Improving practices to prevent and manage CVAD occlusion,

Improving practices to prevent and manage CVAD occlusion,

by Associate Professor Amanda Ullman

 

What do you think is the most common CVAD dysfunction in healthcare? Reading journal articles you'll see most researchers and clinicians focussing on bloodstream infection and thrombosis.

But - catheter occlusion, or blockage, is 5 times more common than both of these complications.

CVADs are essentially long, narrow tubes, through which we frequently administer viscous fluids, like blood products and lipids. Of course they block - especially when we have to use extremely narrow tubes (like in paediatrics).

Children with cancer have been shown to be exceedingly vulnerably to the consequences of occluded CVADs, with CVAD occlusion associated with a reduced survival rate for children with brain tumours, and non-central nervous system cancers (https://journals.lww.com/jpho-online/Abstract/2012/04000/Central_Venous_Line_Dysfunction_is_an_Independent.6.aspx; https://www.jpeds.com/article/S0022-3476(04)00690-0/abstract). The importance of this can't be stressed enough.

Within this project (known as POETIC) a team of interdisciplinary clinicians at the Queensland Children's Hospital Cancer Care Services and Griffith University developed and implemented clinical resources to support the identification and management of CVAD occlusive events. Using this relatively simple, practice guidance (involving assessment, documentation and management pathways) we were able to significantly reduce the incidence of CVAD-related occlusion (from 60 occlusions to 32 occlusions per 1,000 catheter days).

This research was recently published in the Journal of Paediatrics and Child Health (https://onlinelibrary.wiley.com/doi/10.1111/jpc.15067)

We look forward to seeing how you can use or build on this research at your hospitals.