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Development of a paediatric central venous access device database: A retrospective cohort study of practice evolution

Tricia M Kleidon1,2,3, Claire M Rickard2,3, Jessica A Schults1,2,3

  • 1Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia.

Journal of Paediatrics and Child Health
|August 23, 2019
PubMed

Insights

Practice improvements have reduced central venous access device (CVAD) failure in children, but challenges remain. Further innovation is needed to enhance vessel health and preservation during CVAD insertion and use.

Area of Science:

  • Paediatric Medicine
  • Vascular Access
  • Medical Device Technology

Background:

  • Central venous access devices (CVADs) are crucial for managing paediatric patients.
  • Understanding practice evolution, complications, and failure risk factors is essential for optimizing care.
  • Previous data on CVAD outcomes in children requires updated analysis.

Purpose of the Study:

  • To analyze trends in paediatric central venous access device (CVAD) practices.
  • To identify complications and risk factors associated with multiple insertion attempts.
  • To determine factors contributing to CVAD device failure in paediatric populations.

Main Methods:

  • Retrospective cohort study utilizing prospectively collected data from a paediatric CVAD database (2012-2014).
  • Inclusion of patient demographics, insertion details (indication, device, technique), and removal data (complications, dwell time).
  • Statistical analysis included descriptive statistics, incidence rates, logistic regression for insertion attempts, and Cox regression for failure.

Main Results:

  • A total of 1308 CVADs in 863 patients were analyzed; multiple insertion attempts remained static at 14%.
  • CVAD failure rates decreased from 35% in 2012 to 25% in 2014.
  • Risk factors for failure varied by device type, including patient condition (e.g., gastroenterology diagnosis), insertion site, and patient characteristics (e.g., body weight, age).

Conclusions:

  • Advancements in CVAD practices have led to improved insertion and failure outcomes in paediatric patients.
  • Despite improvements, persistent challenges necessitate further innovation in CVAD management.
  • Focus on enhancing vessel health and preservation is critical for children requiring CVADs.
Abstract

Keywords:
central venous catheterclinical registrypaediatricsperipherally inserted central catheterquality carevascular access

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