.V. Advanced) on Continuous PNB. Orientation was provided to anesthetists, operating theatre nurses and ORT/ SURG team nurses before launching. Outcome evaluation was done 3 months later.
Result & Outcome: :
To 1) minimize PNB catheter leakage /oozing 2) reduce catheter dislodgement / migration 3) prevent surrounding skin irritation 4) promote patient’s comfort 5) enhance staff satisfaction. There were 30 cases of continuous PNB throughout the trial period. Each catheter was evaluated in 7 aspects and the corresponding results were as follows: 1) Ease of the first dressing application by anaesthetists - 65% encountered no or minimal difficulties - 27% encountered mild difficulties - 8% enocuntered moderate difficulties 2) Leakage at catheter exit site - nil on POD1/ POD2 - 3 cases (9%) with mild oozing on POD3 3) Catheter migration - 88% nil migration - 4 cases (12%) had < 2cm migration on POD3 - nil premature catheter dislodgement 4) Dressing integrity - 85% intact - 5 cases (15%) had mild edge detachment on POD3 5) Skin condition around the catheter exit site - All patients had intact skin underneath the dressing site. 6) Patient comfort - 92% of patients reported no discomfort regarding the whole PNB catheter and dressing system 7) Nurse satisfaction - 73% of nurses were satisfied on the whole system - 27% of nurses rated as acceptable
