Use of central venous access devices outside of the pediatric intensive care units. Pediatr Res 2025 Feb;97(2):664-670
Date
06/28/2024Pubmed ID
38937641Pubmed Central ID
PMC12884970DOI
10.1038/s41390-024-03337-7Scopus ID
2-s2.0-85197373990 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
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.
Author List
Burek AG, Bumgardner C, Liljestrom T, Porada K, Pan AY, Liegl M, Coon ER, Flynn KE, Ullman AJ, Brousseau DCAuthors
Alina G. Burek MD Associate Professor in the Pediatrics department at Medical College of WisconsinKathryn Eve Flynn PhD Vice Chair, Professor in the Medicine department at Medical College of Wisconsin
Tracey H. Liljestrom MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Amy Y. Pan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentCatheter-Related Infections
Catheterization, Central Venous
Central Venous Catheters
Child
Child, Preschool
Databases, Factual
Female
Humans
Intensive Care Units, Pediatric
Male
Venous Thromboembolism
