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Burek AG, Davis MB, Pechous B, Shaughnessy EE, Meier KA, Mooney S, Woodruff D, Bruner M, Piper L, Liegl M, Pan A, Brousseau DC, Ullman AJ. Inappropriate Use of Peripherally Inserted Central Catheters in Pediatrics: A Multisite Study. Hosp Pediatr 2024; 14:180-188. [PMID: 38404202 PMCID: PMC10896745 DOI: 10.1542/hpeds.2023-007518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 02/27/2024]
Abstract
OBJECTIVES This study aimed to describe how the current practice of peripherally inserted central catheter (PICC) use in hospitalized children aligns with the Michigan Appropriateness Guide for Intravenous Catheters (miniMAGIC) in Children recommendations, explore variation across sites, and describe the population of children who do not receive appropriate PICCs. METHODS A retrospective study was conducted at 4 children's hospitals in the United States. Children with PICCs placed January 2019 to December 2021 were included. Patients in the NICU were excluded. PICCs were categorized using the miniMAGIC in Children classification as inappropriate, uncertain appropriateness and appropriate. RESULTS Of the 6051 PICCs identified, 9% (n = 550) were categorized as inappropriate, 9% (n = 550) as uncertain appropriateness, and 82% (n = 4951) as appropriate. The number of PICCs trended down over time, but up to 20% of PICCs each year were not appropriate, with significant variation between sites. Within inappropriate or uncertain appropriateness PICCs (n = 1100 PICC in 1079 children), median (interquartile range) patient age was 4 (0-11) years, 54% were male, and the main reason for PICC placement was prolonged antibiotic course (56%, n = 611). The most common admitting services requesting the inappropriate/uncertain appropriateness PICCs were critical care 24%, general pediatrics 22%, and pulmonary 20%. Complications resulting in PICC removal were identified in 6% (n = 70) of inappropriate/uncertain PICCs. The most common complications were dislodgement (3%) and occlusion (2%), with infection and thrombosis rates of 1% (n = 10 and n = 13, respectively). CONCLUSIONS Although the majority of PICCs met appropriateness criteria, a substantial proportion of PICCs were deemed inappropriate or of uncertain appropriateness, illustrating an opportunity for quality improvement.
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Affiliation(s)
- Alina G. Burek
- Children’s Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Beth Davis
- University of Iowa Stead Family Childrens Hospital, Iowa City, Iowa
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Brittany Pechous
- University of Iowa Stead Family Childrens Hospital, Iowa City, Iowa
| | - Erin E. Shaughnessy
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Katie A. Meier
- Department of Pediatrics, University of Cincinnati College of Medicine, and Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Sarah Mooney
- Children’s Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dana Woodruff
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Meaghan Bruner
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Laura Piper
- Department of Pediatrics, University of Cincinnati College of Medicine, and Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Melodee Liegl
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Pan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David C. Brousseau
- Department of Pediatrics, Nemours Children’s Health Delaware and the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda J. Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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Sykes S, Ulloa J, Steward D. Midline Catheter Use in the Neonatal Intensive Care Unit. Crit Care Nurs Clin North Am 2024; 36:111-118. [PMID: 38296369 DOI: 10.1016/j.cnc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Neonates admitted to the neonatal intensive care unit (NICU) are a unique population who most often begin life acutely or critically ill. Venous access is required by most acutely/critically ill neonates, especially those born preterm. Access is required for implementing management strategies such as stabilization, medications, fluids, nutrition, and transfusion of blood products. However, achieving and maintaining venous access in these neonates can be difficult, especially in preterm infants due to a myriad of contributing factors. Peripheral intravenous (PIV) catheters and peripherally inserted central catheters (PICC) are 2 common vascular access approaches used in the NICU and have traditionally been the most studied in the neonatal literature. Both options offer advantages and disadvantages. An alternative to PIVs and PICCs is the midline peripheral catheter (MPC), which in the literature may also be referred to as extended dwell peripheral intravenous catheters. Depending on the intended use, the MPC offers a venous access approach between a PIV and PICC. Usage of MPCs in the NICU is slowly increasing with the limited published evidence suggesting they are viable option when considering the need for vascular access. The purpose of this article is to present the advantages and disadvantages of MPCs as an alternative approach for venous access in neonates when appropriate.
