Central Venous Access Devices Care Research Articles

The Effectiveness of Pediatric Central Venous Access Device Surveillance and Rounding Team: A Single-Center Study.

Introduction Central venous access devices (CVADs) are indispensable in the management of pediatric cancer patients, offering vital access to treatment. Yet, complications related to CVADs, such as infections, thrombosis, and dislocations, pose significant risks, potentially leading to prolonged hospitalization, intensive care unit admission, or even mortality. To address these challenges, our hospital established a pediatric CVAD surveillance and rounding team to improve the management and care of pediatric patients with CVADs. Materials and methods This single-center retrospective study evaluated the impact of the pediatric CVAD surveillance and rounding team on the management of pediatric oncology patients with CVADs at Kurashiki Central Hospital, Kurashiki, Japan. We included pediatric cancer patients under 18 years of age who underwent CVAD placement from January 2018 to December 2022. The team conducted weekly rounds focusing on a comprehensive checklist to ensure optimal CVAD care. We compared the incidence of catheter-related complications before and after the establishment of the rounding team using the Student's t-test and Fisher's exact test. Results The study encompassed 28 patients before and 39 after the implementation of the surveillance rounds. Significant reductions were observed in the number of dislocations (from 28.6% to 0%, p = 0.001) and local infections (from 17.9% to 2.6%, p = 0.04). While the decreases in thrombosis, catheter breakage/rupture, and catheter-related bloodstream infections (CRBSIs) did not reach statistical significance, they suggest a favorable trend toward enhanced management of CVADs. Conclusions The establishment of a pediatric CVAD surveillance and rounding team significantly reduced the incidence of dislocations and local infections among pediatric cancer patients with CVADs. This multidisciplinary team approach highlights the importance of continuous surveillance, teamwork, and education in enhancing the quality of CVAD care, contributing to safer patient outcomes and emphasizing the need for continuous improvement in pediatric CVAD management.

Decreasing the incidence of central line-associated bloodstream infection in a medical intensive care unit: a best practice implementation project.

Bloodstream infections are common in critically ill patients using central venous access devices (CVAD) in intensive care units (ICU). This project aimed to decrease the incidence of central line-associated bloodstream infections (CLABSI) by using evidence-based strategies. The project applied the JBI audit and feedback methods. Thirty-two nurses and five resident physicians from the medical ICU of a medical center participated in the project. Preintervention compliance was measured for the 11 key evidence-based criteria (six audit criteria of central venous catheter insertion and five audit criteria of dressing and catheter securement). Strategies were implemented to overcome the barriers identified in the baseline assessment. Impact evaluation and sustainability were conducted to change the CLABSI rate and the competence of healthcare professionals in providing CVAD care. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used for the data collection, analysis, and implementation planning. Barriers included insufficient knowledge among nurses and physicians, poor compliance with the standard CVAD insertion procedure by physicians, inadequate cooperation among the CVAD care team members, and lack of CVAD-related equipment. The strategies included education and training in CVAD care, the establishment of a team resource management program, and the provision of appropriate equipment. Following project implementation, the CLABSI rate decreased from 8.38 to 3.9 BSIs/1000 CVAD-days. The project successfully decreased the CLABSI rate and increased the competence of healthcare professionals. Implementation of best practices in clinical care should focus on leadership, team resource management, education, monitoring, and innovation.

Central venous access device practice across haematology and oncology centres in Australia and New Zealand: a cross-sectional survey.

Central venous access devices (CVADs) are commonly used in malignancies. We conducted an online, anonymous cross-sectional survey of practice regarding CVAD management in haematology centres among clinicians in Australia and New Zealand. We identified variation in clinical practice regarding CVAD selection, insertion, management and removal. These findings highlight research gaps in CVAD care.

Can central venous access device care bundles and regular feedback reduce central line-associated complications in pediatric patients?

Background The use of indwelling central venous access devices (CVADs) in children can result in complications such as infection, occlusion, and dislodgement.Purpose To evaluate whether reinforcing CVAD care bundles by using a regular direct feedback system could reduce such complications in children.Methods The intervention in this retrospective interrupted time-series study was initiated in January 2019. The study was divided into the preintervention (October–December 2018), 3-month postintervention (January–March 2019), and 6-month postintervention (April–June 2019) phases. Risk difference and Poisson regression analyses were used to illustrate the effectiveness of the intervention.Results The hospital-wide central line-related bloodstream infection rate decreased from 10.0/1,000 catheter-days to 4.5/1,000 catheter-days at 3-month postintervention (P=0.39) and to 1.4/1,000 catheter-days at 6-month postintervention (P=0.047). The central line occlusion rate significantly decreased from 30% to 12.8% (P=0.04) and 8.3% (P=0.002) at 3 and 6 months, respectively. Approximately 7% of CVADs became dislodged during the preintervention phase versus 8.5% (P=0.364) and 3.3% (P=0.378) at 3 and 6 months, respectively.Conclusion Reinforcing CVAD care bundles with direct feedback could significantly decrease CVAD-associated complications in terms of infection at 6-month postintervention, and occlusion at 3- and 6-month postintervention. Thus, reinforcement and regular direct feedback might improve care quality in children with CVADs.

