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Impact of changes in catheter management on infectious complications among children with central venous catheters
B J Lange1, M Weiman, E J Feuer
1Departments of Pediatrics, Children's Hospital of Philadelphia, PA, USA.
Insights
Implementing new protocols and education significantly reduced central venous catheter exit-site infections in children. Further interventions are needed to decrease overall infectious complications in this vulnerable population.
Area of Science:
- Pediatric healthcare
- Infectious disease prevention
- Medical device management
Background:
- Central venous catheters (CVCs) are essential for children with chronic illnesses but carry risks of complications.
- Characterizing and reducing CVC-related complications is crucial for improving patient outcomes.
Purpose of the Study:
- To characterize and quantify central venous catheter (CVC)-related complications in pediatric patients.
- To decrease CVC complication rates through enhanced management protocols and staff/parental education.
Main Methods:
- A prospective observational study was followed by an educational intervention and a nonrandomized trial.
- Protocols for CVC care (site cleaning, hub disinfection, dressing, access) were standardized.
- Formal education was provided to healthcare staff and parents of 268 children over 58,290 catheter days.
Main Results:
- Overall CVC-related infections decreased from 4.58 to 3.83 per 1,000 catheter days (not statistically significant).
- Exit-site infections significantly decreased from 0.58 to 0.11 per 1,000 catheter days (P = .02).
- Infectious complication rates in infants receiving parenteral nutrition on the surgical service significantly decreased from 15.46 to 6.67 (P = .02).
Conclusions:
- Standardized CVC management protocols and education effectively reduced exit-site infections in pediatric patients.
- These interventions significantly lowered infectious complication rates in a specific high-risk subgroup (infants on parenteral nutrition).
- Additional strategies are necessary to further mitigate infectious complications associated with CVC use in children.
Objectives:
To characterize and enumerate central venous catheter (CVC)-related complications among children with chronic illnesses, and to reduce the complication rate through changes in CVC management and education.
Design:
A prospective observational study followed by an educational program and a nonrandomized interventional trial.
Setting:
The Children's Hospital of Philadelphia, a tertiary, pediatric facility.
Patients:
268 children with Broviac, Hickman, or Infusaport catheters in place during 58,290 catheter days.
Interventions:
Development and implementation of protocols for cleaning insertion site and hub, use of nonocclusive dressings, and manipulation of access; formal staff and parental education about protocols.
Results:
CVC-related infections fell from 4.58/1,000 catheter-days preintervention to 3.83 postintervention (risk ratio [RR], 0.20; 95% confidence interval [CI95], 0.89-1.622; P = .25); exit-site infections fell from 0.58 to 0.11 (CI95, 1.22-45.64; P = .02); rates among infants on the surgical service fell from 15.46 to 6.67 (RR, 2.31; CI95, 1.10-4.30; P = .02).
Conclusions:
Education and changes in management protocols reduced the incidence of exit-site infections among all patients and reduced the overall infectious complication rate among the infants receiving parenteral nutrition on the surgical service. Other interventions are needed to decrease further the infectious complications in these children.