Improvement of Broviac catheter-related outcomes after the implementation of a quality management system: A before-and-after prospective observational study

Abstract

Background: Because of the high rates of Broviac catheter complications, we started an urgent quality process to reduce this morbidity. The aim is to assess the efficiency of the main actions we have taken in enhancing our practice and improving Broviac outcomes. Methods: We included all neonates and young infants requiring surgical central venous access using a Broviac tunneled catheter. We compared the catheters’ outcomes before and after the implementation of a quality program based on a nurse teaching program, patient selection, and catheter management multidisciplinary protocol. The significance threshold was set at p<0.05. Results: We included 94 patients: 51 in the protocol group and 43 in the control group. The complication rate was reduced from 60.3% to 25.5% with p=0.001. The lifetime of the catheter was improved from 11.3 ± 4.3 days to 19.1 ± 9 days with p=0.007. The catheter infection was reduced from 65.3% to 46.1% with p≤0.001. Conclusion: This quality improvement project shows the utility of a quality assurance program based on careful indications and patient selection, a nursing teaching program, and a multidisciplinary catheter management protocol, in reducing Broviac catheter-related morbidity.

Predictors of perioperative respiratory adverse events among children with upper respiratory tract infection undergoing pediatric ambulatory ilioinguinal surgery: a prospective observational research

“…In our population, the incidence of PRAEs was higher than that in the literature, and an urgent quality process is required to improve the outcomes 10. This may be due to including children who were canceled before 15 days because of severe respiratory infections.…”

“…In our population, the incidence of PRAEs was higher than that in the literature, and an urgent quality process is required to improve the outcomes. 10 This may be due to including children who were canceled before 15 days because of severe respiratory infections. It seems that this delay (15 days after the onset of symptoms, according to the protocol of our department) is insufficient because children who experienced a severe respiratory upper tract infection 15 days ago may retain bronchial hyper-responsiveness (copious secretions), especially in children with respiratory comorbidities or exposed to environmental tobacco smoke.…”

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country

“…Investigating predictors of complications was useful to guide us to the actions required. 8 The main limitations of this study are that we included a heterogeneous pediatric population, as it included patients coming from different departments and requiring central lines for different indications with different ages. This study was not specific to a particular pediatric population.…”

“…It gave us feedback on our habits and warned us about the need to take urgent measures to reduce catheter-related morbidity. Investigating predictors of complications was useful to guide us to the actions required 8…”

“…Although there are several barriers to improving our pediatric difficult venous access outcomes, 32 we have achieved some advantages by changing habits, 8 such as using SVCs in place of Broviac catheters, which were overused previously despite their higher rates of complications (60.2%), 4 but there is still a large gap to an advanced country.…”