Central venous access device management for children undergoing treatment for blood disorders and cancer: a descriptive international cross-sectional survey

Abstract

PURPOSE: This study aimed to explore current central vascular access device (CVAD) management practices in pediatric cancer care globally and compare practices across high-income and middle-income (i.e., upper middle-income and lower middle-income) countries. METHODS: A descriptive cross-sectional international survey was conducted between May 2022 and December 2023. Clinicians involved in CVAD insertion/management for pediatric cancer patients were invited to participate through established clinical networks globally. The survey covered CVAD management practices, including dressings, securements, routine care, and maintenance procedures. RESULTS: A total of 220 responses from 42 countries were received. Polyurethane dressings were most commonly used across all CVAD types (55-65/34.2-40.4). Bordered dressings were the primary securement method for all CVAD types (69-96/161, 42.9-59.6%). Routine practices varied, with 31/102 (30.4%) assessing CVADs hourly during infusion in high-income countries and 22 (37.3%) assessing every shift in middle-income countries. Heparin and normal saline were the commonly used solutions for flushing and locking. Chlorhexidine 2% in 70% alcohol was the predominant decontamination solution in high-income countries (64/102, 62.8%), while alcohol was more common in middle-income countries (22/59, 37.3%). Differences were observed between high-income and middle-income countries in the types of dressings, securements, and maintenance practices used. CONCLUSION: This study revealed significant variability in CVAD management practices for pediatric cancer care globally, particularly between high-income and middle-income countries. These findings highlight the need for standardized, evidence-based guidelines considering resource availability and contextual factors to improve CVAD management in pediatric oncology across diverse healthcare settings.