Prevention of occlusion of central lines for children with cancer: The poetic project

Abstract

Introduction: Central venous access devices (CVAD) are vital medical devices to support the treatment of pediatric cancer, however device occlusion is common, which disrupts treatment. The aim of this study was to improve the identification and management of CVAD occlusions in children with cancer, as well as to identify the demographic and clinical risk factors and device characteristics associated with increased risk for CVAD occlusion. Methods: A pre-post-implementation study was conducted at a metropolitan pediatric oncology facility in Australia, using the Theoretical Domains Framework. Patients with a CVAD for anti-cancer therapy were prospectively followed for occlusive events pre-and post-the implementation of clinical resources, to support the identification and management of CVAD occlusive events. The study interventions were developed and implemented in partnership with key interdisciplinary stakeholders (see Figure 1 and 2). CVAD occlusion and management data were collected and compared pre-and post-implementation. Risk factors for CVAD occlusion were described by mixed-effects poisson regression, and incident rate ratios (IRR). Results: A total of 133 CVADs were inserted into 131 patients for a total of 6,784 catheter days. The incidence of CVAD-related occlusion preimplementation was 59.7 (95% CI 51.4-69.0, per 1,000 catheter days); compared to 31.6 [95% CI 26.4-37.6]; p < 0.01) post-implementation of clinical resources. In multivariate models, other than post-implementation phases (IRR 0.51 [95% CI 0.32-0.81]), only neutropenia significantly increased the risk of CVAD occlusion (IRR 2.14 [95% CI 1.15-3.97]). Conclusion: CVAD occlusions in pediatric oncology are common. This study demonstrates implementation of a co-developed clinical resource can have a significant positive effect on clinical practice (appropriate occlusion management strategies) and associated patient outcomes (decreased CVAD occlusion incidence). Further studies to innovate and improve practice in this area are warranted and should focus on improving the quality of evidence to prevent and manage CVAD occlusion.L6341219222021-02-15 <br />