Hematologic patients' clinical and psychosocial experiences with implanted long-term central venous catheter: self-management versus professionally controlled care.
BACKGROUND
A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients.


OBJECTIVE
This article focuses on patients' clinical and psychosocial experiences with CVC self-care compared with professionally controlled CVC care.


METHODS
Eighty-two patients with tunneled CVCs were enrolled in the randomized controlled trial. The intervention group (n = 42) was trained to perform CVC self-care. The control group (n = 40) followed standard CVC procedure provided by nurses. Eighteen patients were selected for semistructured interviews focusing on patients' clinical and psychosocial experiences with CVCs.


RESULTS
Methods of CVC care have different influences on the patients' clinical and psychosocial outcomes, depending on whether they were hospitalized or outpatients. Central venous catheter was viewed as important because it was the main port of treatment toward a cure, although patients constantly fear complications. Central venous catheter self-care increased patients' independence from health professionals and supported perceived self-efficacy and control. Central venous catheters cause psychosocial problems including altered body perception, sexual activity avoidance, and feeling stigmatized.


CONCLUSIONS
Patients experience increased perceived self-control and independence when individually supervised and trained in CVC self-management. Assuming ownership of CVC care can encourage patients to feel less inhibited about sexual activity and socialization.


CONCLUSIONS
Placement of a tunneled CVC should engage nurses to organize individualized structured and supervised patient education. Stigma originating from CVCs should be carefully considered by health professionals when maintaining CVC insertion for longer periods. Central venous catheters should be removed whenever the potential risks exceed the catheter's functional necessity.
Møller
Tom
T
The University Hospitals Centre for Nursing and Care Research, University Hospital Copenhagen, 9 Blegdamsvej, Copenhagen, Denmark. tom@ucsf.dk
Adamsen
Lis
L
D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods / Q000523:psychology*; D003718:Denmark; D005260:Female; D019337:Hematologic Neoplasms / Q000451:nursing* / Q000523:psychology; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D012725:Sexual Behavior; D012934:Social Isolation; D013315:Stress, Psychological / Q000523:psychology*; D013637:Tape Recording; D013997:Time Factors; D055815:Young Adult