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

Abstract

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 (<i>P</i>=0.39) and to 1.4/1,000 catheter-days at 6-month postintervention (<i>P</i>=0.047). The central line occlusion rate significantly decreased from 30% to 12.8% (<i>P</i>=0.04) and 8.3% (<i>P</i>=0.002) at 3 and 6 months, respectively. Approximately 7% of CVADs became dislodged during the preintervention phase versus 8.5% (<i>P</i>=0.364) and 3.3% (<i>P</i>=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.