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首页> 外文期刊>Journal of paediatrics and child health >Development of a paediatric central venous access device database: A retrospective cohort study of practice evolution and risk factors for device failure
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Development of a paediatric central venous access device database: A retrospective cohort study of practice evolution and risk factors for device failure

机译：儿科中央静脉接入装置的发展数据库：一种回顾性队列的实践演化和设备故障风险因素研究

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Aim To describe practice evolution, complications and risk factors for multiple insertion attempts and device failure in paediatric central venous access devices (CVADs). Methods A paediatric retrospective cohort study using prospectively collected data from CVAD database 2012–2014. Data included were patient (i.e. age, condition), insertion (i.e. indication, device, technique) and removal (complications, dwell). Descriptive statistics and incidence rates were calculated per calendar year and compared. Risk factors for multiple insertion attempts and failure were explored with logistic regression and cox regression, respectively. Results A total of 1308 CVADs were observed over 273?467 catheter‐days in 863 patients. Multiple insertion attempts remained static (14%) and significantly associated with non‐haematological oncology (odds ratio 2.19; 95% confidence interval (CI) 1.08–4.43), respiratory (3.71; 1.10–12.5), gastroenterology (4.18; 1.66–10.5) and other (difficult intravenous access) (2.74; 1.27–5.92). CVAD failure decreased from 35% (2012) to 25% (2014), incidence rate from 1.50 (95% CI 1.25–1.80) to 1.28 (1.06–1.54) per 1000 catheter‐days. Peripherally inserted CVAD failure was significantly associated with lower body weight (per kilogram decrease, hazard ratio (HR) 1.02; 95% CI 1.00–1.03), cephalic vein (1.62; 1.05–2.62), difficult access (1.92; 1.02–3.73), sub‐optimal tip placement (1.69; 1.06–2.69) and gastroenterology diagnosis (2.27; 1.05–4.90). Centrally placed CVAD failure was significantly associated with younger age (per year, HR 1.04; 95% CI 1.00–1.07), tunnelled device (3.38; 2.41–4.73) and gastroenterology diagnosis (1.70; 1.06–2.73). Conclusions While advancement in CVAD practices improved overall CVAD insertion and failure outcomes, further improvements and innovation are necessary to ensure improved vessel health and preservation for children requiring CVAD.
机译：旨在描述在儿科中央静脉接入装置（CVADS）中多插入尝试和设备故障的实践演化，并发症和危险因素。方法采用来自CVAD数据库2012-2014的预期收集数据的儿科回顾队列研究。包括的数据是患者（即年龄，条件），插入（即指示，设备，技术）和去除（并发症，停留）。每个日历年计算描述性统计和发病率。具有逻辑回归和COX回归的多种插入尝试和失败的危险因素。结果在863名患者中，在273岁以下的273℃下观察到1308个CVAD。多种插入尝试保持静态（14％），与非血液神经学肿瘤有显着相关（差距2.19; 95％置信区间（CI）1.08-4.43），呼吸（3.71; 1.10-12.5），胃肠病学（4.18; 1.66-10.5 ）和其他（静脉注射困难）（2.74; 1.27-5.92）。 CVAD故障从35％（2012）减少到25％（2014），发病率从1.50（95％CI 1.25-1.80）到1.28（1.06-1.54）每1000导尿管。外周插入的CVAD失效与较低的体重（每千克降低，危害比（HR）1.02; 95％CI 1.00-1.03），头部静脉（1.62; 1.05-2.62），难以接近（1.92; 1.02-3.73） ，次优先尖端放置（1.69; 1.06-2.69）和胃肠学诊断（2.27; 1.05-4.90）。集中放置的CVAD失败与年龄较小（每年，HR 1.04; 95％CI 1.00-1.07），隧道装置（3.38; 2.41-4.73）和胃肠学诊断（1.70; 1.06-2.73）。结论虽然CVAD实践的进步改善了整体CVAD插入和失效结果，但进一步的改进和创新是必要的，以确保改善需要CVAD的儿童的船舶健康和保存。

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