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Complications of Central Venous Access Devices: A Systematic Review
Amanda J Ullman1, Nicole Marsh2, Gabor Mihala3
1School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and a.ullman@griffith.edu.au.
Insights
Central venous access device (CVAD) failure in children is common, with 25% failing before therapy completion. Hemodialysis and umbilical catheters show higher failure rates, impacting pediatric patient care and healthcare resources.
Area of Science:
- Pediatric critical care medicine
- Medical device engineering
- Evidence-based healthcare
Background:
- Central venous access devices (CVADs) are crucial for pediatric medical treatment.
- CVAD failure and complications lead to treatment interruptions, increased patient morbidity, and mortality.
- Repeated CVAD insertions pose additional risks and strain healthcare resources.
Purpose of the Study:
- To systematically review the existing evidence on the incidence of central venous access device failure and complications in pediatric patients.
- To compare failure and complication rates across different types of CVADs used in pediatrics.
Main Methods:
- Systematic search of major databases (CENTRAL, PubMed, CINAHL) up to January 2015.
- Inclusion of 74 cohort studies examining CVAD failure and complications in pediatrics within the last decade.
- Independent data extraction and quality assessment by two authors.
Main Results:
- Overall, 25% of pediatric CVADs failed before therapy completion (rate: 1.97 per 1000 catheter days).
- Hemodialysis catheters had the highest proportional failure rate (46.4%), while umbilical catheters had the highest rate per 1000 catheter days (28.6).
- Totally implanted devices demonstrated the lowest failure rate per 1000 catheter days (0.15).
Conclusions:
- Pediatric CVAD failure and complications represent a significant global healthcare burden.
- The study's findings highlight the need for improved CVAD management strategies in pediatric populations.
- Limitations include the inclusion of nonrandomized studies, potentially affecting research robustness.
Context:
The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources.
Objective:
To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics.
Data Sources:
Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015.
Study Selection:
Included studies were of cohort design and examined the incidence of CVAD failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure was defined as CVAD loss of function before the completion of necessary treatment, and complications were defined as CVAD-associated bloodstream infection, CVAD local infection, dislodgement, occlusion, thrombosis, and breakage.
Data Extraction:
Data were independently extracted and critiqued for quality by 2 authors.
Results:
Seventy-four cohort studies met the inclusion criteria, with mixed quality of reporting and methods. Overall, 25% of CVADs failed before completion of therapy (95% confidence interval [CI] 20.9%-29.2%) at a rate of 1.97 per 1000 catheter days (95% CI 1.71-2.23). The failure per CVAD device was highest proportionally in hemodialysis catheters (46.4% [95% CI 29.6%-63.6%]) and per 1000 catheter days in umbilical catheters (28.6 per 1000 catheter days [95% CI 17.4-39.8]). Totally implanted devices had the lowest rate of failure per 1000 catheter days (0.15 [95% CI 0.09-0.20]).
Limitations:
The inclusion of nonrandomized and noncomparator studies may have affected the robustness of the research.
Conclusions:
CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.
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