Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care

Ullman, Amanda; Cooke, Marie; Kleidon, Tricia; Rickard, Claire M

doi:10.1111/jpc.13347

Cited by 45 publications

(58 citation statements)

References 39 publications

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“…Numerous non‐modifiable risk factors were observed, which significantly impacted CVAD failure, including age, weight and diagnosis. These findings align with existing studies which demonstrate increased CVAD complications in certain diagnostic groups such as oncology and haematology, catheter types (PICCs) and subsequent catheters . Other non‐modifiable risk factors such as tunnelled cuffed CVADs, compared to TIVPD, increase the risk of catheter failure.…”

Section: Discussionsupporting

confidence: 88%

“…Approximately 25% of hospitalised children receive a central venous access device (CVAD), for treatment administration . Insertion of CVADs can be challenging, and 25% of CVADs fail prior to the completion of therapy, due to mechanical, infectious and vascular complications . The prevalence of complications such as central line‐associated blood stream infection (CLABSI; 1.63 per 1000 catheter‐days) and device occlusion or blockage (e.g.…”

mentioning

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: Discussionsupporting

confidence: 88%

mentioning

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

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“…Currently the burden of CASI on the healthcare environment is estimated by small single population studies,10,40 or as a secondary endpoint of interventional studies 30,41. Research is urgently needed to define the prevalence of CASI within the wider healthcare environment.…”

Section: Discussionmentioning

confidence: 99%

Management of Central Venous Access Device-Associated Skin Impairment

Broadhurst

Moureau

Ullman

2017

Journal of Wound, Ostomy &Amp; Continence Nursing

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“… Central line‐associated bloodstream infection (CLABSI) has emerged as a leading cause of health care‐associated infection and preventable mortality in the 21st century Central venous access devices (CVADs) are increasingly used, with CVADs present in up to one quarter of all paediatric inpatients at any one time Australian paediatric hospitals currently have no consistent national CLABSI surveillance mechanism to allow for cross‐hospital benchmarking. …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

“…Central venous access devices (CVADs) are increasingly being used for delivery of life‐saving interventions: Point prevalence surveys report CVADs present in up to one quarter of all paediatric inpatients . To optimise patient safety, a holistic approach to CLABSI prevention built on robust surveillance and reporting platforms is required.…”

mentioning

confidence: 99%

Lessons learned from a hospital‐wide review of blood stream infections for paediatric central line‐associated blood stream infection prevention

Campbell

Blyth

Hewison

et al. 2018

J Paediatrics Child Health

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Aim Bacteraemia episodes were assessed to calculate a hospital‐wide central line‐associated blood stream infection (CLABSI) rate per 1000 catheter‐days. Secondary objectives were to describe risk factors, microbiology and outcomes of children with CLABSI. Methods A retrospective study was conducted at an Australian tertiary paediatric hospital in children <18 years who had blood culture sampling during the 2‐year period, 2014–2015. All blood culture results were extracted from the hospital's laboratory information system. National Healthcare Safety Network Centres for Disease Control and Prevention definitions for bacteraemia classification were used. Central venous access device (CVAD) insertion and removal dates were obtained from a surgical electronic database and anaesthetic records and then manually validated. Results Of 11 774 processed blood culture bottles, 207 episodes of blood stream infection were observed. Eighty‐five (41%) episodes were community‐acquired bacteraemia (CA‐B) and 122 (59%) health care‐associated bacteraemia (HA‐B), of which 73 (35%) were CLABSI. The hospital‐wide CLABSI rate was 0.62 per 1000 catheter‐days (95% confidence interval: 0.49–0.77). Conditions associated with CLABSI were malignancy (n = 45, 62%) and gastrointestinal failure (n = 6, 8%). Thirty‐three (45%) CLABSI episodes developed in an outpatient setting. Conclusions HA‐B has a significant impact on child health, exceeding the number of CA‐B at our hospital. Children with CVADs are vulnerable in both the inpatient and outpatient settings. Collecting robust data for a hospital‐wide CLABSI rate is important to understand the full spectrum of paediatric CLABSI. The value of validating data using both electronic and manual methods is demonstrated.

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Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care

Abstract: CVADs are prevalent and essential for paediatric health care; however, complications remain a significant problem. Areas identified for improvement were local CVAD guidelines, regular documentation of CVAD site assessment and review of dressing products to improve integrity.

Cited by 45 publications

References 39 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

Management of Central Venous Access Device-Associated Skin Impairment

Lessons learned from a hospital‐wide review of blood stream infections for paediatric central line‐associated blood stream infection prevention

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