Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Can central venous access device care bundles and regular feedback reduce central line-associated complications in pediatric patients?

  • Chaiyakulsil, Chanapai (Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Thammasat University) ;
  • Pharadornuwat, Onsuthi (Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Thammasat University)
  • Received : 2020.01.27
  • Accepted : 2020.06.23
  • Published : 2021.03.15
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Abstract

Background: The use of indwelling central venous access devices (CVADs) in children can result in complications such as infection, occlusion, and dislodgement. Purpose: To evaluate whether reinforcing CVAD care bundles by using a regular direct feedback system could reduce such complications in children. Methods: The intervention in this retrospective interrupted time-series study was initiated in January 2019. The study was divided into the preintervention (October-December 2018), 3-month postintervention (January-March 2019), and 6-month postintervention (April-June 2019) phases. Risk difference and Poisson regression analyses were used to illustrate the effectiveness of the intervention. Results: The hospital-wide central line-related bloodstream infection rate decreased from 10.0/1,000 catheter-days to 4.5/1,000 catheter-days at 3-month postintervention (P=0.39) and to 1.4/1,000 catheter-days at 6-month postintervention (P=0.047). The central line occlusion rate significantly decreased from 30% to 12.8% (P=0.04) and 8.3% (P=0.002) at 3 and 6 months, respectively. Approximately 7% of CVADs became dislodged during the preintervention phase versus 8.5% (P=0.364) and 3.3% (P=0.378) at 3 and 6 months, respectively. Conclusion: Reinforcing CVAD care bundles with direct feedback could significantly decrease CVAD-associated complications in terms of infection at 6-month postintervention, and occlusion at 3- and 6-month postintervention. Thus, reinforcement and regular direct feedback might improve care quality in children with CVADs.

Keywords

Acknowledgement

The authors would like to show appreciation to all the residents, faculties and nursing staff of the Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital for the strong support and extensive cooperation in making this quality improvement project possible and successful. The authors would also like to thank Assistant Professor Prapasri Gulalert, Department of Epidemiology, Faculty of Medicine, Thammasat University for statistical assistance. The authors would also like to thank Dr. Rapee Opasatian for the support and graphical assistance.

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