Unexpected tunnelled central venous access demise: a single institutional study from the UK.
Pediatr Surg Int
; 37(1): 109-117, 2021 Jan.
Article
em En
| MEDLINE
| ID: mdl-33159555
ABSTRACT
PURPOSE:
To explore the factors involved in the demise of tunnelled central vascular access devices (CVADs) in children and describe patterns of failure.METHODS:
A retrospective study including children under 16 years of age undergoing CVAD insertion in a tertiary centre between October 2014 and December 2019. The Kaplan-Meier estimator was used to study CVAD survival and piecewise exponential curves to approximate hazard rates. Related factors were analysed using multivariable regression.RESULTS:
Totally, 684 CVADs were inserted in 499 children. Devices were in situ for 213,821 days (median 244.5). Of those, 261 CVADs (38.2%) failed prematurely; 176 (67%) required replacement. Tunnelled external lines (TELs) failed more frequently than totally implantable devices (p < 0.005).TEL displacement occurred in two high-risk phases, falling to baseline after 90 days. Low age at device insertion and open placement were strongly associated with an increased failure rate. Previous CVAD failure did not increase subsequent failure rate. Premature failure increased procedural cost by £153,949 per year.CONCLUSIONS:
TIDs should be placed in preference to TELs where appropriate. TELs are at highest risk of displacement for 90 days and must be well secured for this duration. Meticulous line care offers significant potential cost savings by reducing line replacements. LEVEL OF EVIDENCE Level III.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cateterismo Venoso Central
/
Cateteres de Demora
/
Falha de Equipamento
/
Cateteres Venosos Centrais
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Child
/
Child, preschool
/
Female
/
Humans
/
Male
País/Região como assunto:
Europa
Idioma:
En
Revista:
Pediatr Surg Int
Assunto da revista:
PEDIATRIA
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Reino Unido