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

Amanda Corley^{1

2

3

4

5}, Ruth H Royle^{3

6}, Nicole Marsh^{1

2

3

4

5}, Emily N Larsen^{1

2

3

4}, E Geoffrey Playford⁷, Matthew R McGrail⁸, Naomi Runnegar^{7

9}, Robert S Ware^{3

6}, Nicole C Gavin^{4

5

10

11}, Evan Alexandrou^{4

12

13}, Marghie Murgo⁵, John R Gowardman^{11

14}, Adrian Regli^{15

16

17}, Claire M Rickard^{1

2

3

4

5

18}

Affiliations

¹ School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
² Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
³ Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.
⁴ Alliance for Vascular Access Teaching and Research Group, Schools of Nursing and Midwifery & Pharmacy and Medical Sciences, Griffith University, Nathan, Queensland, Australia.
⁵ UQ Centre for Clinical Research, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
⁶ School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia.
⁷ Infection Management Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.
⁸ Rural Clinical School, The University of Queensland, Rockhampton, Queensland, Australia.
⁹ Princess Alexandra Southside Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
¹¹ Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.
¹² School of Nursing, University of Wollongong, Wollongong, NSW, Australia.
¹³ Department of Intensive Care, Liverpool Hospital, Liverpool, New South Wales, Australia.
¹⁴ Department of Intensive Care Services and Internal Medicine and Aged Care (IMAC), Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
¹⁵ Intensive Care Unit, SJOG Murdoch Hospital, Perth, Western Australia, Australia.
¹⁶ Medical School, The Notre Dame University, Fremantle, Western Australia, Australia.
¹⁷ Medical School, The University of Western Australia, Perth, Western Australia, Australia.
¹⁸ Metro North Health, Herston Infectious Diseases Institute, Herston, Queensland, Australia.

PMID: 38800854
DOI: 10.1002/jhm.13414

Randomized Controlled Trial

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

Amanda Corley et al. J Hosp Med. 2024 Oct.

. 2024 Oct;19(10):905-917.

doi: 10.1002/jhm.13414. Epub 2024 May 27.

Authors

Affiliations

¹ School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
² Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
³ Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.
⁴ Alliance for Vascular Access Teaching and Research Group, Schools of Nursing and Midwifery & Pharmacy and Medical Sciences, Griffith University, Nathan, Queensland, Australia.
⁵ UQ Centre for Clinical Research, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
⁶ School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia.
⁷ Infection Management Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.
⁸ Rural Clinical School, The University of Queensland, Rockhampton, Queensland, Australia.
⁹ Princess Alexandra Southside Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
¹⁰ Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
¹¹ Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.
¹² School of Nursing, University of Wollongong, Wollongong, NSW, Australia.
¹³ Department of Intensive Care, Liverpool Hospital, Liverpool, New South Wales, Australia.
¹⁴ Department of Intensive Care Services and Internal Medicine and Aged Care (IMAC), Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
¹⁵ Intensive Care Unit, SJOG Murdoch Hospital, Perth, Western Australia, Australia.
¹⁶ Medical School, The Notre Dame University, Fremantle, Western Australia, Australia.
¹⁷ Medical School, The University of Western Australia, Perth, Western Australia, Australia.
¹⁸ Metro North Health, Herston Infectious Diseases Institute, Herston, Queensland, Australia.

PMID: 38800854
DOI: 10.1002/jhm.13414

Abstract

Background: Central venous access devices (CVADs) allow intravenous therapy, haemodynamic monitoring and blood sampling but many fail before therapy completion.

Objective: To quantify CVAD failure and complications; and identify risk factors.

Designs, settings, and participants: Secondary 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.

Results: In 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.

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References

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

Affiliations

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

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical