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Ullman A, Takashima M, Gibson V, Comber E, Borello E, Bradford N, Byrnes J, Cole R, Eisenstat D, Henson N, Howard P, Irwin A, Keogh S, Kleidon T, Martin M, McCleary K, McLean J, Moloney S, Monagle P, Moore A, Newall F, Noyes M, Rowan G, St John A, Wood A, Wolf J, Ware R. Preventing adverse events during paediatric cancer treatment: protocol for a multi-site hybrid randomised controlled trial of catheter lock solutions (the CLOCK trial). BMJ Open 2024; 14:e085637. [PMID: 38986559 PMCID: PMC11243282 DOI: 10.1136/bmjopen-2024-085637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Central venous access devices (CVADs) are commonly used for the treatment of paediatric cancer patients. Catheter locking is a routine intervention that prevents CVAD-associated adverse events, such as infection, occlusion and thrombosis. While laboratory and clinical data are promising, tetra-EDTA (T-EDTA) has yet to be rigorously evaluated or introduced in cancer care as a catheter lock. METHODS AND ANALYSIS This is a protocol for a two-arm, superiority type 1 hybrid effectiveness-implementation randomised controlled trial conducted at seven hospitals across Australia and New Zealand. Randomisation will be in a 3:2 ratio between the saline (heparinised saline and normal saline) and T-EDTA groups, with randomly varied blocks of size 10 or 20 and stratification by (1) healthcare facility; (2) CVAD type and (3) duration of dwell since insertion. Within the saline group, there will be a random allocation between normal and heparin saline. Participants can be re-recruited and randomised on insertion of a new CVAD. Primary outcome for effectiveness will be a composite of CVAD-associated bloodstream infections (CABSI), CVAD-associated thrombosis or CVAD occlusion during CVAD dwell or at removal. Secondary outcomes will include CABSI, CVAD-associated-thrombosis, CVAD failure, incidental asymptomatic CVAD-associated-thrombosis, other adverse events, health-related quality of life, healthcare costs and mortality. To achieve 90% power (alpha=0.05) for the primary outcome, data from 720 recruitments are required. A mixed-methods approach will be employed to explore implementation contexts from the perspective of clinicians and healthcare purchasers. ETHICS AND DISSEMINATION Ethics approval has been provided by Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (HREC/22/QCHQ/81744) and the University of Queensland HREC (2022/HE000196) with subsequent governance approval at all sites. Informed consent is required from the substitute decision-maker or legal guardian prior to participation. In addition, consent may also be obtained from mature minors, depending on the legislative requirements of the study site. The primary trial and substudies will be written by the investigators and published in peer-reviewed journals. The findings will also be disseminated through local health and clinical trial networks by investigators and presented at conferences. TRIAL REGISTRATION NUMBER ACTRN12622000499785.
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Affiliation(s)
- Amanda Ullman
- The University of Queensland, Brisbane, Queensland, Australia
| | - Mari Takashima
- The University of Queensland, Brisbane, Queensland, Australia
| | - Victoria Gibson
- The University of Queensland, Brisbane, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Elouise Comber
- The University of Queensland, Brisbane, Queensland, Australia
| | - Eloise Borello
- The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Brisbane, Queensland, Australia
| | - Roni Cole
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - David Eisenstat
- The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nicole Henson
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Philippa Howard
- The University of Queensland, Brisbane, Queensland, Australia
| | - Adam Irwin
- University Of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Samantha Keogh
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tricia Kleidon
- Queensland Children's Hospital, Queensland Health, South Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Nathan, Queensland, Australia
| | - Michelle Martin
- Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Karen McCleary
- Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Jordana McLean
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Susan Moloney
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Paul Monagle
- Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew Moore
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Fiona Newall
- The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michelle Noyes
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Gemma Rowan
- The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Amanda St John
- Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Andrew Wood
- Starship Children's Health, Auckland, Auckland, New Zealand
| | - Joshua Wolf
- St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Robert Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Schults JA, Reynolds H, Rickard CM, Culwick MD, Mihala G, Alexandrou E, Ullman AJ. Dressings and securement devices to prevent complications for peripheral arterial catheters. Cochrane Database Syst Rev 2024; 5:CD013023. [PMID: 38780138 PMCID: PMC11112983 DOI: 10.1002/14651858.cd013023.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Peripheral arterial catheters (ACs) are used in anaesthesia and intensive care settings for blood sampling and monitoring. Despite their importance, ACs often fail, requiring reinsertion. Dressings and securement devices maintain AC function and prevent complications such as infection. OBJECTIVES To evaluate the effectiveness of peripheral AC dressing and securement devices to prevent failure and complications in hospitalised people. SEARCH METHODS We searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus up to 16 May 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform up to 16 May 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different dressing and securement devices for the stabilisation of ACs in hospitalised people. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias using Cochrane's RoB 1 tool. We resolved disagreements by discussion, or by consulting a third review author when necessary. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included five RCTs with 1228 participants and 1228 ACs. All included studies had high risk of bias in one or more domains. We present the following four comparisons, with the remaining comparisons reported in the main review. Standard polyurethane (SPU) plus tissue adhesive (TA) compared with SPU: we are very uncertain whether use of SPU plus TA impacts rates of AC failure (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.20 to 0.98; I² = 0%; 2 studies, 165 participants; very low-certainty evidence). Neither study (165 participants) reported catheter-related bloodstream infections (CRBSI), thus we are very uncertain whether SPU plus TA impacts on the incidence of CRBSI (very low-certainty evidence). It is very uncertain whether use of SPU plus TA impacts AC dislodgement risk (RR 0.54, 95% CI 0.03 to 9.62; I² = 44%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts AC occlusion rates (RR 1.20, 95% CI 0.37 to 3.91; I² = 3%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts rates of adverse events with few reported events across groups (RR 0.89, 95% CI 0.09 to 8.33; I² = 0%; 2 studies, 165 participants; very low-certainty evidence). Bordered polyurethane (BPU) compared to SPU: we are very uncertain whether use of BPU impacts rates of AC failure (RR 0.67, 95% CI 0.21 