Substantial harm associated with failure of chronic paediatric central venous access devices.

Ullman AJ, Kleidon T, Cooke M, Rickard CM. Substantial harm associated with failure of chronic paediatric central venous access devices. BMJ Case Reports. 2017.

Central venous access devices (CVADs) are essential to modern paediatric healthcare, however device complications and failures remain high. This case study illustrates the complex and harmful experience of a young child with CVAD dependency and failure due to 'short gut syndrome' (significant bowel resection as a result of intestinal failure secondary to gastroschisis).

In the first 2½ years of her life the child experienced ten CVAD insertions, nine failed CVAD devices, and a CVAD-associated bloodstream infection caused by Klebsiella pneumonia. Such complications and device failures led to extended hospital stays, multiple anaesthetics, invasive procedures, injuries, vascular depletion, interrupted nutrition, delayed treatment and substantial healthcare costs. Most complications resulting in CVAD failure were related to mechanical causes, particularly dislodgement and fracture. This significant CVAD-replacement rate caused the child's central vasculature to develop significant thrombotic occlusion, limiting future CVAD placements.

With an estimated cost of over $10 000 AUD, the need for frequent insertion or rewiring of a tunnelled CVAD leads to significant international health service costs. Meanwhile, ongoing CVAD complications and failure is also associated with poorer quality of life for both the child and her family.

Despite the regularity with which CVADs are used with paediatric patients, CVAD maintenance procedures for this population are not well supported by the evidence. This results in potentially preventable complications, particularly during the later stages of CVAD dwell. This case study highlights the need to prevent CVAD-associated harm through the development of high-quality evidence to improve vascular access outcomes for paediatric patients.