Ms Mari Takashima1, Ms Jessica Schults2, Mr Gabor Mihala1, Ms Amanda Corley2, Ms Amanda Ullman1
1Griffith University, Nathan, Australia
2Queensland Health, Australia
Introduction:Central venous access devices (CVADs) are a vital medical device during critical care admission. Despite CVAD commonality in the ICU, serious patient harm, relating to insertion and management, remains prevalent. However, there is no such synthesis of CVAD data in ICU. The primary aim of this systematic review was to determine the proportion and rate of CVAD failure and complications in adult ICU.
Methods:A systematic search was undertaken in four electronic databases in September 2017. Included studies were of observational or interventional design and reported CVAD failure and complications in adult ICU settings. Data were extracted on the primary outcome, CVAD failure, and secondary outcomes: CVAD complications (central line associated bloodstream infection [CLABSI], catheter related bloodstream infection [CRBSI], catheter related thrombosis, occlusion, catheter removal due to suspected infection, dislodgement, breakage, and local infection).
Results:A total of 63 studies involving 50,000 CVADs (396,951 catheter days) were included. CVAD failure was 5% (95% CI 3-6%), with the highest rates and proportion of failure in hemodialysis catheters. Overall CLABSI rate was 4.59 per 1,000 catheter days (95% CI 2.31-6.86), with the highest rate in non-tunneled CVADs. Removal of CVAD due to suspected infection was high (17%; 20.4 per 1,000 catheter days; 95% CI 15.7-25.2).
Conclusion:CVAD complications and device failure is a prevalent and significant problem in the adult ICU. The high proportion of CVADs removed due to suspicion of infection, despite low overall CLABSI and CRBSI rates, indicates a need for robust practice guidelines for removal of CVADs suspected of infection.
Mari Takashima is a senior research assistant for Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University. She has a Master degree in Clinical Epidemiology.