to 2.13; 1 study, 60 participants; very low-certainty evidence). BPU may make little or no difference to CRBSI compared to SPU (RR 3.05, 95% CI 0.12 to 74.45; I² = not applicable as 1 study (60 participants) reported 0 events; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to the risk of AC dislodgement compared with SPU (RR 0.75, 95% CI 0.17 to 3.22; I² = 0%; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to occlusion risk compared with SPU (RR 0.80, 95% CI 0.60 to 1.07; I² = 0%; 2 studies, 572 participants; low-certainty evidence). It is very uncertain whether BPU impacts on the risk of adverse events compared with SPU (RR 0.33, 95% CI 0.01 to 7.87; 1 study, 60 participants; very low-certainty evidence). SPU plus sutureless securement devices (SSD) compared to SPU: we are very uncertain whether SPU plus SSD impacts risk of AC failure compared with SPU (RR 0.78, 95% CI 0.40 to 1.52; I² = 0%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain if SPU plus SSD impacts CRBSI incidence rate with no events in both groups (2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of dislodgement (RR 0.14, 95% CI 0.01 to 2.57; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of AC occlusion (RR 1.94, 95% CI 0.50 to 7.48; I² = 38%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain whether SPU plus SSD impacts on the risk of adverse events (RR 1.94, 95% CI 0.19 to 20.24; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence). Integrated securement dressings compared to SPU: integrated securement dressings may result in little or no difference in risk of AC failure compared with SPU (RR 1.96, 95% CI 0.80 to 4.84; 1 study, 105 participants; low-certainty evidence); may result in little or no difference in CRBSI incidence with no events reported (1 study, 105 participants; low-certainty evidence); may result in little or no difference in the risk of dislodgement (RR 0.33, 95% CI 0.04 to 3.04; 1 study, 105 participants; low-certainty evidence), may result in little or no difference in occlusion rates with no events reported (1 study, 105 participants; low-certainty evidence), and may result in little or no difference in the risk of adverse events (RR 0.35, 95% CI 0.01 to 8.45; 1 study, 105 participants; low-certainty evidence). AUTHORS' CONCLUSIONS There is currently limited rigorous RCT evidence available about the relative clinical effectiveness of AC dressing and securement products. Limitations of current evidence include small sample size, infrequent events, and heterogeneous outcome measurements. We found no clear difference in the incidence of AC failure, CRBSI, or adverse events across AC dressing or securement products including SPU, BPU, SSD, TA, and integrated securement products. The limitations of current evidence means further rigorous RCTs are needed to reduce uncertainty around the use of dressing and securement devices for ACs.
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Affiliation(s)
- Jessica A Schults
- Herston Infectious Diseases Institute, Nursing Midwifery Research Centre, Metro North Health, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Heather Reynolds
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Claire M Rickard
- Herston Infectious Diseases Institute, Nursing Midwifery Research Centre, Metro North Health, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- NHMRC Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Gabor Mihala
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| | - Evan Alexandrou
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- School of Nursing, University of Wollongong, New South Wales, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- NHMRC Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Centre of Children's Health Research, South Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Australia
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Takashima M, Hyun A, Xu G, Lions A, Gibson V, Cruickshank M, Ullman A. Infection Associated With Invasive Devices in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e42-e56. [PMID: 38161188 DOI: 10.1542/hpeds.2023-007194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT Indwelling invasive devices inserted into the body for extended are associated with infections. OBJECTIVE This study aimed to estimate infection proportion and rates associated with invasive devices in pediatric healthcare. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) postinsertion infection complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device local, organ, and bloodstream infection (BSIs) pooled proportion and incidence rate (IR) per-1000-device-days per device type were reported. RESULTS A total of 116 studies (61 554 devices and 3 632 364 device-days) were included. The highest number of studies were central venous access devices associated BSI (CVAD-BSI), which had a pooled proportion of 8% (95% confidence interval [CI], 6-11; 50 studies) and IR of 0.96 per-1000-device-days (95% CI, 0.78-1.14). This was followed by ventilator-associated pneumonia in respiratory devices, which was 19% (95% CI, 14-24) and IR of 14.08 per-1000-device-days (95%CI, 10.57-17.58). CONCLUSIONS Although CVAD-BSI and ventilator associated pneumonia are well-documented, there is a scarcity of reporting on tissue and local organ infections. Standard guidelines and compliance initiatives similar to those dedicated to CVADs should be implemented in other devices in the future.
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Affiliation(s)
- Mari Takashima
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Areum Hyun
- The University of Queensland, Queensland, Australia
| | - Grace Xu
- The University of Queensland, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | | | - Victoria Gibson
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Marilyn Cruickshank
- Sydney Children's Hospitals Network, New South Wales, Australia
- The University of Technology Sydney, New South Wales, Australia
| | - Amanda Ullman
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
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Ullman A, Hyun A, Gibson V, Newall F, Takashima M. Device Related Thrombosis and Bleeding in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e25-e41. [PMID: 38161187 DOI: 10.1542/hpeds.2023-007345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT The risk of invasive device-related thrombosis and bleeding contributes to morbidity and mortality, yet their prevalence by device-types is poorly understood. OBJECTIVES This study aimed to estimate pooled proportions and rates of thrombotic and bleeding complications associated with invasive devices in pediatric health care. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) reporting thrombotic and bleeding complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device-specific pooled thromboses (symptomatic, asymptomatic, unspecified) and bleeding (major, minor). RESULTS Of the 107 studies, 71 (66%) focused on central venous access devices. Symptomatic venous thromboembolism in central venous access devices was 4% (95% confidence interval [CI], 3-5; incidence rate 0.03 per 1000 device-days, 95% CI, 0.00-0.07), whereas asymptomatic was 10% (95% CI, 7-13; incidence rate 0.25 per 1000 device-days, 95% CI, 0.14-0.36). Both ventricular assist devices (28%; 95% CI, 19-39) and extracorporeal membrane oxygenation (67%; 95% CI, 52-81) were often associated with major bleeding complications. CONCLUSIONS This comprehensive estimate of the incidence and prevalence of device-related thrombosis and bleeding complications in children can inform clinical decision-making, guide risk assessment, and surveillance.
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Affiliation(s)
- Amanda Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | - Areum Hyun
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Fiona Newall
- Royal Children's Hospital Melbourne, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
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Tian L, Su Y, Gao H, Wang L, Zeng J, Yang Q, Li W, Lin P, Gao Y, Tan X, Yang H, Feng X, Luo H, Li W, Zhang X, Wu X, Li Y. Development and validation of a nomogram model for central venous access device-related thrombosis in hospitalized children. Eur J Pediatr 2023; 182:4909-4919. [PMID: 37606700 DOI: 10.1007/s00431-023-05078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 08/23/2023]
Abstract
This study aimed to develop and validate a nomogram model of central venous access device-related thrombosis (CRT) for hospitalized children. A total of 503 consecutive cases from a hospital in Changsha City, Hunan Province were stochastically classified into the training set and internal validation set at a ratio of 7:3, and 85 consecutive cases in two hospitals in Urumqi City, Xinjiang Uygur Autonomous Region were collected as an external validation set. Univariate analysis and multivariate analysis on CRT-related risk factors of hospitalized children were conducted, a logistic regression model was employed to establish the nomogram, and the discrimination, calibration, and decision curve analysis was performed to assess the proposed nomogram model. The nomogram model involved seven independent risk factors, including blind catheterization, abnormal liver function, central line-associated bloodstream infection, infection, number of catheter lines, leukemia, and bed rest > 72 h. The discrimination results showed that the area under the receiver operating characteristic curve of the training set, internal validation set, and external validation set was 0.74, 0.71, and 0.76 respectively, and the accuracy rates of the proposed nomogram model were 79%, 72%, and 71% in the training set, internal validation set, and external validation set. The calibration results also showed that the calibration curve had great fitness for each dataset. More importantly, the decision curve suggested that the proposed nomogram model had a prominent clinical significance. CONCLUSION The nomogram model can be used as a risk assessment tool to reduce the missed diagnosis rate and the incidence of CRT in hospitalized children. WHAT IS KNOWN • Central venous access device-related thrombosis is generally asymptomatic for hospitalized children, causing the missed diagnosis of central venous access device-related thrombosis easily. • No risk prediction nomogram model for central venous access device-related thrombosis in hospitalized children has been established. WHAT IS NEW • A visual and personalized nomogram model was built by seven accessible variables (blind catheterization, abnormal liver function, central line-associated bloodstream infection, infection, number of catheter lines, leukemia, and bed rest > 72 h). • The model can effectively predict the risk of central venous access device-related thrombosis for hospitalized children.
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Affiliation(s)
- Lingyun Tian
- Department of Nursing, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yanan Su
- Reproductive Center, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Huimin Gao
- Operation Room, Xiangya Hospital of Central South University, Changsha, China
| | - Liqian Wang
- Ward of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Jiaqi Zeng
- Department of Pain, the , Third Xiangya Hospital of Central South University, Changsha, China
| | - Qiuhong Yang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Wan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Pan Lin
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yijing Gao
- School of Nursing, Xinjiang Medical University, Urumqi, China
| | - Xin Tan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Haifan Yang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xinyu Feng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hui Luo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Weijuan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiumin Zhang
- Department of Nursing, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Xing Wu
- Department of Nursing, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Office of hospital, the Seventh Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Yinglan Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China.
- National Clinical Research Center of Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China.
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Tian L, Feng X, Yang H, Tan X, Gao Y, Luo H, Li W, Yan P, Li Y. Knowledge, attitude, and practice of pediatric nurses in prevention of central venous access device-related thrombosis in hospitalized children: a nationwide cross-sectional survey. Eur J Pediatr 2023; 182:3481-3490. [PMID: 37184646 DOI: 10.1007/s00431-023-04997-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023]
Abstract
Central venous access device-related thrombosis (CRT) is a common complication in hospitalized children. The pediatric nurses' knowledge, attitude, and practice are of great significance for CRT prevention in hospitalized children. The purpose of this study was to elaborate on the level and influencing factors of pediatric nurses' knowledge, attitude, and practice on the prevention related to CRT in hospitalized children. This national cross-sectional study was carried out in China from January 16, 2021, to April 23, 2021. A multi-stage sampling method was adopted, and 1060 pediatric nurses from 21 hospitals participated in this study. The current situation and influencing factors of pediatric nurses' knowledge, attitude, and practice were investigated by descriptive statistics, approximate t test or independent-sample t test, nonparametric Kruskal-Wallis H test, one-way analysis of variance, and multiple linear regression analysis. The relationship among pediatric nurses' knowledge, attitude, and practice was explored by the Pearson correlation analysis. Among all pediatric nurses involved in this study, 25% had insufficient knowledge, 18% had negative attitudes, and 24% had poor behaviors. The main influencing factors on the knowledge, attitude, and practice included the highest education level of pediatric nurses (β = 0.10, P = .001), whether received training related to CRT prevention (β = 0.09-0.14, P < .01), whether CRT-related knowledge was enough for dealing with clinical work (β = 0.18-0.21, P < .001), and the importance of hospitals/departments on children CRT prevention (β = 0.16-0.24, P < .001). There was a positive correlation between knowledge, attitude, and practice (r = 0.24-0.77, P < .01). Conclusion: Pediatric nurses' CRT-prevention knowledge and practice are unsatisfactory, while their preventive attitude toward CRT prevention is optimistic. This study assists the formulation of comprehensive intervention strategies for pediatric nurses in preventing CRT in hospitalized children by hospital-related organizations and nursing managers, so as to improve the participation of pediatric nurses in CRT prevention and reduce the occurrence of CRT for hospitalized children. What is Known: • As a common complication in hospitalized children, CRT can induce many potentially serious complications. • A professional nursing team is an important prerequisite for reducing CRT incidence. What is New: • The levels of pediatric nurses' knowledge and practice are not satisfactory, while pediatric nurses' preventive attitude toward CRT prevention is optimistic. • Hospital-related organizations and nursing managers should highlight the importance of CRT prevention and encourage pediatric nurses to improve their expertise and strengthen the training related to CRT prevention.
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Affiliation(s)
- Lingyun Tian
- Department of Nursing, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xinyu Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Haifan Yang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xin Tan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yijing Gao
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Hui Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Weijuan Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Ping Yan
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China.
| | - Yinglan Li
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China.
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.
