Unexpected tunnelled central venous access demise: a single institutional study from the UK

Area of Science:

• Pediatric vascular access
• Medical device failure analysis
• Healthcare economics

Background:

• Central vascular access devices (CVADs) are crucial for pediatric care.
• Understanding CVAD failure is essential for optimizing patient outcomes and resource allocation.

Purpose of the Study:

• To investigate factors contributing to the failure of tunnelled central vascular access devices (CVADs) in children.
• To characterize patterns of CVAD failure in a pediatric population.

Main Methods:

• Retrospective study of 684 CVAD insertions in children under 16 years (Oct 2014 - Dec 2019).
• Kaplan-Meier analysis for CVAD survival and multivariable regression for failure factors.
• Analysis of device type, insertion method, age, and prior failure history.

Main Results:

• 38.2% of CVADs failed prematurely, with 67% requiring replacement.
• Tunnelled external lines (TELs) showed higher failure rates than totally implantable devices (p<0.005).
• Low age at insertion and open placement were linked to increased failure; TEL displacement peaked within 90 days. Premature failures incurred an annual cost of £153,949.

Conclusions:

• Totally implantable devices (TIDs) are preferred over TELs when feasible.
• TELs require enhanced security for the initial 90 days due to high displacement risk.
• Improved line care practices can significantly reduce CVAD replacements and associated costs.