Dr Amanda Corley1,2,3, Professor Nicole Marsh1,2,3, Ms Emily Larsen1,2,3, Ms Ruth Cocksedge4, Professor Claire Rickard1,2,3
1AVATAR Group & School of Nursing and Midwifery, Griffith University, Nathan, Brisbane, Australia
2Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Herston, Brisbane, Australia
3School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, Australia
4Centre for Applied Economics, School of Medicine, Griffith University , Nathan, Brisbane, Australia
Introduction: Central venous access devices (CVAD) are a vital medical device but develop infectious complications necessitating premature removal. We examined risk factors for central line-associated blood stream infection (CLABSI) in patients ≥16 years to determine modifiable practices amenable to change.
Methods: In this secondary analysis of data from a 10-site randomised controlled trial, central line-associated blood stream infection (CLABSI), occlusion and dislodgement were examined using Cox proportional hazards regression models informed by Bayesian information criteria.
Results: 1892 CVADs were included in the multivariable analysis: 806 non-tunnelled CVADs (reference), 757 peripherally-inserted central catheters (PICCs) and 329 tunnelled CVADs. CLABSI was highest in tunnelled CVADs (n=39, 11.9%), compared with 5.3% for PICCs (n=40) and 2.6% for non-tunnelled CVADs (n=21). Factors associated with increased CLABSI for tunnelled and non-tunnelled CVADs was having only 1-2 lumens (Hazard Ratio [HR] 29.94, p<0.001; and HR 8.20, p=0.045, respectively). Multiple attempts/difficult insertions were also significantly associated with CLABSI in tunnelled CVADs (HR 6.26, p=0.013), and administration of blood products in PICCs (HR 1.70, p=0.04). Factors associated with lower rates of CLABSI were the use of an antimicrobial catheter and chlorhexidine gluconate dressing in non-tunnelled CVADs (HR 0.23, p=0.004; and HR 0.41, p=0.05, respectively).
Conclusions: Modifiable risk factors for CVAD complications have been identified, particularly observing strict infection prevention protocols when accessing heavily-used catheters with fewer lumens, and ensuring that tunnelled CVADs are inserted by experienced clinicians to limit multiple attempts. These findings can inform practice change to reduce the incidence of preventable CLABSI and improve patient outcomes.
Biography: Amanda Corley, RN, PhD, is an experienced intensive care nurse with 25 years’ experience and specialties in cardiac surgical and respiratory critical care. Amanda has particular expertise and interest in the management and care of vascular access devices, particularly ECMO (Extra Corporeal Membrane Oxygenation) cannula. She is a Research Fellow with the School of Nursing and Midwifery and Menzies Health Institute QLD at Griffith University.