- National Clinical Research Center of Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Experiences of children with central venous access devices: a mixed-methods study. Pediatr Res 2023; 93:160-167. [PMID: 35411069 PMCID: PMC9876783 DOI: 10.1038/s41390-022-02054-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Our study aims to explore the experience of having a central venous access device (CVAD) from the perspective of the child and family and how movements within and outside of hospital environments influence this experience. METHODS A mixed-methods study was conducted across Children's Health Queensland (Australia), including inpatient and home-care settings. Children less than 18 years with CVADs were eligible and followed for 3 months or CVAD removal. A subgroup of primary caregivers participated in semi-structured interviews. Quantitative and qualitative measures of child and family CVAD experiences were explored. RESULTS In total, 163 patients with 200 CVADs were recruited and followed for 6993 catheter days (3329 [48%] inpatients; 3147 [45%] outpatients; 517 [7%] home). Seventeen participants were interviewed. Experiences of having a CVAD were complex but predominantly positive primarily related to personalized CVAD care, healthcare quality, and general wellbeing. Their experience was shaped by their movements through hospital and home environments, including care variation and distress with procedures. Device selection and insertion location further influenced experience, including safety, impairments in activities of daily living, school, and recreation. CONCLUSIONS CVAD experiences were influenced by nonmodifiable (e.g., diagnosis) and modifiable factors (e.g., education; care variation). Clinical approaches and policies that account for family and child considerations should be explored. IMPACT Variation in decision making and management for pediatric CVADs is accepted by many clinicians, but the influence this variation has on the health experience of children and their families is less well explored. This is the first study to draw from a broad range of children requiring CVADs to determine their experience within and outside of healthcare facilities. Interdisciplinary clinicians and researchers need to work collaboratively with children and their families to provide resources and support services to ensure they have positive experiences with CVADs, no matter where they are managed, or who they are managed by.
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Schults JA, Rickard CM, Charles K, Rahiman S, Millar J, Baveas T, Long D, Kleidon TM, Macfarlane F, Mehta NM, Runnegar N, Hall L. Quality measurement and surveillance platforms in critically ill children: A scoping review. Aust Crit Care 2022:S1036-7314(22)00097-2. [PMID: 36117039 DOI: 10.1016/j.aucc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/24/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND/AIM The objective of this study was to describe current surveillance platforms which support routine quality measurement in paediatric critical care. METHOD Scoping review. The search strategy consisted of a traditional database and grey literature search as well as expert consultation. Surveillance platforms were eligible for inclusion if they collected measures of quality in critically ill children. RESULTS The search strategy identified 21 surveillance platforms, collecting 57 unique outcome (70%), process (23%), and structural (7%) quality measures. Hospital-associated infections were the most commonly collected outcome measure across all platforms (n = 11; 52%). In general, case definitions were not harmonised across platforms, with the exception of nationally mandated hospital-associated infections (e.g., central line-associated blood stream infection). Data collection relied on manual coding. Platforms typically did not provide an evidence-based rationale for measures collected, with no identifiable reports of co-designed, consensus-derived measures or consumer involvement in measure selection or prioritisation. CONCLUSIONS Quality measurement in critically ill children lacks uniformity in definition which limits local and international benchmarking. Current surveillance activities for critically ill children focus heavily on outcome measurement, with process, structural, and patient-reported measures largely overlooked. Long-term outcome measures were not routinely collected. Harmonisation of paediatric intensive care unit quality measures is needed and can be achieved using prioritisation and consensus/co-design methods.
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Affiliation(s)
- Jessica A Schults
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Metro North Hospital and Health Service, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia; School of Nursing and Midwifery Griffith University, Queensland, Australia; Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia.
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Metro North Hospital and Health Service, Queensland, Australia; School of Nursing and Midwifery Griffith University, Queensland, Australia
| | - Karina Charles
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia; School of Nursing and Midwifery Griffith University, Queensland, Australia; Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Sarfaraz Rahiman
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Johnny Millar
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Australia
| | - Thimitra Baveas
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Debbie Long
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; School of Nursing and Midwifery Griffith University, Queensland, Australia; Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Fiona Macfarlane
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Nilesh M Mehta
- Perioperative & Critical Care Center for Outcomes Research (PC-CORE), USA; Department of Anesthesiology, Critical Care & Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, USA; Harvard Medical School, Boston, USA
| | - Naomi Runnegar
- School of Medicine, University of Queensland, St Lucia, Queensland, Australia; Infection Management, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Lisa Hall
- School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
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Zhang JJ, Nataraja RM, Lynch A, Barnes R, Ferguson P, Pacilli M. Factors affecting mechanical complications of central venous access devices in children. Pediatr Surg Int 2022; 38:1067-1073. [PMID: 35513517 PMCID: PMC9163013 DOI: 10.1007/s00383-022-05130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Factors leading to mechanical complications following insertion of central venous access devices (CVADs) in children are poorly understood. We aimed to quantify the rates and elucidate the mechanisms of these complications. METHODS Retrospective (2016-2021) review of children (< 18 years old) receiving a CVAD. Data, reported as number of cases (%) and median (IQR), were analysed by Fisher's exact test, chi-squared test and logistic regression analysis. RESULTS In total, 317 CVADs (245 children) were inserted. Median age was 5.0 (8.9) years, with 116 (47%) females. There were 226 (71%) implantable port devices and 91 (29%) Hickman lines. Overall, 54 (17%) lines had a mechanical complication after 0.4 (0.83) years from insertion: fracture 19 (6%), CVAD migration 14 (4.4%), occlusion 14 (4.4%), port displacement 6 (1.9%), and skin tethering to port device 1 (0.3%). Younger age and lower weight were associated with higher risk of complications (p < 0.0001). Hickman lines had a higher incidence of complications compared to implantable port devices [24/91 (26.3%) vs 30/226 (13.3%); p = 0.008]. CONCLUSION Mechanical complications occur in 17% of CVADs at a median of < 6 months after insertion. Risk factors include younger age and lower weight. Implantable port devices have a lower complications rate. LEVEL OF EVIDENCE Level 4: case-series with no comparison group.
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Affiliation(s)
- Jessica J Zhang
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Amiria Lynch
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Richard Barnes
- Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia
| | - Peter Ferguson
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia.
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia.
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.
