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Standardizing Preoperative Evaluation for Pediatric Central Venous Access: A Care Algorithm to Improve Safety.
Monica L Wagner1, Darcy Doellman, Kimberly N Forlenza
1University of Cincinnati College of Medicine, Department of Surgery, Cincinnati, OH (Drs Wagner and Falcone); Cincinnati Children's Hospital Medical Center, Pediatric General and Thoracic Surgery, Cincinnati, OH (Mss Doellman, Forlenza, and Bradshaw; Drs Fischer, Kara, and Falcone). Monica L. Wagner, MD, is a general surgery resident in the Department of Surgery at the University of Cincinnati College of Medicine. Darcy Doellman, MSN, RN, CRNI®, VA-BC, is a clinical manager of the vascular access team at Cincinnati Children's Hospital Medical Center. She has extensive expertise and is nationally recognized in the field of pediatric vascular access. Kimberly N. Forlenza, MS, participated in this work as part of the special master's program in physiology at the University of Cincinnati College of Medicine, Department of Pharmacology & Systems Physiology. Kevin Fischer, DNP, APRN, is an advanced practice provider in pediatric surgery at Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery. Setenay Tuncel Kara, PhD, is a lead quality improvement specialist in the James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center. She has worked on numerous quality improvement initiatives across the hospital. Ursula Bradshaw, MA, BS, is a quality analyst at Cincinnati Children's Hospital Medical Center, Quality & Transformation Analytics and Data. Richard A. Falcone, Jr, MD, MPH, MMM, is a professor of surgery in the Department of Surgery at the University of Cincinnati College of Medicine practicing within the Division of Pediatric General and Thoracic Surgery at Cincinnati Children's Hospital Medical Center. He is also the associate chief of staff for surgical services, responsible for oversight of operations.
A new care algorithm standardizes preoperative screening for pediatric central vascular access device (CVAD) placement, improving patient risk stratification and supporting optimal device selection for safer procedures.
Area of Science:
- Pediatric medicine
- Medical device safety
- Healthcare informatics
Background:
- Central vascular access device (CVAD) placement is a frequent procedure in pediatric care.
- Selecting the appropriate CVAD is crucial for optimizing patient treatment and minimizing risks.
Purpose of the Study:
- To develop and implement a standardized care algorithm for preoperative screening before pediatric CVAD placement.
- To integrate evidence-based practices for CVAD selection, risk stratification, and preoperative evaluation.
Main Methods:
- A multidisciplinary team designed a care algorithm with three key components: CVAD selection, patient risk stratification, and preoperative evaluation.
- A stepwise approach involving provider education and electronic health record integration was employed.
- The algorithm was based on existing literature and clinical recommendations.
Main Results:
- The implemented algorithm achieved 82% patient risk stratification among inpatients.
- The standardization process aimed to improve the safety and efficacy of pediatric CVAD procedures.
Conclusions:
- The developed care algorithm effectively standardizes preoperative screening for pediatric CVAD placement.
- This approach enhances patient safety by guiding appropriate device selection and risk assessment, integrating current evidence into clinical practice.
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