THERAPIES: THe Evaluation of practice & Risks from Adminstration of Pharmacotherapies into Intravascular devicES
CCCF ePoster library. Kissoon R. Oct 26, 2015; 117376; P44
Randolph Kissoon
Randolph Kissoon
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Abstract
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P44


Topic: Survey (quantitative or qualitative)


THERAPIES: THe Evaluation of practice & Risks from Adminstration of Pharmacotherapies into Intravascular devicES



Randolph Kissoon, P. Dekate, C. Parshuram

Centre for Safety Research, The Hospital for Sick Children, Toronto, Canada | Centre for Safety Research, The Hospital for Sick Children, Toronto, Canada | Centre for Safety Research, The Hospital for Sick Children, Toronto, Canada

Introduction: Vascular access devices (VAD) are used extensively for monitoring and the provision of therapy in critically-ill children. Experience suggests that multiple infusions are administered through a limited number of available lumens. This has the potential to increase the incidence of device malfunction and complication.

Objectives: To describe the utilization of VADs, as well as the frequency and nature of VAD malfunction and complication.

Methods: A prospective observational study of children in a quaternary ICU. The main outcomes were complications at VAD-level (thrombosis, infection, insertion-site, mal-placement) and lumen-level (partial and complete lumen occlusion, leakage).
Data was abstracted by daily review of vascular access devices; their insertion-site, the caliber and length of the catheter and the nature of associated infusions. Data on lumen function was collected through surveying bedside nurses. Results were reported descriptively.


Results:

369 patient observations were made, which translated into 404 central device observations (238 central venous lines, 159 peripherally inserted central catheters, 5 ports, 1 tunneled, 1 popliteal sheath). These devices had a total of 740 observed lumens through which 1767 infusions were administered.

Common observed VAD utilization included the provision of parenteral nutrition (lipids and TPN), which accounted for 21% of administered infusions; the provision of inotropic agents or other agents to support heart function, 27%; and the provision of sedation or pain management, 13%.
58 (8%) lumens were observed to be heparin locked and thus were not in use. It was also found that within a 4-hour window, one or more nurse interventions occurred in 494 (28%) of the administered infusions.

There were 90 (22%) observed occurrences of VAD-level complications: 7 infections, 3 device mal-placements, 13 insertion-site complications (bleeding 5, impaired local circulation 2, irritation 3, extravasation 3); Thrombosis occurred in 67 (17%) devices; 16% of the time for central venous lines and 18% for peripherally inserted central catheters.

Lumen-level complications occurred in 50 (7%) lumen observations; there were 33 (4%) partial occlusions, 4 (0.5%) complete occlusions, and 13 (2%) lumens with leakage.



Conclusion: Vascular access through central lines is common in critically ill children, and available lumens were actively used.
Complications to VAD affected 1 in 4-5 devices - mainly thrombosis, however complete loss of function of lumens was relatively uncommon.





References: NA
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