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Pediatric Surgery International

Published in:

01-01-2021 | Original Article

Unexpected tunnelled central venous access demise: a single institutional study from the UK

Authors: Georgina Bough, Nicholas J. Lambert, Florin Djendov, Claire Jackson

Published in: Pediatric Surgery International | Issue 1/2021

Abstract

Purpose

To explore the factors involved in the demise of tunnelled central vascular access devices (CVADs) in children and describe patterns of failure.

Methods

A retrospective study including children under 16 years of age undergoing CVAD insertion in a tertiary centre between October 2014 and December 2019. The Kaplan–Meier estimator was used to study CVAD survival and piecewise exponential curves to approximate hazard rates. Related factors were analysed using multivariable regression.

Results

Totally, 684 CVADs were inserted in 499 children. Devices were in situ for 213,821 days (median 244.5). Of those, 261 CVADs (38.2%) failed prematurely; 176 (67%) required replacement.

Tunnelled external lines (TELs) failed more frequently than totally implantable devices (p < 0.005).TEL displacement occurred in two high-risk phases, falling to baseline after 90 days.

Low age at device insertion and open placement were strongly associated with an increased failure rate. Previous CVAD failure did not increase subsequent failure rate.

Premature failure increased procedural cost by £153,949 per year.

Conclusions

TIDs should be placed in preference to TELs where appropriate. TELs are at highest risk of displacement for 90 days and must be well secured for this duration. Meticulous line care offers significant potential cost savings by reducing line replacements.

Level of evidence

Level III.

Available only for authorised users

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Title: Unexpected tunnelled central venous access demise: a single institutional study from the UK
Authors: Georgina Bough
Nicholas J. Lambert
Florin Djendov
Claire Jackson
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 1/2021
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-020-04771-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Unexpected tunnelled central venous access demise: a single institutional study from the UK

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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