Development and implementation of an antimicrobial lock therapy guideline in a pediatric hospital.

The development and implementation of an antimicrobial lock therapy guideline at a large pediatric hospital are described. Central venous access devices (CVADs) are essential in the medical management of patients requiring long-term total parenteral nutrition, chemotherapy, or hemodialysis. However, the use of a CVAD carries a significant risk of the development of central line-associated bloodstream infection (CLABSI). Antimicrobial lock therapy is indicated for patients with CLABSIs who have no signs of exit site or tunnel infection and for whom catheter salvage is a goal. An antimicrobial lock therapy guideline was developed and implemented at a large pediatric hospital by an interprofessional team consisting of providers specializing in CVAD care. Development and implementation of the guideline included a needs assessment, a literature review, determination of patient selection criteria, addition of compounding formulations, development of administration techniques, and education. In all 10 instances of lock therapy in the 18 months after guideline implementation, the criteria for use were met; in 60% of those instances, patients received care from an infectious diseases physician. Each of the available lock solutions was used at least once during the 18-month period. Overall, implementation of a guideline on administration of antimicrobial lock therapy was successful. Nine patients received antimicrobial lock therapy in the 18 months after policy implementation; although 2 had their line removed (1 due to repeated line infections), neither required line replacement.

Référentiel de pratiques professionnelles : soins et surveillance des accès veineux centraux de l’adulte pour la nutrition parentérale

Central venous access devices (CVAD) are essential for the administration of parenteral nutrition. The quality of the care of CVAD influences the risk of complications and so the quality of life of the patients and the costs of care. Numerous infectious or non-infectious complications of CVAD can be prevented by appropriate, standardized protocols of care. Information about the care of CVAD and complications is essential for the early recognition and treatment of complications and should be shared between patients and caregivers. This article describes an audit for CAVD care that can be used to improve quality of care in a professional practice evaluation program.

Implementing a new teaching and learning strategy for CVAD care.

Central venous access devices (CVADs) are now a fundamental part of contemporary healthcare. Despite having many advantages, there are also complications associated with them. Evidence suggests that educating and training health professionals who maintain CVADs is essential for preventing such complications, however, the most effective approach for this training has not been evaluated. The aim of this study was to determine whether the introduction of an innovative educational intervention within a higher education institution (HEI) improved the confidence and knowledge of registered nurses dealing with CVADs. A survey design consisting of a self-completion questionnaire and open-ended questions was used. This study demonstrated that nurses felt more confident following participation in the training. In addition, nurses discussed the advantages of training outside of the clinical setting as it provided them with a safe place to practise and gave them time to learn without interruption. The findings from this study suggest that the HEIs can provide an effective and safe environment for registered nurses to build confidence and knowledge in CVAD management.

Central venous access devices site care practices: an international survey of 34 countries.

Effective postinsertion management of central venous access devices (CVADs) is important to prevent CVAD-associated complications, including catheter-associated bloodstream infections. Although there is a wealth of evidence-based guidelines available to guide the care of CVADs, applying their recommendations to the clinical setting across variable patient groups, CVAD types and international healthcare settings is challenging. This may result in patients receiving suboptimal care. A cross-sectional descriptive study using an online survey was performed with an aim to determine current CVAD site care practices internationally. The CVAD site care domains included skin antisepsis, dressing selection, frequency of dressing change and device securement practices across impaired and unimpaired CVAD sites. Clinicians (n = 1044) residing in 34 countries reported diversity in their practice, with the majority of respondents practicing as nurses (89%) from North America (81%) as vascular access specialists (52%). The respondents' reported practice was variant, with differing inconsistency to guidelines throughout each of the domains. There was wide variance in the management of CVAD sites with impaired skin integrity, such as rash, skin stripping/adhesive-related injuries and drainage. Vascular access clinicians reported high levels of confidence in managing CVAD sites, including those with impaired skin. These inconsistencies are reflective of the complex and heterogeneous populations requiring CVADs, the evidence available to support practice in this area, the skills and knowledge of the clinicians caring for them and the resources of the healthcare setting. Further research and education is necessary to ensure that CVAD site care is undertaken effectively to minimise preventable complications.

