Neonatal observational vascular access (NOVA): an Australian audit

Abstract

Background: Sick and preterm neonates require the delivery of fluids, medications, nutrition or blood products during hospitalisation. Thus, lifesaving treatment is often dependant on vascular access to deliver these treatments. However, the expected dependability and subsequent complications for a number of neonatal vascular access devices (VADs) is poorly understood. Studies in adults and paediatrics have resulted in evidence-based strategies for VAD insertion and maintenance towards the reduction of preventable complications. This study sought to identify current neonatal VAD practice, utility and complications towards targeted improvement.

Methods: A prospective audit of VAD management and associated complications was conducted over 3 months at the Royal Brisbane and Women’s Hospital’s, Neonatal Unit (Australia). All neonates requiring a VAD were eligible to participate. Primary outcomes were: (i) VAD complication resulting in catheter failure and (ii) VAD-associated skin complications. Neonates were assessed second daily for primary outcomes, and clinical utility such as frequency of device use. Descriptive statistics have been used, relevant to data characteristics. Associations between VAD- complications and clinical characteristics were assessed using Chi-square, Mann-Whitney U and Kruskall-Wallis tests, as appropriate. Variables with p < 0.05 were significant.

Results: In total 140 neonates received 302 VADs, for 1375.3 catheter days. Median age was 33.8 weeks (30.4–37.4) and weight was 2006 (1352–2956) grams. Prematurity (86; 61%) or respiratory failure (73; 52%) were attributed to most admissions. Multiple VADs were needed frequently (62; 44%) with dwell time reported as 2.3 (1.5–3.9) days for peripheral venous; 4.9 (2.7–6.8) days for umbilical venous; and 11.8 (7.9–14.3) days for peripherally inserted central catheters (PICC). VAD failure effected: peripheral venous (68; 36.6%), PICCs (5, 20.0%), umbilical venous devices (6; 11.5%); at a rate of 58.9 (47.4–73.2) per 1000 catheter days. VAD insertions were chiefly for fluids and medications administration (peripheral (184, 98.9%) umbilical venous (52, 100%)). Daily checks reflected high/continuous use (>87%) for VADs and skin complications impacted 12% of patients (23 complications in 17 patients).

Conclusions: VAD’s within this study were frequently accessed and often associated with complications. Comparison of results remains difficult, due to inadequate reporting of VAD complications within networks (e.g. ANZNN, VON). Harm associated with VAD complications is an important indicator for prevention of morbidity and mortality. This study has begun to identify causes of neonatal VAD failure which will inform strategies to reduce VAD complications.