Chronic Central Venous Access: From Research Consensus Panel to National Multistakeholder Initiative

Baskin, Kevin M.; Durack, Jeremy C.; Abu‐Elmagd, Kareem; Doellman, Darcy; Drews, Barbara B.; Journeycake, Janna M.; Kocoshis, Samuel A.; McLennan, Gordon; Rupp, Stephen M.; Towbin, Richard B.; Wasse, Haimanot; Mermel, Leonard A.; Toomay, Seth; Camillus, John C.; Ahrar, Kamran; White, Sarah B.

doi:10.1016/j.jvir.2017.12.009

Cited by 17 publications

(28 citation statements)

References 44 publications

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“…Taurolidine citrate was indicated for patients with a history of more than one CABSI, residing within the hospital and did not have any medication infusion for at least 6 h. Longterm sequelae for CVAD failure and complications for children with chronic, vascular‐access‐dependent conditions are severe. In its most extreme scenario, loss of central venous catheter or absence of an accessible central venous pathway can mean loss of life …”

Section: Discussionmentioning

confidence: 99%

“…In its most extreme scenario, loss of central venous catheter or absence of an accessible central venous pathway can mean loss of life. 23 Multifactorial influences are likely responsible for the 50% reduction in catheter removal due to suspected infection, as until 2014, catheter removal to treat CLABSI was considered necessary. Now the microorganism responsible for CLABSI influences the decision to remove the catheter or attempt catheter salvage with a prolonged course of empiric and direct antibiotic therapy, supplemented by catheter lock.…”

Section: Discussionmentioning

confidence: 99%

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Development of a paediatric central venous access device database: A retrospective cohort study of practice evolution and risk factors for device failure

Kleidon

Rickard

Schults

et al. 2019

J Paediatrics Child Health

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Aim To describe practice evolution, complications and risk factors for multiple insertion attempts and device failure in paediatric central venous access devices (CVADs). Methods A paediatric retrospective cohort study using prospectively collected data from CVAD database 2012–2014. Data included were patient (i.e. age, condition), insertion (i.e. indication, device, technique) and removal (complications, dwell). Descriptive statistics and incidence rates were calculated per calendar year and compared. Risk factors for multiple insertion attempts and failure were explored with logistic regression and cox regression, respectively. Results A total of 1308 CVADs were observed over 273 467 catheter‐days in 863 patients. Multiple insertion attempts remained static (14%) and significantly associated with non‐haematological oncology (odds ratio 2.19; 95% confidence interval (CI) 1.08–4.43), respiratory (3.71; 1.10–12.5), gastroenterology (4.18; 1.66–10.5) and other (difficult intravenous access) (2.74; 1.27–5.92). CVAD failure decreased from 35% (2012) to 25% (2014), incidence rate from 1.50 (95% CI 1.25–1.80) to 1.28 (1.06–1.54) per 1000 catheter‐days. Peripherally inserted CVAD failure was significantly associated with lower body weight (per kilogram decrease, hazard ratio (HR) 1.02; 95% CI 1.00–1.03), cephalic vein (1.62; 1.05–2.62), difficult access (1.92; 1.02–3.73), sub‐optimal tip placement (1.69; 1.06–2.69) and gastroenterology diagnosis (2.27; 1.05–4.90). Centrally placed CVAD failure was significantly associated with younger age (per year, HR 1.04; 95% CI 1.00–1.07), tunnelled device (3.38; 2.41–4.73) and gastroenterology diagnosis (1.70; 1.06–2.73). Conclusions While advancement in CVAD practices improved overall CVAD insertion and failure outcomes, further improvements and innovation are necessary to ensure improved vessel health and preservation for children requiring CVAD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Development of a paediatric central venous access device database: A retrospective cohort study of practice evolution and risk factors for device failure

Kleidon

Rickard

Schults

et al. 2019

J Paediatrics Child Health

View full text Add to dashboard Cite

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“…The majority of published studies report infection rates using the surveillance definition of central line–associated bloodstream infections, which may significantly overestimate the true CRBSI rate . Conversely, the influence of penalties for reporting healthcare‐associated infections and the associated reluctance to obtain blood cultures (as well as the historic aversion to peripheral venous sampling in children) may account for significant underreporting of catheter infections . Both strategies increase uncertainty and may result in presumptive treatment of catheter‐related infection without adequate confirmation, leading to unnecessary catheter removal and other potentially harmful treatment.…”

