Substantial harm associated with failure of chronic paediatric central venous access devices

BMJ Case Rep. 2017 Jul 6:2017:bcr2016218757. doi: 10.1136/bcr-2016-218757.

Abstract

Central venous access devices (CVADs) form an important component of modern paediatric healthcare, especially for children with chronic health conditions such as cancer or gastrointestinal disorders. However device failure and complications rates are high.Over 2½ years, a child requiring parenteral nutrition and associated vascular access dependency due to 'short gut syndrome' (intestinal failure secondary to gastroschisis and resultant significant bowel resection) had ten CVADs inserted, with ninesubsequently failing. This resulted in multiple anaesthetics, invasive procedures, injuries, vascular depletion, interrupted nutrition, delayed treatment and substantial healthcare costs. A conservative estimate of the institutional costs for each insertion, or rewiring, of her tunnelled CVAD was $A10 253 (2016 Australian dollars).These complications and device failures had significant negative impact on the child and her family. Considering the commonality of conditions requiring prolonged vascular access, these failures also have a significant impact on international health service costs.

Keywords: Congenital Disorders; Infection Control In Hospital; Intravenous / Infusion Nursing.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Australia / epidemiology
  • Catheter-Related Infections / complications
  • Catheter-Related Infections / drug therapy
  • Catheter-Related Infections / microbiology*
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / economics
  • Catheterization, Central Venous / instrumentation
  • Central Venous Catheters / adverse effects*
  • Central Venous Catheters / economics
  • Central Venous Catheters / microbiology
  • Child, Preschool
  • Cost of Illness
  • Equipment Failure / economics
  • Female
  • Gastroschisis / diagnosis
  • Gastroschisis / surgery*
  • Humans
  • Infant
  • Klebsiella pneumoniae / isolation & purification
  • Parenteral Nutrition / instrumentation*
  • Parenteral Nutrition / methods
  • Short Bowel Syndrome / complications*
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents