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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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McBride CA, Rahiman S, Schlapbach LJ, Schults JA, Kleidon TM, Kennedy M, Paterson RS, Byrnes J, Ware RS, Ullman AJ. Comparing ivWatch biosensor to standard care to identify extravasation injuries in the paediatric intensive care: a protocol for a randomised controlled trial. BMJ Open 2022; 12:e047765. [PMID: 35190407 PMCID: PMC8862432 DOI: 10.1136/bmjopen-2020-047765] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Peripheral intravenous catheters (PIVCs) frequently fail during therapy administration, resulting in infusates pooling in the surrounding tissue. These extravasation injuries can cause significant pain, tissue destruction and scarring. ivWatch is a biosensor that uses visible and near-infrared light to measure tissue changes surrounding the PIVC and alert clinicians when extravasation may occur. The effectiveness of ivWatch, in comparison to clinical observation, in decreasing injury severity is unknown. The present study aims to investigate whether using ivWatch may potentially detect injury earlier and decrease the severity of PIVC extravasation injuries. METHODS AND ANALYSIS A single centre, parallel group, open-label superiority randomised controlled trial comparing (a) standard care (clinical observation) to (b) ivWatch monitoring in addition to standard care, to decrease the severity of extravasation injuries. 200 children with PIVCs inserted in the distal half of the limb, receiving intermediate-risk to high-risk infusates for ≥24 hours, will be consecutively recruited at a paediatric intensive care unit in Queensland, Australia. The primary outcome is extravasation severity, measured by the Cincinnati Children's Extravasation Harm Scale. Secondary outcomes include severity assessed with three-dimensional camera imaging, extravasation volume, treatment sequelae, the number of PIVCs used and dwell time, quality of life and healthcare costs. The between treatment difference in extravasation severity will be compared using ordinal logistic regression, with the treatment group included as the main effect, and reported with corresponding 95% CIs. Estimates of value will be presented as net monetary benefits and cost per reduction in extravasation injury severity, both presented with corresponding 95% credible intervals. ETHICS AND DISSEMINATION This study received approval from the Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (reference number: HREC/20/QCHQ/60867) and the Griffith University HREC (reference number: 2020/310) and will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12620000317998.
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Affiliation(s)
- Craig Antony McBride
- Surgical Team: Infants, Toddlers, Children (STITCh), Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Sarfaraz Rahiman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Department of Intensive Care Medicine and Neonatology, Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Jessica A Schults
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Herston Infectious Disease Institute, Metro North Health, Herston, Queensland, Australia
| | - Tricia M Kleidon
- Surgical Team: Infants, Toddlers, Children (STITCh), Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Melanie Kennedy
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Rebecca S Paterson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Robert S Ware
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Amanda Judith Ullman
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Nathan, Queensland, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, 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: 19] [Impact Index Per Article: 9.5] [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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Høvik LH, Gjeilo KH, Lydersen S, Rickard CM, Røtvold B, Damås JK, Solligård E, Gustad LT. Monitoring quality of care for peripheral intravenous catheters; feasibility and reliability of the peripheral intravenous catheters mini questionnaire (PIVC-miniQ). BMC Health Serv Res 2019; 19:636. [PMID: 31488150 PMCID: PMC6729030 DOI: 10.1186/s12913-019-4497-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/30/2019] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) account for a mean of 38% of catheter associated bloodstream infections (CABSI) with Staphylococcus aureus, which are preventable if deficiencies in best practice are addressed. There exists no feasible and reliable quality surveillance tool assessing all important areas related to PIVC quality. Thus, we aimed to develop and test feasibility and reliability for an efficient quality assessment tool of overall PIVC quality. METHODS The Peripheral Intravenous Catheter- mini Questionnaire, PIVC-miniQ, consists of 16 items calculated as a sum score of problems regarding the insertion site, condition of dressing and equipment, documentation, and indication for use. In addition, it contains background variables like PIVC site, size and insertion environment. Two hospitals tested the PIVC-miniQ for feasibility and inter-rater agreement. Each PIVC was assessed twice, 2-5 min apart by two independent raters. We calculated the intraclass correlation coefficient (ICC) for each hospital and overall. For each of the 16 items, we calculated negative agreement, positive agreement, absolute agreement, and Scott's pi. RESULTS Sixty-three raters evaluated 205 PIVCs in 177 patients, each PIVC was assessed twice by independent raters, in total 410 PIVC observations. ICC between raters was 0.678 for hospital A, 0.577 for hospital B, and 0.604 for the pooled data. Mean time for the bedside assessment of each PIVC was 1.40 (SD 0.0007) minutes. The most frequent insertion site symptom was "pain and tenderness" (14.4%), whereas the most prevalent overall problem was lack of documentation of the PIVC (26.8%). Up to 50% of PIVCs were placed near joints (wrist or antecubital fossae) or were inserted under suboptimal conditions, i.e. emergency department or ambulance. CONCLUSIONS Our study highlights the need for PIVC quality surveillance on ward and hospital level and reports the PIVC-miniQ to be a reliable and time efficient tool suitable for frequent point-prevalence audits.
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Affiliation(s)
- Lise Husby Høvik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway. .,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway.
| | - Kari Hanne Gjeilo
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Department of Cardiothoracic Surgery, Department of Cardiology and National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Claire M Rickard
- Alliance for Vascular Access teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Benedikte Røtvold
- Department of Anesthesia, Levanger Hospital, Clinic of Surgery, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jan Kristian Damås
- Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway.,Department of Infectious Diseases, St. Olavs Hospital, Trondheim, Norway
| | - Erik Solligård
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
| | - Lise Tuset Gustad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Gemini Center for Sepsis Research, St. Olavs Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Medicine, Levanger Hospital, Clinic of Medicine and rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway
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