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  • Development of a paediatric central venous access device database: A retrospective cohort study of practice evolution and risk factors for device failure

    Author(s)
    Kleidon, Tricia M
    Rickard, Claire M
    Schults, Jessica A
    Mihala, Gabor
    McBride, Craig A
    Rudkin, John
    Chaseling, Brett
    Ullman, Amanda J
    Griffith University Author(s)
    Ullman, Amanda J.
    McBride, Craig
    Mihala, Gabor
    Schults, Jessica
    Rickard, Claire
    Kleidon, Patricia
    Year published
    2019
    Metadata
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    Abstract
    Aim: To describe practice evolution, complications and risk factors for multiple insertion attempts and device failure in paediatric central venous access devices (CVADs). Methods: A paediatric retrospective cohort study using prospectively collected data from CVAD database 2012–2014. Data included were patient (i.e. age, condition), insertion (i.e. indication, device, technique) and removal (complications, dwell). Descriptive statistics and incidence rates were calculated per calendar year and compared. Risk factors for multiple insertion attempts and failure were explored with logistic regression and cox regression, ...
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    Aim: To describe practice evolution, complications and risk factors for multiple insertion attempts and device failure in paediatric central venous access devices (CVADs). Methods: A paediatric retrospective cohort study using prospectively collected data from CVAD database 2012–2014. Data included were patient (i.e. age, condition), insertion (i.e. indication, device, technique) and removal (complications, dwell). Descriptive statistics and incidence rates were calculated per calendar year and compared. Risk factors for multiple insertion attempts and failure were explored with logistic regression and cox regression, respectively. Results: A total of 1308 CVADs were observed over 273 467 catheter‐days in 863 patients. Multiple insertion attempts remained static (14%) and significantly associated with non‐haematological oncology (odds ratio 2.19; 95% confidence interval (CI) 1.08–4.43), respiratory (3.71; 1.10–12.5), gastroenterology (4.18; 1.66–10.5) and other (difficult intravenous access) (2.74; 1.27–5.92). CVAD failure decreased from 35% (2012) to 25% (2014), incidence rate from 1.50 (95% CI 1.25–1.80) to 1.28 (1.06–1.54) per 1000 catheter‐days. Peripherally inserted CVAD failure was significantly associated with lower body weight (per kilogram decrease, hazard ratio (HR) 1.02; 95% CI 1.00–1.03), cephalic vein (1.62; 1.05–2.62), difficult access (1.92; 1.02–3.73), sub‐optimal tip placement (1.69; 1.06–2.69) and gastroenterology diagnosis (2.27; 1.05–4.90). Centrally placed CVAD failure was significantly associated with younger age (per year, HR 1.04; 95% CI 1.00–1.07), tunnelled device (3.38; 2.41–4.73) and gastroenterology diagnosis (1.70; 1.06–2.73). Conclusions: While advancement in CVAD practices improved overall CVAD insertion and failure outcomes, further improvements and innovation are necessary to ensure improved vessel health and preservation for children requiring CVAD.
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    Journal Title
    Journal of Paediatrics and Child Health
    DOI
    https://doi.org/10.1111/jpc.14600
    Note
    This publication has been entered into Griffith Research Online as an Advanced Online Version.
    Subject
    Paediatrics and Reproductive Medicine
    Clinical Sciences
    Public Health and Health Services
    central venous catheter
    clinical registry
    paediatrics
    peripherally inserted central catheter
    quality care
    Publication URI
    http://hdl.handle.net/10072/386750
    Collection
    • Journal articles

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