Incidence and risk factors for central venous access device failure in hospitalized adults: A multivariable analysis of 1892 catheters

Author:

Corley Amanda12345ORCID,Royle Ruth H.36,Marsh Nicole12345ORCID,Larsen Emily N.1234ORCID,Playford E. Geoffrey7,McGrail Matthew R.8,Runnegar Naomi79,Ware Robert S.36,Gavin Nicole C.451011,Alexandrou Evan41213,Murgo Marghie5,Gowardman John R.1114,Regli Adrian151617,Rickard Claire M.12345ORCID

Affiliation:

1. School of Nursing and Midwifery Griffith University Nathan QLD Australia

2. Nursing and Midwifery Research Centre Royal Brisbane and Women's Hospital Herston QLD Australia

3. Menzies Health Institute Queensland Griffith University Nathan QLD Australia

4. Alliance for Vascular Access Teaching and Research Group Schools of Nursing and Midwifery & Pharmacy and Medical Sciences Griffith University Nathan QLD Australia

5. UQ Centre for Clinical Research, School of Nursing, Midwifery and Social Work The University of Queensland Brisbane QLD Australia

6. School of Medicine and Dentistry Griffith University Nathan QLD Australia

7. Infection Management Services Princess Alexandra Hospital, Metro South Hospital and Health Service Woolloongabba QLD Australia

8. Rural Clinical School The University of Queensland Rockhampton QLD Australia

9. Princess Alexandra Southside Clinical School, Faculty of Medicine The University of Queensland Brisbane QLD Australia

10. Cancer Care Services Royal Brisbane and Women's Hospital Herston QLD Australia

11. Faculty of Medicine The University of Queensland St Lucia QLD Australia

12. School of Nursing University of Wollongong Wollongong NSW Australia

13. Department of Intensive Care Liverpool Hospital Liverpool NSW Australia

14. Department of Intensive Care Services and Internal Medicine and Aged Care (IMAC) Royal Brisbane and Women's Hospital Herston QLD Australia

15. Intensive Care Unit SJOG Murdoch Hospital Perth WA Australia

16. Medical School The Notre Dame University Fremantle WA Australia

17. Medical School The University of Western Australia Perth WA Australia

Abstract

AbstractBackgroundCentral venous access devices (CVADs) allow intravenous therapy, haemodynamic monitoring and blood sampling but many fail before therapy completion.ObjectiveTo quantify CVAD failure and complications; and identify risk factors.Designs, Settings and ParticipantsSecondary analysis of multicentre randomised controlled trial including patients aged ≥16 years with a non‐tunnelled CVAD (NTCVAD), peripherally‐inserted central catheter (PICC) or tunnelled CVAD (TCVAD). Primary outcome was incidence of all‐cause CVAD failure (central line‐associated bloodstream infection [CLABSI], occlusion, accidental dislodgement, catheter fracture, thrombosis, pain). Secondary outcomes were CLABSI, occlusion and dislodgement. Cox regression was used to report time‐to‐event associations.ResultsIn 1892 CVADs, all‐cause failure occurred in 10.2% of devices: 49 NTCVADs (6.1%); 100 PICCs (13.2%); 44 TCVADs (13.4%). Failure rates for CLABSI, occlusion and dislodgement were 5.3%, 1.8%, and 1.7%, respectively. Independent CLABSI predictors were blood product administration through PICCs (hazard ratio (HR) 2.62, 95% confidence interval (CI) 1.24–5.55); and in TCVADs, one or two lumens, compared with three to four (HR 3.36, 95%CI 1.68–6.71), intravenous chemotherapy (HR 2.96, 95%CI 1.31–6.68), and diabetes (HR 3.25, 95%CI 1.40–7.57). Independent factors protective for CLABSI include antimicrobial NTCVADs (HR 0.23, 95%CI 0.08–0.63) and lipids in TCVADs (HR 0.32, 95%CI 0.14–0.72). NTCVADs inserted at another hospital (HR 7.06, 95%CI 1.48–33.7) and baseline infection in patients with PICCs (HR 2.72, 95%CI 1.08–6.83) were predictors for dislodgement. No independent occlusion predictors were found. Modifiable risk factors were identified for CVAD failure, which occurred for 1‐in‐10 catheters. Strict infection prevention measures and improved CVAD securement could reduce CLABSI and dislodgement risk.

Publisher

Wiley

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