Central Venous Access Device Failure: Incidence and Risk Factors in Hospitalized Adults

Central venous access devices (CVADs) are essential for delivering medications, fluids, and monitoring patients in hospital settings. However, CVAD failure remains a significant challenge, leading to infections, complications, and increased healthcare costs. A recent multivariable analysis of 1,892 CVADs sheds light on the key risk factors associated with device failure and highlights areas for improvement in vascular access care.

Study Overview
This study analyzed data from hospitalized adults aged 16+ with three types of CVADs:
- Non-tunneled CVADs (NTCVADs)
- Peripherally inserted central catheters (PICCs)
- Tunneled CVADs (TCVADs)

The primary focus was on all-cause device failure, including central line-associated bloodstream infections (CLABSI), occlusion, accidental dislodgement, catheter fracture, thrombosis, and pain.

Key Findings
10.2% of CVADs failed, with NTCVADs (6.1%) having the lowest failure rate, while PICCs (13.2%) and TCVADs (13.4%) were more prone to complications.
CLABSI (5.3%) was the most common issue, followed by occlusion (1.8%) and dislodgement (1.7%).
Higher CLABSI risk was linked to blood product administration via PICCs (2.62x), fewer lumens in TCVADs (3.36x), chemotherapy use (2.96x), and diabetes (3.25x).
Antimicrobial NTCVADs (77% risk reduction) and IV lipids in TCVADs (68% risk reduction) proved protective against infections.

Implications for Clinical Practice
? Strict infection prevention measures can help reduce CLABSI rates, especially for patients receiving chemotherapy or blood products.
? More securement strategies are needed to prevent dislodgement, particularly in transferred patients.
? Alternative device choices should be considered for high-risk patients to minimize complications.

Conclusion
With 1 in 10 CVADs failing prematurely, this study highlights the urgent need for improved vascular access care. By identifying modifiable risk factors, clinicians can implement targeted interventions to enhance patient safety, reduce complications, and improve outcomes.

Read More:https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.13414 

Authors: Amanda Corley, Ruth H. Royle, Nicole Marsh, Emily N. Larsen