Postprocedural Patient Instructions for Central Venous Ports and Biliary Tubes: Assessment of Clinical Benefit and Impact on Quality of Life

Abstract

BackgroundThis study aimed to demonstrate that despite their potentially significant impact on patient quality of life (QOL), many postprocedural practices for central venous port (CVP) placement, biliary tube (BT) placement, and BT change may not be evidence-based. MethodsA mixed-methods, institutional review board–approved, cross-sectional survey was conducted to assess impact of written postprocedural instructions on QOL in patients who underwent CVP placement and BT placement or change at a single center between April 2018 and May 2020, followed by a targeted literature search for evidence pertaining to the instructions patients noted were most detrimental to QOL. ResultsFifty seven of 840 (6.8%) of contacted CVP patients and 52/166 (31.3%) of contacted BT patients participated in the study. Four instructions (one from CVP and three from BT) were identified as having greater negative than positive responses based on a seven-point Likert scale of impact on QOL: the CVP instruction related to avoiding repetitious movements of the arm, while the BT instructions related to avoiding sleeping on the tube, submerging in water, and daily dressing changes. A Medline database literature search did not demonstrate substantial evidence supporting the implementation of these instructions postprocedurally. DiscussionInstructions regarding avoiding repetitious movements of the arm, sleeping on the BT, and changing the dressing daily have no evidence-based clinical benefit on outcomes and have a negative impact on patient QOL. Due to risk of antibiotic-resistant infection (e.g., Pseudomonas) from showering or swimming, BT submersion should be avoided.