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BMJ Case Reports 2017; doi:10.1136/bcr-2016-218757
  • Reminder of important clinical lesson
  • CASE REPORT

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

  1. Claire M Rickard1,3
  1. 1 School of Nursing and Midwifery, Griffith University, Nathan, Australia
  2. 2 Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, Brisbane, Australia
  3. 3 Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia
  4. 4 Department of Anaesthetics, Lady Cilento Children's Hospital, Brisbane, Australia
  1. Correspondence to Dr Amanda J Ullman, a.ullman{at}griffith.edu.au
  • Accepted 9 June 2017
  • Published 6 July 2017

Summary

Central venous access devices (CVADs) form an important component of modern paediatric healthcare, especially for children with chronic health conditions such as cancer or gastrointestinal disorders. However device failure and complications rates are high.

Over 2½ years, a child requiring parenteral nutrition and associated vascular access dependency due to ‘short gut syndrome’ (intestinal failure secondary to gastroschisis and resultant significant bowel resection) had ten CVADs inserted, with ninesubsequently failing. This resulted in multiple anaesthetics, invasive procedures, injuries, vascular depletion, interrupted nutrition, delayed treatment and substantial healthcare costs. A conservative estimate of the institutional costs for each insertion, or rewiring, of her tunnelled CVAD was $A10 253 (2016 Australian dollars).

These complications and device failures had significant negative impact on the child and her family. Considering the commonality of conditions requiring prolonged vascular access, these failures also have a significant impact on international health service costs.

Footnotes

  • Contributors All authors have made substantial contributions to the paper and are in agreement with the content. AJU and TK analysed and interpreted the patient data regarding the underlying vascular progression. AJU was the major contributor in writing the manuscript. MC and CRM contributed to the conceptual design and manuscript preparation. All authors read and approved the final manuscript.

  • Competing interests Griffith University has received unrestricted investigator initiated research grants to support research projects undertaken by AJU from product manufacturers (3M, Adhezion, Angiodynamics, B. Braun, Centurion Medical Products). Griffith University has received consultancy payments on AJU’s behalf from manufacturers (3M, BD). Griffith University has received unrestricted investigator initiated research and education grants to support projects undertaken by TK from product manufacturers (3M, Adhezion, Angiodynamics, Baxter, Centurion Medical Products). Griffith University has received consultancy payments on TK’s behalf from manufacturers (BD and Angiodynamics). Griffith University has received unrestricted investigator initiated research or educational grants on CRM’s behalf from product manufacturers (3M, Adhezion, Angiodynamics; B. Braun, Becton Dickinson; Carefusion; Centurion Medical Products; Entrotech, Smiths Medical, Teleflex). Griffith University has received consultancy payments on CRM’s behalf from manufacturers (3M, B. Braun, BD, ResQDevices, Smiths Medical). Griffith University has received an unrestricted investigator initiated research or educational grant on MC’s behalf from manufacturers (Baxter, BD).

  • Patient consent Obtained from Guardian.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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