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Affiliation(s)
- Stephanie Sykes
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA.
| | - Jodi Ulloa
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA
| | - Deborah Steward
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA
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Zhang P, Jia M, Li WY, Li J, Niu JL, Ding H, Zhou WM. Cannulation via the external jugular vein--An alternative to conventional peripherally inserted central catheterisation for paediatric patients. BMC Pediatr 2023; 23:579. [PMID: 37980462 PMCID: PMC10657000 DOI: 10.1186/s12887-023-04403-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023] Open
Abstract
PURPOSE This study aimed to describe a peripherally inserted central catheterisation (PICC) for paediatric patients with inaccessible access and a high risk of general anaesthesia (GA). METHODS This was a retrospective observational study involving all paediatric inpatients who performed the PICC via an EJV approach without GA between September 2014 and September 2021 in a provincial key clinical speciality. RESULTS A total of 290 EJV line placement attempts were performed, and 29 were excluded due to missing placement results, resulting in a sample size of 261. The anatomical localisation, punctures, and catheterisation success rates for this practice were 100%, 100%, and 90.04%, respectively. The placement success rate in children younger than one year was 93.75% (45/48). The median line duration of use was 19 days, with a median length of catheter insertion of 13 cm. The most common complications were catheter malposition (n = 20) and dislodgement (n = 7). CONCLUSION The PICC via an EJV approach without GA is a feasible and safe practice with acceptable success and complication rates, and low costs. It might be an attractive alternative for obtaining central vascular access for paediatric patients.
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Affiliation(s)
- Ping Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Open Fracture and Limb Reconstruction Nursing Professional Committee, Guangdong Nursing Association, Guangzhou, 510170, China
| | - Miao Jia
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Open Fracture and Limb Reconstruction Nursing Professional Committee, Guangdong Nursing Association, Guangzhou, 510170, China
| | - Wan-Yuan Li
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Juan Li
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jin-Lei Niu
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hong Ding
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Wang-Mei Zhou
- Department of Emergency, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Marsh N, Larsen EN, O'Brien C, Groom P, Kleidon TM, Alexandrou E, Young E, McCarthy K, Rickard CM. Comparing the use of midline catheters versus peripherally inserted central catheters for patients requiring peripherally compatible therapies: A pilot randomised controlled trial (the compact trial). Infect Dis Health 2023; 28:259-264. [PMID: 37142538 DOI: 10.1016/j.idh.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Midline catheter (MC) use has increased in acute-care settings, particularly for patients with difficult venous access or requiring peripherally compatible intravenous therapy for up-to 14 days. Our aim was to assess feasibility and generate clinical data comparing MCs with Peripherally Inserted Central Catheters (PICCs). METHODS A two-arm parallel group pilot randomised controlled trial (RCT), comparing MCs with PICCs, was conducted in a large tertiary hospital in Queensland between September 2020 and January 2021. The primary outcome was study feasibility, measured against rates of eligibility (>75%), consent (>90%), attrition (<5%); protocol adherence (>90%) and missing data (<5%). The primary clinical outcome was all-cause device failure. RESULTS In total, 25 patients were recruited. The median patient age was 59-62 years; most patients were overweight/obese, with ≥2 co-morbidities. PRIMARY OUTCOMES The eligibility and protocol adherence criteria were not met; of 159 screened patients, only 25 (16%) were eligible, and three patients did not receive their allocated intervention post-randomisation (88% adherence). All-cause failure occurred in two patients allocated to MC (20%) and one PICC (8.3%). CONCLUSIONS Our study found that a fully powered RCT testing MCs compared with PICCs is not currently feasible in our setting. We recommend a robust process evaluation before the introduction of MCs into clinical practice.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia.
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia.
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| | - Peter Groom
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| | - Tricia M Kleidon
- School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia; Queensland Children's Hospital, South Brisbane, Queensland, Australia.
| | - Evan Alexandrou
- Liverpool Hospital, New South Wales, Australia; School of Nursing, University of Wollongong, New South Wales, Australia.
| | - Emily Young
- School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia.
| | - Kate McCarthy
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| | - Claire M Rickard
- Nursing and Midwifery Research Centre, Internal Medicine Services, Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Nursing and Midwifery, Centre for Applied Health Economics, School of Medicine and Dentistry, Patient Centred Health Services, Menzies Health Institute Queensland, Alliance for Vascular Access, Teaching and Research, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Herston, Queensland, Australia.
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Burek AG, Liljestrom T, Dundon M, Shaughnessy EE, Suelzer E, Ullman A. Long peripheral catheters in children: A scoping review. J Hosp Med 2022; 17:1000-1009. [PMID: 36165458 DOI: 10.1002/jhm.12968] [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] [Received: 06/02/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Long peripheral catheters (LPCs) are emerging vascular access devices used for short-medium term vascular access needs. Literature in adults suggests LPCs have longer dwell-times than peripheral intravenous catheters (PIVs) and lower rates of serious complications than peripherally inserted central catheters (PICCs). The role of LPCs in children is less established. The objective of this scoping review is to describe and synthesize the existing literature on the effectiveness and safety of LPCs in children. METHODS This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches were done in MEDLINE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, Scopus, CINAHL (Ebsco), and Google Scholar most recently on February 22, 2022. Studies were included if published in English on or after 2000 and included patients <18 years of age. RESULTS Twenty-one studies were included. The body of literature is variable in quality, measurements, and reported outcomes. Median dwell-time ranged from 5 to 14 days. The rate of completion of therapy ranged from 20% to 86%. Dislodgement, occlusion, and infiltration were the most common complications reported (0%-31%). Venous thromboembolism rates ranged from 0% to 13%. The rate of catheter-related bloodstream infection was 0% in 9 of 10 studies. Less than 50% of studies reported comparative outcomes. CONCLUSION LPCs show promising outcomes in select populations, with longer dwell-time than PIVs and possibly lower rates of serious complications than PICCs. However, more research is needed to clarify the optimal use of LPCs in pediatrics.
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Affiliation(s)
- Alina G Burek
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tracey Liljestrom
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Melanie Dundon
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erin E Shaughnessy
- Department of Pediatrics, University of Alabama at Birmingham and Children's of Alabama, Birmingham, Alabama, USA
| | - Elizabeth Suelzer
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amanda Ullman
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Giardina M, Barillà D, Crimi C, Arone A, Benedetto F, Lucanto C, Natoli R, Messina R, David A, Noto A. Ultrasound-guided placement of long peripheral cannula in children with cystic fibrosis. Pediatr Pulmonol 2022; 57:2060-2066. [PMID: 35574730 PMCID: PMC9545099 DOI: 10.1002/ppul.25978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/03/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The natural history of cystic fibrosis (CF) lung disease is a chronic deterioration of lung function with intermittent episodes of pulmonary infectious exacerbations (PExs). Reliable venous access is a milestone of effective management of such exacerbations, managed both in hospital and outpatient chronic therapy. The aim of our study was to analyze the feasibility of ultrasound-guided positioning of long peripheral catheters (LPC) as reliable midterm venous access in children affected by CF. METHODS In this single-center prospective study, over a 60-month period, we included paediatric CF subjects admitted with PExs and undergoing intravenous antibiotic treatment. LPCs were inserted in all participants by paediatric anaesthesiologists with ultrasound guide technique. Prospective data were collected assessing catheter positioning procedure and complications. RESULTS A total of 122 LPC insertions were performed in 55 CF children. Participants had a median age of 6.75 years (interquatile range: 3.7-13.5) at the time of catheter insertion. Implantation was successful on the first attempt in 86% of cases; 2 (1%) major insertion-related complications were reported. Eighty-eight percent of catheters were electively removed at the end of antibiotic therapy without any complication. Seven percent of the catheters were removed electively for occlusion and 2% for local dislodgment. CONCLUSIONS The results of the present study suggest that ultrasound-guided positioning of LPCs are safe alternative means of peripheral venous access in children with chronic diseases such as CF.
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Affiliation(s)
- Massimiliano Giardina
- Division of Anesthesia and Critical Care, A. O. U. Policlinico "G. Martino", Messina, Italy
| | - David Barillà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Vascular Surgery, Policlinico G. Martino, University of Messina, Messina, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco", University Hospital, Catania, Italy
| | - Amelia Arone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Filippo Benedetto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Vascular Surgery, Policlinico G. Martino, University of Messina, Messina, Italy
| | - Cristina Lucanto
- Regional Centre for Cystic Fibrosis, A. O. U. Policlinico G.Martino, Messina, Italy
| | - Rossella Natoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Roberto Messina
- Division of Anesthesia and Critical Care, A. O. U. Policlinico "G. Martino", Messina, Italy
| | - Antonio David
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Critical Care, University of Messina, Messina, Italy
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Critical Care, University of Messina, Messina, Italy
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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: 15] [Impact Index Per Article: 7.5] [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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