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

Abstract

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.

Prevention of occlusion of cEnTral lInes for children with cancer: An implementation study

“…The multivariable model was adjusted for age, weight, gender, diagnosis, leukocytes, patient location at day 1, device number, CVAD type, lumen numbers and presence of blood product infusion, which were the risk factors presented in previous literature. 3,13 The group and subject ID (repeated measures) were used for random effects in this model to adjust for the effects of clustering within…”

“…Mixed effects Poisson regression was used to determine the association between occlusion events and pre‐ and post‐group, reported as incident rate ratio (IRR). The multivariable model was adjusted for age, weight, gender, diagnosis, leukocytes, patient location at day 1, device number, CVAD type, lumen numbers and presence of blood product infusion, which were the risk factors presented in previous literature 3,13 . The group and subject ID (repeated measures) were used for random effects in this model to adjust for the effects of clustering within groups and same subject when assessing the association between the outcome of interest and independent factors.…”

“…Central venous access devices (CVADs) are essential for the short-and long-term care provision of~50 000 Australian children annually. [1][2][3] Almost all children with cancer require the insertion of a CVAD to enable the safe administration of anticancer drugs, supportive therapies, and for blood sampling. Despite their ubiquity and necessity, one in three CVADs used during treatment for paediatric cancer is associated with a severe complication and subsequent device failure; disrupting essential treatment.…”

“…Central venous access devices (CVADs) are essential for the short‐ and long‐term care provision of ~50 000 Australian children annually 1–3 . Almost all children with cancer require the insertion of a CVAD to enable the safe administration of anti‐cancer drugs, supportive therapies, and for blood sampling.…”

Risk Factors for Central Venous Access Device-Related Thrombosis in Hospitalized Children: A Systematic Review and Meta-Analysis

“…The economic cost includes the direct (reinsertion procedures, therapy delays, and extended inpatient stays) and indirect medical cost (personnel and resource utilization). [8][9][10] In addition, CRT can result in chronic venous obstruction and the loss of vascular access, postthrombotic syndrome, and pulmonary embolism. 11 Hospitalized children with CVAD are vulnerable to VTE due to their potentially poor health, and the vulnerability may be further exacerbated by CVAD catheterizing and managementrelated risk factors.…”