Related Experiment Video
Updated: Jun 22, 2025
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Use of central venous access devices outside of the pediatric intensive care units
Alina G Burek1,2, Chris Bumgardner3, Tracey Liljestrom3,4
1Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI, USA. aburek@mcw.edu.
Insights
Central venous access device (CVAD) use in non-ICU settings decreased over ten years. Lower utilization sites often have dedicated teams guiding device selection, suggesting resource variation impacts CVAD use.
Area of Science:
- Pediatric Hospital Medicine
- Vascular Access
- Patient Safety
Background:
- Central venous access devices (CVADs) are linked to central line-associated bloodstream infections (CLABSI) and venous thromboembolism (VTE).
- Understanding non-intensive care unit (ICU) CVAD trends and associated complications is crucial for patient safety.
Purpose of the Study:
- To analyze 10-year trends in non-ICU CVAD utilization among children.
- To describe complication rates (CLABSI, VTE) associated with non-ICU CVADs.
- To compare hospital resources, such as vascular access teams and device selection guides, between low and high CVAD utilization sites.
Main Methods:
- Combined data from the Pediatric Health Information System (PHIS) database and hospital surveys.
- Analyzed 10-year trends (2012-2021) in non-ICU CVAD encounters for pediatric patients.
- Described variation and complication rates (2017-2021) and compared resources using Fisher's exact test.
Main Results:
- Non-ICU CVAD use declined from 6.3% to 3.8% of hospitalizations over a decade.
- CLABSI and VTE rates were 4.0% and 3.4%, respectively, among 67,830 non-ICU CVAD encounters (2017-2021).
- Significant institutional variation in CVAD use (1.4-16.9%) was observed; low-use sites were more likely to have teams guiding device selection.
Conclusions:
- CVAD utilization outside the ICU is decreasing, but significant institutional variation persists.
- Hospital resources, particularly vascular access teams and guided device selection, may influence CVAD utilization rates.
- Despite the availability of alternatives like midline catheters, their use remains infrequent in many institutions.
Background:
Central venous access devices (CVAD) are associated with central line associated bloodstream infection (CLABSI) and venous thromboembolism (VTE). We identified trends in non-intensive care unit (ICU) CVAD utilization, described complication rates, and compared resources between low and high CVAD sites.
Methods:
We combined data from the Pediatric Health Information System (PHIS) database and surveys from included hospitals. We analyzed 10-year trends in CVAD encounters for non-ICU children between 01/2012-12/2021 and described variation and complication rates between 01/2017-12/2021. Using Fisher's exact test, we compared resources between low and high CVAD users.
Results:
CVAD use decreased from 6.3% to 3.8% of hospitalizations over 10 years. From 2017-2021, 67,830 encounters with CVAD were identified. Median age was 7 (IQR 2-13) years; 46% were female. Significant variation in CVAD utilization exists (range 1.4-16.9%). Rates of CLABSI and VTE were 4.0% and 3.4%, respectively. Survey responses from 33/41 (80%) hospitals showed 91% had vascular access teams, 30% used vascular access selection guides, and 70% used midline/long peripheral catheters. Low CVAD users were more likely to have a team guiding device selection (100% vs 43%, p = 0.026).
Conclusions:
CVAD utilization decreased over time. Significant variation in CVAD use remains and may be associated with hospital resources.
Impact:
Central venous access device (CVAD) use outside of the ICU is trending down; however, significant variation exists between institutions. Children with CVADs hospitalized on the acute care units had a CLABSI rate of 4% and VTE rate of 3.4%. 91% of surveyed institutions have a vascular access team; however, the services provided vary between institutions. Even though 70% of the surveyed institutions have the ability to place midline/long peripheral catheters, the majority use these catheters less than a few times per month. Institutions with low CVAD use are more likely to have a vascular access team that guides device selection.
Related Concept Videos
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:30Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...