Infection Related to Implantable Central Venous Access Devices in Cancer Patients: Epidemiology and Risk Factors

To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections. Prospective cohort study. Referral hospital for cancer in São Paulo, Brazil. We prospectively evaluated all implantable CVADs employed between January 2009 and December 2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death. Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and limiting CVAD insertion in neutropenic patients have on the rates of such infections. During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days ([Formula: see text]). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use. Establishing a multidisciplinary team specifically focused on CVAD care, together with systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices.

Challenges in the Management of Pediatric Central Venous Access Devices in the Community

Central venous access devices (CVADs) play an essential role in the care of critically ill children. Significant challenges exist for teams in managing CVADs particularly in a community setting. The authors aimed to assess the experience of general practitioners (GPs) caring for children with CVADs. From 200 CVADs inserted in a pediatric hospital in 2009, 50 patients were randomly selected and 44 GPs were forwarded a questionnaire. Twenty (46%) GPs responded. The main reasons (n = 22) for using CVADs were medication administration (n = 11), nutrition (n = 6), and blood sampling (n = 5). Thirteen (65%) GPs had no education in CVAD management and 14 (70%) were unaware of existing guidelines. Those identified by GPs as having primary responsibility for care of CVADs in the community included hospital/pediatric teams (n = 9), parents (n = 3), GPs (n = 2), public health nurses (n = 1), and palliative care (“home care”) teams (n = 1). The main challenges (n = 15) identified by GPs were lack of education (n = 4), line management difficulties (n = 3), infection risk (n = 3), infrequent exposure to CVADs (n = 3), and poor communication (n = 1). GPs felt that these challenges could be addressed through: education (n = 8), increased manpower and community support (n = 1), and improved communication (n = 1). This study highlights the inconsistency and challenges for GPs surrounding CVAD use in children. Further education and support is necessary to assist GPs in their use particularly when providing end-of-life care for children in the community.

Central venous access devices Part 1: devices for acute care

This two-part article provides an overview of central venous access devices (CVADs) for acute and longer-term use. Part 1 reviews the classifications of vascular access devices before focusing on CVADs for the acute care setting. The rationale for selecting the central route is explained. Clinical indications for the use of CVADs in acute care are discussed and an overview of the related therapies is provided. The practical procedure for insertion of an acute care CVAD is explained using a step-by-step approach. Infection control aspects of device insertion are highlighted and recommendations from epic2 are incorporated into the practical procedure. Key aspects of CVAD care are discussed and the procedure for removal of non-tunnelled central catheters is presented. Part 2 focuses on the use of CVADs for longer-term care.

Consensus recommendations for use of central venous access devices in haemophilia

Venous access is essential for delivery of haemophilia factor concentrate. Wherever possible, peripheral veins remain the route of choice, and the use of central venous access devices (CVADs) should be limited to cases of clear need in patients with caregivers able to exercise diligence in CVAD care and should continue no longer than necessary. CVADs are of recognized value for repeated administration of coagulation factors in haemophilia, particularly for prophylaxis and immune tolerance therapy and in young children. Evidence to guide best practices has been fragmentary, and standardized methods for CVAD usage have yet to be established. We have developed management recommendations based upon available published evidence as well as extensive clinical experience. These recommendations address patient and CVAD selection; CVAD placement, care and removal; caregiver/patient guidance; and complications, including infection and thrombosis. In the absence of inhibitors, ports are recommended, primarily because of fewer associated infections than with external catheters. For patients with inhibitors, ports also appear to be associated with fewer infections. Infection is the most frequent complication, and recommendations to prevent and treat infections are supported by extensive clinical data and experience. Strict adherence to handwashing and aseptic technique are essential elements of catheter care. Evidence-based data regarding the detection and treatment of CVAD-related thrombotic complications are limited. Caregiver education is an integral part of CVAD use and the procedural practices of users should be regularly re-assessed. These recommendations provide a basis for sound current CVAD practice and are expected to undergo further refinements as new evidence is compiled and clinical experience is gained.

Recombinant tissue plasminogen activator for central venous access device occlusion

Maintaining and restoring the function of central venous access devices (CVAD) is an important component of pediatric oncology nursing care. Until 1999, Abbokinase Open Cath (urokinase; Abbott, Abbott Park, IL), a thrombolytic agent was the product primarily used to resolve thrombotic occlusions in intravascular devices. Changes in the manufacturing process mandated by the FDA have resulted in a lack of availability of Abbokinase Open Cath. Recombinant tissue plasminogen activator (TPA) has provided an alternative solution for clearing occluded intravascular devices. This article reviews the literature supporting the use of TPA for CVAD clearance and discusses the process of how to administer the medication. Future implications for research about the use of TPA, and its role in the care of CVADs are discussed.