Incidence and risk factors for central venous access device failure in hospitalized adults: A multivariable analysis of 1892 catheters

Abstract

Background

Central venous access devices (CVADs) allow intravenous therapy, haemodynamic monitoring and blood sampling but many fail before therapy completion.

Objective

To quantify CVAD failure and complications; and identify risk factors.

Designs, Settings, and Participants

Secondary analysis of multicentre randomised controlled trial including patients aged ≥16 years with a non-tunnelled CVAD (NTCVAD), peripherally-inserted central catheter (PICC) or tunnelled CVAD (TCVAD). Primary outcome was incidence of all-cause CVAD failure (central line-associated bloodstream infection [CLABSI], occlusion, accidental dislodgement, catheter fracture, thrombosis, pain). Secondary outcomes were CLABSI, occlusion and dislodgement. Cox regression was used to report time-to-event associations.

Results

In 1892 CVADs, all-cause failure occurred in 10.2% of devices: 49 NTCVADs (6.1%); 100 PICCs (13.2%); 44 TCVADs (13.4%). Failure rates for CLABSI, occlusion and dislodgement were 5.3%, 1.8%, and 1.7%, respectively. Independent CLABSI predictors were blood product administration through PICCs (hazard ratio (HR) 2.62, 95% confidence interval (CI) 1.24–5.55); and in TCVADs, one or two lumens, compared with three to four (HR 3.36, 95%CI 1.68–6.71), intravenous chemotherapy (HR 2.96, 95%CI 1.31–6.68), and diabetes (HR 3.25, 95%CI 1.40–7.57). Independent factors protective for CLABSI include antimicrobial NTCVADs (HR 0.23, 95%CI 0.08–0.63) and lipids in TCVADs (HR 0.32, 95%CI 0.14–0.72). NTCVADs inserted at another hospital (HR 7.06, 95%CI 1.48–33.7) and baseline infection in patients with PICCs (HR 2.72, 95%CI 1.08–6.83) were predictors for dislodgement. No independent occlusion predictors were found. Modifiable risk factors were identified for CVAD failure, which occurred for 1-in-10 catheters. Strict infection prevention measures and improved CVAD securement could reduce CLABSI and dislodgement risk.