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Pediatric central venous access devices: practice, performance, and costs. Pediatr Res 2022; 92:1381-1390. [PMID: 35136199 PMCID: PMC9700519 DOI: 10.1038/s41390-022-01977-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Healthcare delivery is reliant on a functional central venous access device (CVAD), but the knowledge surrounding the burden of pediatric CVAD-associated harm is limited. METHODS A prospective cohort study at a tertiary-referral pediatric hospital in Australia. Children <18 years undergoing insertion of a CVAD were screened from the operating theatre and intensive care unit records, then assessed bi-weekly for up to 3 months. Outcomes were CVAD failure and complications, and associated healthcare costs (cost of complications). RESULTS 163 patients with 200 CVADs were recruited and followed for 6993 catheter days, with peripherally inserted central catheters most common (n = 119; 60%). CVAD failure occurred in 20% of devices (n = 30; 95% CI: 15-26), at an incidence rate (IR) of 5.72 per 1000 catheter days (95% CI: 4.09-7.78). CVAD complications were evident in 43% of all CVADs (n = 86; 95% CI: 36-50), at a rate of 12.29 per 1000 catheter days (95% CI: 9.84-15.16). CVAD failure costs were A$826 per episode, and A$165,372 per 1000 CVADs. Comparisons between current and recommended practice revealed inconsistent use of ultrasound guidance for insertion, sub-optimal tip-positioning, and appropriate device selection. CONCLUSIONS CVAD complications and failures represent substantial burdens to children and healthcare. Future efforts need to focus on the inconsistent use of best practices. IMPACT Current surveillance of central venous access device (CVAD) performance is likely under-estimating actual burden on pediatric patients and the healthcare system. CVAD failure due to complication was evident in 20% of CVADs. Costs associated with CVAD complications average at $2327 (AUD, 2020) per episode. Further investment in key diverse practice areas, including new CVAD types, CVAD pathology-based occlusion and dislodgment strategies, the appropriate use of device types, and tip-positioning technologies, will likely lead to extensive benefit.
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Ferraz-Torres M, Escalada-Hernandez P, San Martín-Rodriguez L, Delarosa R, Saenz R, Soto-Ruiz MN. Predictive Factors for Anxiety during Blood Sampling and Insertion of Peripheral Intravenous Catheters in Paediatric Patients in Spain. J Pediatr Nurs 2021; 61:e35-e41. [PMID: 33931258 DOI: 10.1016/j.pedn.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Invasive procedures for diagnosis purposes such as venepuncture and peripheral venous catheter insertion are painful procedures that cause great stress for paediatric patients. The objective of this study is to find out the factors that have an impact on the level of anxiety experienced by children undertaken these procedures. DESIGN AND METHODS Prospective study, 359 children between 2 and 15 years old were included, treated in a tertiary reference hospital in the region of Navarra (Spain). The impact of the variables recorded was analysed using a regressive analysis, the Wong-Baker and FLACC scales were used to measure the level of pain and the PACBIS scale to measure the level of stress and anxiety. RESULTS The average age of the participants was 7.93 years (SD: 4.04), with 51.8% (n = 186) boys and 48.2% (n = 173) girls. The mean value of pain recorded was 4.43 (SD:3.10). 45.7% (n = 123) of the venepuncture techniques was associated with minimum level of anxiety, including 11.1% of intravenous catheterization. Variables determining the anxiety has been detected such as age, sex, level of pain, parental conduct and time spent on the procedure. CONCLUSIONS Paediatric patients experience high levels of anxiety when undergoing painful procedures which are conditioned by multifactorial reasons. The increase in stress is directly related to the older age (>6 years old) of the patient, and statistically significant by the female gender, the longer duration of the technique and the parental block. PRACTICE IMPLICATIONS Healthcare professionals should work on some of the variables and apply measures aimed to mitigate anxiety levels. For example, reducing the duration of the procedure, training parents, and distracting techniques.
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Affiliation(s)
- M Ferraz-Torres
- Clinical Records at Complejo Hospitalario de Navarra (CHN), Spain.
| | | | | | - R Delarosa
- Oncología pediátrica, Complejo Hospitalario Donostia, Spain.
| | - R Saenz
- Unidad de reanimación post-anestésica, Complejo Hospitalario de Navarra, Spain.
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Schults JA, Woods C, Cooke M, Kleidon T, Marsh N, Ray-Barruel G, Rickard CM. Healthcare practitioner perspectives and experiences regarding vascular access device data: An exploratory study. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1721750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jessica A. Schults
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
- Department of Anaesthesia and Pain Management, Queensland Children’s Hospital, Queensland, Australia
| | - Christine Woods
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- Department of Anaesthesia and Pain Management, Queensland Children’s Hospital, Queensland, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
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Time-Driven Cost Analysis of Noncuffed Venous Catheter Placement in Infants: Bedside versus IR Suite. J Vasc Interv Radiol 2021; 32:1479-1487. [PMID: 34358685 DOI: 10.1016/j.jvir.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare the direct bundled costs of interventional radiology (IR) suite versus bedside placement of noncuffed central venous catheters in infants. METHODS A single-center retrospective review was performed of all noncuffed upper extremity (peripherally inserted central venous catheter [PICC]) and tunneled femoral (tunneled femoral central venous catheter [TCVC]) catheters placed in infants between January 1, 2018, and December 31, 2018. Propensity score matching was performed adjusting for age, birth weight, procedure weight, and catheter days. Process maps for each procedure were created based on location and sedation type. Technical success and complications were recorded for each placement. The total direct bundled cost for each catheter placement was calculated by summing the procedure and complication costs. RESULTS A total of 142 procedures were performed on 126 matched patients with a technical success of 96% at the bedside and 100% in the IR suite (P = .08). The complication rates did not significantly differ between the 2 groups (P = .51). The total direct bundled costs for catheter placement were $1421.3 ± 2213.2 at the bedside and $2256.8 ± 3264.7 in the IR suite (P = .001). CONCLUSIONS The bundled cost of bedside femoral catheter placement is significantly less than that of fluoroscopic TCVC and PICC placement performed in the IR suite, mainly related to differences in sedation costs.
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Positioning of Vascular Access in Pediatric Patients: An Observational Study Focusing on Adherence to Current Guidelines. J Clin Med 2021; 10:jcm10122590. [PMID: 34208254 PMCID: PMC8230876 DOI: 10.3390/jcm10122590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Venous access devices (VADs) play an important role in different clinical contexts. In pediatric subjects, VAD placement is more complicated than in adults due to children’s poor cooperativity and reduced vascular access. Adherence to guidelines for the placement of VADs could prevent the occurrence of complications, but data in the literature are general and not exhaustive, especially with regard to the pediatric population. The objective of this study was to assess adherence to guidelines for the placement of VADs in a pediatric setting. A retrospective observational study was conducted in the general ward of a pediatric hospital in the northern region of Italy. Data related to consecutive admissions in the period from 1 January to 31 December 2019 were collected according to the availability of clinical documentation. A cohort of 251 subjects was considered, yielding a total of 367 VADs. Device permanence in situ and the effective administration of intravenous therapy were associated with an increased risk of complications, while adherence to guidelines was an important protective factor. Adherence to guidelines for the placement of VADs is an independent and positive predictive factor for the prevention of complications due to the presence of a vascular device.
