Central venous access devices play a crucial role in healthcare settings. However, there is concern regarding the high incidence of blockages occurring before the completion of treatments and existing guidelines for occlusion management are not consistently followed. To explore the decision-making and problem-solving process of occlusion management and identify enablers and barriers to implementing evidence for occlusion management in pediatric cancer care. A qualitative design with individual semi-structured interviews. Participants were selected by purposeful sampling from a tertiary-referral pediatric facility, and semi-structured interviews were conducted. A total of 13 clinicians and 5 parents were interviewed. The thematic analysis revealed four main decision-making/problem-solving themes: 1) clinical reasoning and judgement for central venous access devices occlusion, 2) capability in central venous access devices occlusion management, 3) colleague collaboration in the escalation process and 4) lack of adequate support to manage the occlusion. This study identified positive and negative influences on the problem-solving process, including clinicians' psychological capabilities, social and physical resources, and beliefs about consequences. This study found that clinicians in pediatric cancer care were able to manage central venous access device occlusions using clinical reasoning and judgment skills, which may conflict with evidence-based practices. The study confirmed the importance of a team approach and prior experience in managing central venous access devices in pediatric oncology settings and identified potential conflicts between clinician decisions based on the patient's current and anticipated conditions and implementation of evidence-based practice. Improving documentation and providing visual aids could benefit clinicians' problem-solving processes.

中文翻译：

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儿科癌症护理中中心静脉导管闭塞的问题解决过程：一项定性研究

中心静脉接入装置在医疗保健环境中发挥着至关重要的作用。然而，人们担心在完成治疗之前阻塞发生率很高，并且现有的阻塞管理指南并未得到一致遵循。探索闭塞管理的决策和问题解决过程，并确定在儿科癌症护理中实施闭塞管理证据的推动因素和障碍。带有个人半结构化访谈的定性设计。参与者是通过有目的地从三级转诊儿科机构中抽样选出的，并进行了半结构化访谈。总共采访了 13 名临床医生和 5 名家长。专题分析揭示了四个主要决策/问题解决主题：1) 中心静脉接入装置闭塞的临床推理和判断，2) 中心静脉接入装置闭塞管理的能力，3) 升级过程中的同事协作，4)缺乏足够的支持来管理闭塞。这项研究确定了对问题解决过程的积极和消极影响，包括临床医生的心理能力、社会和物质资源以及对后果的信念。这项研究发现，儿科癌症护理的临床医生能够利用临床推理和判断技能来管理中心静脉通路装置闭塞，这可能与循证实践相冲突。该研究证实了在儿科肿瘤学环境中管理中心静脉通路装置的团队方法和先前经验的重要性，并确定了临床医生根据患者当前和预期状况做出的决定与实施循证实践之间的潜在冲突。改进文档记录并提供视觉辅助可以有利于临床医生解决问题的过程。