Use of central venous access devices outside of the pediatric intensive care units

Alina G Burek; Chris Bumgardner; Tracey Liljestrom; Kelsey Porada; Amy Y Pan; Melodee Liegl; Eric R Coon; Kathryn E Flynn; Amanda J Ullman; David C Brousseau

doi:10.1038/s41390-024-03337-7

Use of central venous access devices outside of the pediatric intensive care units

Pediatr Res. 2024 Jun 27. doi: 10.1038/s41390-024-03337-7. Online ahead of print.

Authors

Alina G Burek^{1

2}, Chris Bumgardner³, Tracey Liljestrom^{3

4}, Kelsey Porada⁴, Amy Y Pan⁴, Melodee Liegl⁴, Eric R Coon⁵, Kathryn E Flynn⁶, Amanda J Ullman^{7

8}, David C Brousseau⁹

Affiliations

¹ Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI, USA. [email protected].
² Department of Pediatrics, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, USA. [email protected].
³ Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI, USA.
⁴ Department of Pediatrics, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, USA.
⁵ Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
⁶ Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, USA.
⁷ School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia.
⁸ Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia.
⁹ Department of Pediatrics, Nemours Children's Health Delaware and the Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, USA.

PMID: 38937641
DOI: 10.1038/s41390-024-03337-7

Abstract

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.