Section: Failure Points and Essential Components Of Carementioning

confidence: 99%

“…Through the 21st Century Cures Act, the U.S. Congress emphasized the need for interoperability, that is, the ability for health information access, use, and exchange by authorized persons “without special effort.” The concepts embodied in this law are timely and germane to the complex coordination‐of‐care needs of high‐risk patients. Development of unified and unambiguous electronic vocabulary specifications is essential . It is imperative that such a unified venous access vocabulary become the community standard, including electronic health record, registry, and other health information technology vendors; payers; publishers; and government and private agencies.…”

Section: Failure Points and Essential Components Of Carementioning

confidence: 99%

“…Data could also be linked through the patient's Unique Device Identifier to permit coordination with national outcome tracking networks like the National Health Safety Network and other big data sources to inform guidelines, standards, reimbursement, and policy development. The needs for a robust and interoperable central venous access registry and for large‐scale prospective research have been identified as national multistakeholder priorities …”

Section: Failure Points and Essential Components Of Carementioning

confidence: 99%

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Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

Baskin

Mermel

Saad

et al. 2019

J Parenter Enteral Nutr

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Children with chronic illness often require prolonged or repeated venous access. They remain at high risk for venous catheter–related complications (high‐risk patients), which largely derive from elective decisions during catheter insertion and continuing care. These complications result in progressive loss of the venous capital (patent and compliant venous pathways) necessary for delivery of life‐preserving therapies. A nonstandardized, episodic, isolated approach to venous care in these high‐need, high‐cost patients is too often the norm, imposing a disproportionate burden on affected persons and escalating costs. This state‐of‐the‐art review identifies known failure points in the current systems of venous care, details the elements of an individualized plan of care, and emphasizes a patient‐centered, multidisciplinary, collaborative, and evidence‐based approach to care in these vulnerable populations. These guidelines are intended to enable every practitioner in every practice to deliver better care and better outcomes to these patients through awareness of critical issues, anticipatory attention to meaningful components of care, and appropriate consultation or referral when necessary.*

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Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation

Klaiber

Probst

Hackbusch

et al. 2021

Langenbecks Arch Surg

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Background There is still no reference standard for the implantation of totally implantable venous access ports (TIVAPs). A recently published multicentre randomised controlled trial (RCT) revealed a significantly greater risk of pneumothorax after closed cannulation than after an open strategy. The aim of this meta-analysis was to provide an update of the available evidence for the safety and effectiveness of primary open versus closed cannulation strategy. Methods RCTs comparing outcomes of open cut-down of the cephalic vein and closed cannulation of the subclavian vein were sought systematically in MEDLINE, Web of Science and CENTRAL. The primary outcome was the occurrence of pneumothorax. A beta-binominal model was applied to combine the respective outcomes, and results are presented as odds ratios (OR) with 95% confidence interval (CI). Results Six RCTs with a total of 1831 patients were included in final analysis. Meta-analysis showed statistically significant superiority of the open cut-down technique regarding pneumothorax (OR 0.308, 95% CI 0.122 to 0.776), but a statistically significant higher failure of the primary technique for the open cut-down technique than for closed cannulation (OR 2.364, 95% CI 1.051 to 5.315). There were no significant differences between the two procedures regarding other morbidity endpoints. Conclusion This meta-analysis shows a general superiority of open cut-down of the cephalic vein over closed cannulation of the subclavian vein regarding the occurrence of pneumothorax. Open cut-down should be the first-line approach for TIVAP implantation. Closed cannulation should be performed with ultrasound as second-line procedure if the open technique fails. Systematic review registration PROSPERO CRD42013005180

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Chronic Central Venous Access: From Research Consensus Panel to National Multistakeholder Initiative

Cited by 17 publications

References 44 publications

Development of a paediatric central venous access device database: A retrospective cohort study of practice evolution and risk factors for device failure

Development of a paediatric central venous access device database: A retrospective cohort study of practice evolution and risk factors for device failure

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation

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