Content area
Full Text
Use with totally implanted venous access devices
Vapocoolant sprays are used in some facilities to manage pain associated with accessing totally implanted venous access devices (TIVADs). They are neither indicated nor contraindicated, and literature supporting safe and effective use within this process is lacking. The purpose of this article is to evaluate the use of vapocoolant sprays within the TIVAD access process and to facilitate best practice accounting for product use and safety, institutional policy, and individual patient needs.
KEYWORDS
vapocoolant sprays; totally implanted venous access device; evidence-based practice
Totally implanted venous access devices (TIVADs) are frequently used in patients with cancer receiving hematopoietic stem cell transplantations or requiring administration of irritant or vesicant chemotherapies (Moran & Camp-Sorrell, 2002; Schiffer et al., 2013; Schulmeister, 2017). They are typically placed, under anesthesia, by a surgeon or interventional radiologist into a pocket between the skin and rib, carrying the disadvantage of being the most expensive venous access device to insert (Schiffer et al., 2013; Schulmeister, 2017) and, subsequently, to remove if complications occur.
TIVAD access can be performed the same day the TIVAD is placed. Bruising, inflammation, and discomfort are common (Schulmeister, 2017; Young, Young, Vogel, Sutkowski, & Venkataperumal, 2016), possibly warranting pain management. Central line-associated blood stream infections (CLABSIs) and surgical site infections (SSIs) are major complications with TIVADs that can be prevented by standardizing procedures and implementing evidence-based practice (Camp-Sorrell, 2009; Conley, 2016; Marschall et al., 2014; O'Grady et al., 2011). Preventing infection is particularly important in oncology because TIVADs are accessed frequently and in the presence of neutropenia, increasing risk (Camp-Sorrell, 2009; Conley, 2016; Moran & Camp-Sorrell, 2002; O'Grady et al., 2011; Schiffer et al., 2013). Although there is debate on the necessity (Cope & Matey, 2017; Eisenberg, 2011), some policies mandate sterile techniques because of the importance of CLABSI and SSI prevention.
Cleansing the access site with chlorhexidine gluconate (CG) is imperative (Camp-Sorrell, 2009; Conley, 2016; Cope & Matey, 2017; O'Grady et al., 2011). CG is applied using friction for 30 seconds, followed by 30 seconds of waiting for the solution to dry (Camp-Sorrell, 2009; Cope & Matey, 2017). However, policies indicating anesthetic application prior to CG limit the usefulness of vapocoolant sprays that have an effect time of less than one...