1. The Health Roundtable CSA level monitoring from Hickman line Vs peripherally Presenter: Dalia Joseph Health Service: Melbourne Health Bone Marrow Transplant Unit Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1

2. The Health Roundtable KEY PROBLEM  Cyclosporine (CSA) levels in Bone Marrow Transplant (BMT) patients were monitored via peripheral blood samples.  BMT patients are thrombocytopenic and often have poor venous access due to the intense nature of chemotherapy in the past.  This profile can cause pain, bleeding, discomfort and patients often become anxious. The process can be time consuming for staff. 2

3. The Health Roundtable AIM OF THIS INNOVATION  There was not adequate comparative studies available measuring the results of blood samples from BMT patients taken from central line (Hickman) vs. peripherally.  The project aimed to compare blood results when taken from the Hickman compared to peripherally.  If it was found that there was opportunity to take blood results from the Hickman instead of peripherally, the patient experience could be improved and staff time optimised. 3

4. The Health Roundtable BASELINE DATA  Prior to the project, CSA levels in BMT patients were monitored twice a week via peripheral blood samples.  Only blood levels for BMT patients with poor venous access were taken from the Hickman.  It was thought that infusing CSA through the white lumen of the Hickman line and blood collection from the red lumen of the Hickman line may result in contamination and as such blood was taken peripherally. 4

5. The Health Roundtable KEY CHANGES IMPLEMENTED  Twenty patients randomised for the study over 18 months.  Eighty paired results from taking blood samples from the Hickman line vs. peripherally.  Poster kept in patients room to remind staff to infuse cyclosporine through the white lumen of the Hickman line.  Patients provided information about the study  Education was given to all medical and nursing staff in BMT unit about the project.  Visual prompts and reminders incorporated on the hand over sheet and also verbally handed over.  (1-2 slides) 5

6. The Health Roundtable OUTCOMES SO FAR  Out of 80 paired result, 74 patients (92.5%) had no significant difference when blood was collected from Hickman line and peripherally at the same time.  Practice has now changed in line with the project results and CSA is infused through the white lumen of the Hickman line and blood is collected from the red lumen of the Hickman to avoid line contamination. Blood is not collected peripherally.  Patient and staff satisfaction has significantly increased. 6

7. The Health Roundtable LESSONS LEARNT  There is no significant difference in the blood result when the blood is collected from Hickman line and peripherally at the same time.  Need to continually educate new medical and nursing staff about the project and to follow the correct procedure to sustain the result.  We will continue to monitor the CSA levels from Hickman line to track the accuracy of the project. 7