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

Abstract

Aim: Central venous access devices (CVADs) are vital medical devices to support the treatment of paediatric cancer; however, device occlusion is common, which disrupts treatment. This study aimed to improve the identification and management of CVAD occlusions in children with cancer, as well as to identify the demographic, clinical and device characteristics associated with increased risk for CVAD occlusion. Methods: A pre-post-implementation study was conducted at a metropolitan paediatric oncology facility in Australia, using the Theoretical Domains Framework. Patients with a CVAD for anti-cancer therapy were prospectively followed for occlusive events pre-and post-the implementation of clinical resources to support the identification and management of CVAD occlusive events. CVAD occlusion and management data were collected and compared pre-and post-implementation. Risk factors for CVAD occlusion were described by mixed-effects Poisson regression and incident rate ratios (IRR). Results: A total of 133 CVADs were inserted into 131 patients for a total of 6784 catheter days. The incidence of CVAD-related occlusion preimplementation was 59.7 (95% confidence interval (CI) 51.4-69.0, per 1000 catheter days); compared to 31.6 (95% CI 26.4-37.6); P < 0.01) postimplementation of clinical resources. In multivariate models, other than post-implementation phases (IRR 0.51 (95% CI 0.32-0.81)), only neutropaenia significantly increased the risk of CVAD occlusion (IRR 2.14 (95% CI 1.15-3.97)). Conclusion: CVAD occlusions in paediatric oncology are common. The development and implementation of CVAD occlusion resources to guide the identification and management of occlusive episodes led to a significant decrease in occlusive events.

Routine Catheter Lock Solutions in Pediatric Cancer Care

“…Abbreviation: A$, Australian dollars.Cost per episode was derived from previous work 31 a Estimated using general linear model, gamma family log link.…”

“…Most complication treatment costs were sourced from a previous cost analysis conducted at the same hospital. 31 Partial occlusions were modeled on standard treatment practice at the site and informed by expert opinion and cost using local hospital pricing arrangements. As cost data are skewed, a general linear model was performed using a gamma family, log-link specification.…”

“…The number of heparin episodes was estimated based on management protocol. Most complication treatment costs were sourced from a previous cost analysis conducted at the same hospital 31 . Partial occlusions were modeled on standard treatment practice at the site and informed by expert opinion and cost using local hospital pricing arrangements.…”

A Multidisciplinary Approach and Development of an Algorithm for Timely Repair of Central Venous Access in Pediatric Patients

“…Pediatric intestinal failure (IF) is characterized by the inability of the gastrointestinal tract to absorb adequate nutrition and fluid to maintain hydration and support growth resulting in the need for long-term parenteral nutrition (PN) delivered via a CVC [ 1 ]. Long-term CVC usage can result in various complications, including central-line associated bloodstream infection (CLABSI), venous thrombosis, and catheter compromise [ 2 , 3 ]. Catheter compromise can include urinary tract infection, obstruction, urinary leakage, and genitourinary tract trauma [ 4 ].…”