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15
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Ullman AJ, August D, Kleidon T, Walker R, Marsh NM, Bulmer A, Pearch B, Runnegar N, Schults JA, Leema J, Lee-Archer P, Biles C, Southam K, Gibson V, Byrnes J, Ware RS, Chopra V, Coulthard A, Mollee P, Rickard CM, Harris PNA. Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomised controlled trial protocol. BMJ Open 2021; 11:e042475. [PMID: 33853797 PMCID: PMC8054085 DOI: 10.1136/bmjopen-2020-042475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/11/2021] [Accepted: 03/31/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic complications. METHODS AND ANALYSIS A multicentre, parallel group, superiority randomised controlled trial with two experimental arms ((1) hydrophobic PICC (with pressure-activated valve); (2) chlorhexidine gluconate-impregnated PICC (with external clamp)) and one control group ((3) conventional polyurethane PICC (with external clamp)). Recruitment of 1098 adult and paediatric patients will take place over 2 years at three tertiary-referral hospitals in Queensland, Australia. Patients are eligible for inclusion if their PICC is to be inserted for medical treatment, with a vascular size sufficient to support a 4-Fr PICC or larger, and with informed consent. The primary outcome is PICC failure, a composite of thrombotic (venous thrombosis, breakage and occlusion) and infective complications (PICC-associated bloodstream infection and local infection). Secondary outcomes include: all-cause PICC complication; thrombotic complications; infective complications; adverse events (local or systemic reaction); PICC dwell time; patient/parent satisfaction; and healthcare costs. Differences between both intervention groups and the control group will be compared using Cox proportional hazards regression. Effect estimates will be presented as HRs with corresponding 95% CI. ETHICS AND DISSEMINATION Ethical approval from Queensland Health (HREC/QCHQ/48682) and Griffith University (Ref. No. 2019/094). Results will be published. TRIAL REGISTRATION NUMBER ACTRN12619000022167.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- Royal Brisbane and Woman's Hospital, Metro North Health Service District, Herston, Queensland, Australia
| | - Deanne August
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Royal Brisbane and Woman's Hospital, Metro North Health Service District, Herston, Queensland, Australia
| | - Tricia Kleidon
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rachel Walker
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Princess Alexandra Hospital, Metro South Health Service District, Woolloongabba, Queensland, Australia
| | - Nicole M Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Royal Brisbane and Woman's Hospital, Metro North Health Service District, Herston, Queensland, Australia
| | - Andrew Bulmer
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Benjamin Pearch
- Princess Alexandra Hospital, Metro South Health Service District, Woolloongabba, Queensland, Australia
| | - Naomi Runnegar
- Princess Alexandra Hospital, Metro South Health Service District, Woolloongabba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Jessica A Schults
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- Royal Brisbane and Woman's Hospital, Metro North Health Service District, Herston, Queensland, Australia
| | - Joanne Leema
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Princess Alexandra Hospital, Metro South Health Service District, Woolloongabba, Queensland, Australia
| | - Paul Lee-Archer
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Cathy Biles
- Princess Alexandra Hospital, Metro South Health Service District, Woolloongabba, Queensland, Australia
| | - Katrina Southam
- Royal Brisbane and Woman's Hospital, Metro North Health Service District, Herston, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Vineet Chopra
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alan Coulthard
- Royal Brisbane and Woman's Hospital, Metro North Health Service District, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Peter Mollee
- Princess Alexandra Hospital, Metro South Health Service District, Woolloongabba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Royal Brisbane and Woman's Hospital, Metro North Health Service District, Herston, Queensland, Australia
| | - Patrick N A Harris
- Royal Brisbane and Woman's Hospital, Metro North Health Service District, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
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Peripherally Inserted Central Catheter Thrombosis After Placement via Electrocardiography vs Traditional Methods. Am J Med 2021; 134:e79-e88. [PMID: 32673624 DOI: 10.1016/j.amjmed.2020.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown. METHODS Prospectively collected data from patients that received peripherally inserted central catheters at 52 Michigan hospitals were analyzed. The method used to confirm tip confirmation at insertion and deep vein thrombosis outcomes were extracted from medical records. Multivariate models (accounting for the clustered nature of the data) were fitted to assess the association between peripherally inserted central catheter-related deep vein thrombosis and method of tip confirmation (electrocardiographic vs radiographic imaging). RESULTS A total of 42,687 peripherally inserted central catheters (21,098 radiology vs 21,589 electrocardiographic) were included. Patients receiving electrocardiographic-confirmed peripherally inserted central catheters had fewer comorbidities compared with those that underwent placement via radiology. Overall, deep vein thrombosis occurred in 594 (1.3%) of all peripherally inserted central catheters. Larger catheter size (odds radio [OR] 1.32; 95% confidence interval [CI], 0.93-1.90 per unit increase in gauge), history of deep vein thrombosis, and cancer were associated with increased risk of deep vein thrombosis (OR 2.00; 95% CI, 1.65-2.43 and OR 1.62; 95% CI, 1.16-2.26, respectively) using logistic regression. Following adjustment, electrocardiographic guidance was associated with a significant reduction in peripherally inserted central catheter-related deep vein thrombosis compared with radiographic imaging (OR 0.74; 95% CI, 0.58-0.93; P = .0098). CONCLUSION The use of electrocardiography to confirm peripherally inserted central catheter tip placement at the cavoatrial junction was associated with significantly fewer deep vein thrombosis events than radiographic imaging. Use of this approach for peripherally inserted central catheter insertion may help improve patient safety, particularly in high-risk patients.
