Dr Kerrie Curtis1, Associate Professor Karla Gough2, Professor Samantha Keogh3, Professor Meinir Krishnasamy1
1University Of Melbourne, Melbourne, Australia, 2Peter MacCallum Cancer Centre, Melbourne, Australia, 3Queensland University of Technology, Brisbane, Australia
Biography:
Dr Kerrie Curtis is a nationally and internationally recognised expert cancer nurse specialising in vascular access. Kerrie is Chair, Cancer Nurses Society of Australia vascular access committee leading national projects including CNSA Vascular Access Devices: Evidence-Based Clinical Practice Guidelines and is lead author of the eviQ suite of CVAD resources.
Abstract:
Background
Central venous access devices (CVADs) are essential for the administration of systemic anticancer therapies (SACTs) and supportive care for patients with haematological malignancies. Disease pathophysiology and side effects of SACTS increase the risk of complications and premature removal, and subsequent treatment disruption, increased morbidity, and mortality. This study aimed to comprehensively describe documented CVAD performance over a 12-month period in patients with haematological cancers.
Method
A multi-site cohort study was undertaken in four tertiary hospitals in Melbourne, Australia. Data were accessed from multidisciplinary documentation and platforms in patient health records, and administrative datasets. Data were analysed descriptively for the full sample and per device type. Cox regression analysis was used to identify baseline factors associated with premature removal of the first CVAD in the study period.
Results
A total of 1078 CVADs were inserted in 673 patients between 1 September 2020 to 31 August 2021. Of the 881 (82%) removed, 369 (42%) were removed prematurely due to infection related (n=208, 57%) and non-infection related reasons (n=201, 54%). Most CVADs (n=919, 85%) had documented complications during their dwell time. Multivariable Cox regression results indicated four factors were associated with an increased risk of premature removal. Clinical variation in multidisciplinary management and current evidence was identified.
Conclusion
An unacceptably high proportion of CVADs in patients with haematological malignancies had complications documented during the dwell time and were prematurely removed. Inconsistency between current evidence and clinical practice highlights considerable opportunity to positively impact CVAD outcomes in this cohort.