Prevention of Occlusion of cEnTral lInes for Children with cancer: An implementation study

Ullman, Amanda J. and Condon, Paula and Edwards, Rachel and Gibson, Victoria and Takashima, Mari and Schults, Jessica and Dean, Anna and Cattanach, Paula and Nicholls, Wayne and Osborne, Sonya ORCID: https://orcid.org/0000-0002-2826-0627 and Rickard, Claire M. and Cooke, Marie and Kleidon, Tricia (2020) Prevention of Occlusion of cEnTral lInes for Children with cancer: An implementation study. Journal of Paediatrics and Child Health, 56 (12). pp. 1875-1884. ISSN 1034-4810


Abstract

Aim
Central venous access devices (CVADs) are vital medical devices to support the treatment of paediatric cancer; however, device occlusion is common, which disrupts treatment. This study aimed to improve the identification and management of CVAD occlusions in children with cancer, as well as to identify the demographic, clinical and device characteristics associated with increased risk for CVAD occlusion.

Methods
A pre–post-implementation study was conducted at a metropolitan paediatric oncology facility in Australia, using the Theoretical Domains Framework. Patients with a CVAD for anti-cancer therapy were prospectively followed for occlusive events pre- and post- the implementation of clinical resources to support the identification and management of CVAD occlusive events. CVAD occlusion and management data were collected and compared pre- and post-implementation. Risk factors for CVAD occlusion were described by mixed-effects Poisson regression and incident rate ratios (IRR).

Results
A total of 133 CVADs were inserted into 131 patients for a total of 6784 catheter days. The incidence of CVAD-related occlusion preimplementation was 59.7 (95% confidence interval (CI) 51.4–69.0, per 1000 catheter days); compared to 31.6 (95% CI 26.4–37.6); P < 0.01) post implementation of clinical resources. In multivariate models, other than post-implementation phases (IRR 0.51 (95% CI 0.32–0.81)), only neutropaenia significantly increased the risk of CVAD occlusion (IRR 2.14 (95% CI 1.15–3.97)).

Conclusion
CVAD occlusions in paediatric oncology are common. The development and implementation of CVAD occlusion resources to guide the identification and management of occlusive episodes led to a significant decrease in occlusive events.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Date Deposited: 10 Dec 2020 03:01
Last Modified: 23 Apr 2021 00:37
Uncontrolled Keywords: catheterization, peripheral; central venous catheter; implementation science; neoplasm; oncology nursing; venous thrombosis
Fields of Research (2008): 11 Medical and Health Sciences > 1110 Nursing > 111003 Clinical Nursing: Secondary (Acute Care)
Fields of Research (2020): 42 HEALTH SCIENCES > 4205 Nursing > 420501 Acute care
Socio-Economic Objectives (2008): E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
Socio-Economic Objectives (2020): 20 HEALTH > 2003 Provision of health and support services > 200304 Inpatient hospital care
20 HEALTH > 2003 Provision of health and support services > 200306 Midwifery
20 HEALTH > 2001 Clinical health > 200199 Clinical health not elsewhere classified
Funding Details:
Identification Number or DOI: https://doi.org/10.1111/jpc.15067
URI: http://eprints.usq.edu.au/id/eprint/40342

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