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Catheter related thrombosis in hospitalized infants: A neural network approach to predict risk factors. Thromb Res 2021; 200:34-40. [PMID: 33529871 DOI: 10.1016/j.thromres.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION We sought to investigate the predictors of catheter-related thrombosis (CRT) in a cohort of critically ill hospitalized infants and using a novel approach (the artificial neural network - ANN) in combination with conventional statistics to identify/confirm those predictors. METHODS We performed a retrospective analysis of all infants with a central or peripherally inserted central venous catheter (CVC/PICC) between 2015 and 2018. ANN was generated to investigate the predictors of CRT. The predictive variables examined in the ANN were age, gender, weight, co-morbid conditions, line type, use of ultrasound (USG), emergent line placement, location of line tip, any major surgical procedures, use of mechanical ventilation, exposure to cardio-pulmonary bypass (CPB), past-history of CVC/PICC, or thrombosis. Binary logistic regression was performed to calculate odds ratios (ORs) and determine which factors were significant in predicting CRT. RESULTS Of total of 613 infants, 59.9% of patients had a history of previous CVC or PICC and 12.2% had a history of thrombus as documented by USG in the past three months. CPB exposure was present in 48.1%. The incidence of CRT was 10.7%. Independent predictors of CRT were the line tip in IVC (OR: 2.37, 1.08-5.21, P = 0.032), history of thrombosis (OR: 2.40, 1.16-4.96, P = 0.019), previous CVC/PICC (OR: 2.80, 1.24-6.33, P = 0.014) and exposure to CPB (OR: 2.749, 1.08-6.98, P = 0.034). A sensitivity analysis was performed to determine the normalized importance of each variable used to create the ANN. The most important variables were age (with normalized importance of 100%), history of thrombosis, weight, and exposure to CPB (normalized importance of 68.2%). CONCLUSIONS Nearly 1 in 10 infants developed CRT. We found that catheter tip in IVC, exposure to CPB, history of vein thrombosis and history of CVC/PICC placement in the past 3 months are independently associated with a higher risk of CRT in infants by using conventional and neural network methods.
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18
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Bough G, Lambert NJ, Djendov F, Jackson C. Unexpected tunnelled central venous access demise: a single institutional study from the UK. Pediatr Surg Int 2021; 37:109-117. [PMID: 33159555 DOI: 10.1007/s00383-020-04771-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To explore the factors involved in the demise of tunnelled central vascular access devices (CVADs) in children and describe patterns of failure. METHODS A retrospective study including children under 16 years of age undergoing CVAD insertion in a tertiary centre between October 2014 and December 2019. The Kaplan-Meier estimator was used to study CVAD survival and piecewise exponential curves to approximate hazard rates. Related factors were analysed using multivariable regression. RESULTS Totally, 684 CVADs were inserted in 499 children. Devices were in situ for 213,821 days (median 244.5). Of those, 261 CVADs (38.2%) failed prematurely; 176 (67%) required replacement. Tunnelled external lines (TELs) failed more frequently than totally implantable devices (p < 0.005).TEL displacement occurred in two high-risk phases, falling to baseline after 90 days. Low age at device insertion and open placement were strongly associated with an increased failure rate. Previous CVAD failure did not increase subsequent failure rate. Premature failure increased procedural cost by £153,949 per year. CONCLUSIONS TIDs should be placed in preference to TELs where appropriate. TELs are at highest risk of displacement for 90 days and must be well secured for this duration. Meticulous line care offers significant potential cost savings by reducing line replacements. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Georgina Bough
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Nicholas J Lambert
- Department of Physics, University of Otago, Dunedin, New Zealand
- The Dodd-Walls Centre for Photonic and Quantum Technologies, University of Otago, Dunedin, New Zealand
| | - Florin Djendov
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Claire Jackson
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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19
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Ullman AJ, Condon P, Edwards R, Gibson V, Takashima M, Schults J, Dean A, Cattanach P, Nicholls W, Osborne S, Rickard CM, Cooke M, Kleidon T. Prevention of occlusion of cEnTral lInes for children with cancer: An implementation study. J Paediatr Child Health 2020; 56:1875-1884. [PMID: 32808404 DOI: 10.1111/jpc.15067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/05/2020] [Accepted: 03/11/2020] [Indexed: 12/23/2022]
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 pre-implementation 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) post-implementation 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.
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Affiliation(s)
- Amanda J Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.,Queensland Children's Hospital, Children's Health Service District, Brisbane, Queensland, Australia
| | - Paula Condon
- Queensland Children's Hospital, Children's Health Service District, Brisbane, Queensland, Australia
| | - Rachel Edwards
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Children's Hospital, Children's Health Service District, Brisbane, Queensland, Australia
| | - Victoria Gibson
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Children's Hospital, Children's Health Service District, Brisbane, Queensland, Australia
| | - Mari Takashima
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Jessica Schults
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.,Queensland Children's Hospital, Children's Health Service District, Brisbane, Queensland, Australia
| | - Anna Dean
- Queensland Children's Hospital, Children's Health Service District, Brisbane, Queensland, Australia
| | - Paula Cattanach
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Children's Hospital, Children's Health Service District, Brisbane, Queensland, Australia
| | - Wayne Nicholls
- Queensland Children's Hospital, Children's Health Service District, Brisbane, Queensland, Australia
| | - Sonya Osborne
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,University of Southern Queensland, Faculty of Health, Engineering and Sciences, School of Nursing and Midwifery, Ipswich, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Children's Hospital, Children's Health Service District, Brisbane, Queensland, Australia
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20
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Tian L, Li W, Su Y, Gao H, Yang Q, Lin P, Wang L, Zeng J, Li Y. Risk Factors for Central Venous Access Device-Related Thrombosis in Hospitalized Children: A Systematic Review and Meta-Analysis. Thromb Haemost 2020; 121:625-640. [PMID: 33186995 DOI: 10.1055/s-0040-1720976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify the potential associations of patient-, treatment-, and central venous access device (CVAD)-related factors with the CVAD-related thrombosis (CRT) risk in hospitalized children. METHODS A systematic search of PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP database was conducted. RevMan 5.3 and Stata 12.0 statistical software were employed for data analysis. RESULTS In terms of patient-related factors, the patient history of thrombosis (odds ratio [OR] = 3.88, 95% confidence interval [CI]: 2.57-5.85), gastrointestinal/liver disease (OR = 1.85, 95% CI: 0.99-3.46), hematologic disease (OR = 1.45, 95% CI: 1.06-1.99), and cancer (OR = 1.58, 95% CI: 1.01-2.48) were correlated with an increased risk of CRT. In terms of treatment-related factors, parenteral nutrition (PN)/total PN (OR = 1.70, 95% CI: 1.21-2.39), hemodialysis (OR = 2.17, 95% CI: 1.34-3.51), extracorporeal membrane oxygenation (OR = 1.51, 95% CI: 1.31-1.71), and cardiac catheterization (OR = 3.92, 95% CI: 1.06-14.44) were associated with an increased CRT risk, while antibiotics (OR = 0.46, 95% CI: 0.32-0.68) was associated with a reduced CRT risk. In terms of the CVAD-related factors, CRT risk was more significantly increased by peripherally inserted central catheter than tunneled lines (OR = 1.81, 95% CI: 1.15-2.85) or totally implantable venous access port (OR = 2.81, 95% CI: 1.41-5.60). And subclavian vein catheterization significantly contributed to a lower CRT risk than femoral vein catheterization (OR = 0.36, 95% CI: 0.14-0.88). Besides, multiple catheter lines (OR = 4.06, 95% CI: 3.01-5.47), multiple catheter lumens (OR = 3.71, 95% CI: 1.99-6.92), central line-associated bloodstream infection (OR = 2.66, 95% CI: 1.15-6.16), and catheter malfunction (OR = 1.65, 95% CI: 1.07-2.54) were associated with an increased CRT risk. CONCLUSION The exact identification of the effect of risk factors can boost the development of risk assessment tools with stratifying risks.
