CVAD Complications in Haematology Patients: A Call for Evidence-Based Practice

Reliable central venous access is critical for patients with haematological malignancies undergoing intensive treatment. However, the risk of complications and premature catheter removal remains high in this population. This multi-site cohort study aimed to evaluate the performance and complication rates of central venous access devices (CVADs) across four major hospitals in Melbourne, Australia.

Study Overview
The study included 1,078 CVADs inserted in 673 adult patients between September 2020 and August 2021. CVAD types included PICCs, tunnelled central lines, and implantable ports. Researchers assessed complications during dwell time and analyzed risk factors associated with premature device removal, defined as removal before the end of therapy or planned discontinuation.

Key Findings

• 85% of CVADs (n = 919) had at least one documented complication.
• 42% of all CVADs were removed prematurely, mainly due to:

1. Infection-related causes (57%)
2. Non-infectious issues such as occlusion, dressing problems, or migration (54%)

• Multivariable Cox regression identified higher risk of premature removal for:

1. Short-term devices (e.g., CICCs and FICCs)
2. Urgent procedures
3. Concurrent CVADs in the same patient
4. Use of X-ray (vs. fluoroscopy) for tip confirmation

• Clinical variation in practice was widespread, including inconsistent documentation, suboptimal tip positioning, and lack of standard securement materials.

Conclusion
This study highlights the unacceptably high complication and premature removal rates among patients with blood cancers. Variation in clinical practice, combined with outdated or inconsistent techniques, contributes to poor CVAD outcomes. The authors advocate for evidence-informed, standardised approaches across the CVAD lifecycle—selection, insertion, care, and removal—to reduce preventable complications and support value-based care.

Read more:https://onlinelibrary.wiley.com/doi/10.1002/jha2.1090 

Authors: Kerrie Curtis, Samantha Keogh, Meinir Krishnasamy, Karla Gough