Road map for improvement: An audit of central venous access devices in Australian paediatric facilities
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Presenter: Ms Amanda Ullman1, Ms Tricia Kleidon1,2, Professor Claire Rickard1, Professor Marie Cooke1
1Alliance for Vascular Access Teaching and Research, Menzies Health Institute, Griffith University , Nathan, Australia, 2Lady Cilento Children’s Hospital, Brisbane, Australia
Date of Presentation: 27th October 2016
Abstract
Aim
Central venous access devices (CVADs) management is complex and complications are common. Strategies have been developed to help reduce preventable causes of CVAD complication; however the translation of this evidence to the bedside is challenging.
The study aimed to examine paediatric CVAD practices including prevalence, management and rate of complications.
Method
A prospective, point prevalence audit was conducted throughout tertiary paediatric facilities in Australia between September and November 2015, using validated data collection tools.
Results
Across the six sites, 1,027 patients were screened with CVADs prevalent in 26.1% (n=268). Variation and inconsistencies in management practices were evident, with CVAD dressings not meeting the basic criteria of clean, dry and intact for 13.5% of CVADs, and non-sterile dressing products used to reinforce 26.4% of CVAD. Almost half of CVADs audited (49.4%) had no documentation on the bedside chart regarding site assessment in the previous four hours, and 13.4% had no planned use in the next 24 hours.
CVAD-associated complications within the previous seven days were evident in 9.5% of CVADs, most commonly catheter blockage (5.7% CVAD) and bloodstream infection (1.9% CVAD). Peripherally inserted central catheters (16.9%) in comparison to other catheter types (7.4%; p=0.04) and subsequent CVADs (14.1%) in comparison to initial CVADs (6.5%; p=0.04), had significantly higher proportions of CVAD-associated complications in the previous seven days.
Conclusions
Specific areas of potential improvement were the variable local CVAD management guidelines, and dressing products to improve dressing integrity and sterility.