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Affiliation(s)
- Lingyun Tian
- Xiangya Nursing School, Central South University, Changsha, China.,School of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Wan Li
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yanan Su
- Xiangya Nursing School, Central South University, Changsha, China
| | - Huimin Gao
- Xiangya Nursing School, Central South University, Changsha, China
| | - Qiuhong Yang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Pan Lin
- Xiangya Nursing School, Central South University, Changsha, China
| | - Liqian Wang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Jiaqi Zeng
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yinglan Li
- Xiangya Nursing School, Central South University, Changsha, China.,School of Nursing, Xinjiang Medical University, Urumqi, China
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21
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Bludevich BM, Chandler NM, Gonzalez R, Danielson PD, Snyder CW. Outcomes of Pediatric Central Venous Access Device Placement With Concomitant Surgical Procedures. J Surg Res 2020; 259:451-457. [PMID: 33616076 DOI: 10.1016/j.jss.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Children frequently undergo placement of a tunneled central venous catheter or port (CVAD) concomitantly with other surgical procedures (CVAD-CP), but the risk factors for early CVAD complications with this practice are unclear. METHODS Children undergoing CVAD-CP were identified from the National Surgical Quality Improvement Program-Pediatric 2012-2016 database. Predictor variables included demographics, CP characteristics, malignancy, and CVAD type. Outcome variables were CVAD-associated bloodstream infection (CLABSI) or new deep venous thrombosis (nDVT) within 30 d. Patients with and without CLABSI or nDVT were compared, and the temporal relationship of nDVT and CLABSI was investigated. Multivariable logistic regression modeling was used to assess independent risk factors for CLABSI. RESULTS Of 2036 patients included, median age was 1.5 y, 35% had malignancy, and 40% had a clean concomitant procedure. Overall, 1.3% developed CLABSI and 0.7% developed nDVT. Multivariable regression modeling revealed higher risk of CLABSI with clean CPs (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.06-5.34, P = 0.035), tunneled catheters (OR 3.2, 95% CI 1.18-8.56, P = 0.022), and longer anesthesia duration (OR 1.02 per 10 min, 95% CI 1.00-1.04, P = 0.042). nDVT was strongly associated with CLABSI (21% CLABSI among those with DVT, 0.5% among those without, P ≤ 0.0001). In all cases of nDVT with CLABSI, the diagnosis of DVT preceded diagnosis of CLABSI, by a median of 7 d. CONCLUSIONS The type of CVAD and characteristics of the concomitant procedure influence early CLABSI after CVAD-CP. The unexpected finding of higher CLABSI rates among clean concomitant procedures suggests that perioperative prophylactic antibiotics should not be withheld in this setting, but requires prospective validation. nDVT is frequently diagnosed prior to CLABSI, suggesting a possible role for antibiotics in the treatment of postoperative DVT after CVAD placement.
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Affiliation(s)
- Bryce M Bludevich
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Raquel Gonzalez
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Christopher W Snyder
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
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22
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Schults J, Kleidon T, Chopra V, Cooke M, Paterson R, Ullman AJ, Marsh N, Ray-Barruel G, Hill J, Devrim İ, Hammarskjold F, Pedreira ML, Bertoglio S, Egan G, Mimoz O, van Boxtel T, DeVries M, Magalhaes M, Hallam C, Oakley S, Rickard CM. International recommendations for a vascular access minimum dataset: a Delphi consensus-building study. BMJ Qual Saf 2020; 30:722-730. [PMID: 32963025 PMCID: PMC8380895 DOI: 10.1136/bmjqs-2020-011274] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/13/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Data regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset. METHODS A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international vascular access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in vascular access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for vascular access devices. RESULTS A total of 64 of 225 interdisciplinary healthcare professionals from 11 countries responded to Round 1 and 2 surveys (response rate of 34% and 29%, respectively). From the original 52 items, 50 items across five domains emerged from the Delphi procedure.Items related to demographic and clinical characteristics (n=5; eg, age), device characteristics (n=5; eg, device type), insertion (n=16; eg, indication), management (n=9; eg, dressing and securement), and complication and removal (n=15, eg, occlusion) were identified as requirements for a minimum dataset to track and evaluate vascular access device use and outcomes. CONCLUSION We developed and internally validated a minimum dataset for vascular access device research. This study generated new knowledge to enable healthcare systems to collect relevant, useful and meaningful vascular access data. Use of this standardised approach can help benchmark clinical practice and target improvements worldwide.
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Affiliation(s)
- Jessica Schults
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia .,Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Tricia Kleidon
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Vineet Chopra
- The Patient Safety Enhancement Program, Division of Hospital Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Marie Cooke
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Rebecca Paterson
- Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Amanda J Ullman
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Nicole Marsh
- Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Gillian Ray-Barruel
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.,QUII Jubilee Hospital, Nathan, Queensland, Australia
| | - Jocelyn Hill
- Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - İlker Devrim
- Dr. Behçet Uz Training and Research Hospital, İzmir, Turkey
| | - Fredrik Hammarskjold
- Department of Anaesthesia and Intensive Care, County Hospital Ryhov, Jonkoping, Sweden
| | | | - Sergio Bertoglio
- Department of Surgery, University of Genoa, Genova, Liguria, Italy
| | - Gail Egan
- Interventional Radiology, Stanford Health Care, Stanford, California, USA
| | - Olivier Mimoz
- Emergency Department, University Hospital Centre Poitiers, Poitiers, France
| | - Ton van Boxtel
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michelle DeVries
- Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA
| | - Maria Magalhaes
- Neonatal Intensive Care, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio, Brazil
| | - Carole Hallam
- Infection Prevention Society, Seafield, West Lothian, UK
| | | | - Claire M Rickard
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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23
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Central venous catheter-related thrombosis in children and adults. Thromb Res 2020; 187:103-112. [DOI: 10.1016/j.thromres.2020.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
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