title: Management of functional complications of totally implantable venous access devices by an advanced practice nursing team: 5 years of clinical experience.
abstract: OBJECTIVE
  Our aim is to describe the number and distribution of requests addressed to an Advanced Practice Nursing team for functional problems of totally implantable venous access devices (TIVADs) and to describe, in detail, the malfunction management by the type and number of additional investigations and treatment modalities.
  
  
  METHODS
  The Advanced Practice Nursing team recorded data about all requests for support as part of the standard care. A specific protocol, the Leuven Malfunction Management Protocol was used for troubleshooting. In this descriptive, retrospective study, data of 3950 consecutive requests for TIVAD-related functional problems in 2019 patients were analyzed. Data collection included (1) demographic information, (2) device-related details, and (3) malfunction and follow-up details.
  
  
  RESULTS
  'Easy injection, impossible aspiration' was the most frequently documented functional problem (66.9%) for all requests for help. Of all malfunctions, catheter tip was in an optimal position in 73.4%, thrombolytics were administered in 59.0%, and a linogram was performed in 4.9%. TIVAD removal/exchange was advised in 4.4% of the requests.
  
  
  CONCLUSIONS
  TIVAD malfunction-defined operationally in terms of injection and/or aspiration problems-reflect all functional complications encountered in practice. Adherence to the Leuven Malfunction Management Protocol can ensure that, in most cases, catheter patency can be fully restored without removing or replacing the TIVAD. The Advanced Practice Nursing team coordinates the following treatments, investigations, and procedures: radiological catheter tip verification; thrombolytic agent administration and, if necessary, subsequent injection of solutions to dissolve drug precipitates or lipid deposits; linogram; percutaneous sleeve stripping; and TIVAD removal/replacement.
authors.affiliation: Department of Surgical Oncology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. godelieve.goossens@uzleuven.be
authors.forename: Godelieve Alice
authors.initials: GA
authors.lastname: Goossens
authors.forename: Marguerite
authors.initials: M
authors.lastname: Stas
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
mesh_terms: D000293:Adolescent; D000328:Adult; D057179:Advanced Practice Nursing / Q000458:organization & administration*; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000451:nursing*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000451:nursing*; D010348:Patient Care Team / Q000458:organization & administration; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents