School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Queensland, Australia.
Pediatrics. 2015 Nov;136(5):e1331-44. doi: 10.1542/peds.2015-1507. Epub 2015 Oct 12.
The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources.
To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics.
Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015.
Included studies were of cohort design and examined the incidence of CVAD failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure was defined as CVAD loss of function before the completion of necessary treatment, and complications were defined as CVAD-associated bloodstream infection, CVAD local infection, dislodgement, occlusion, thrombosis, and breakage.
Data were independently extracted and critiqued for quality by 2 authors.
Seventy-four cohort studies met the inclusion criteria, with mixed quality of reporting and methods. Overall, 25% of CVADs failed before completion of therapy (95% confidence interval [CI] 20.9%-29.2%) at a rate of 1.97 per 1000 catheter days (95% CI 1.71-2.23). The failure per CVAD device was highest proportionally in hemodialysis catheters (46.4% [95% CI 29.6%-63.6%]) and per 1000 catheter days in umbilical catheters (28.6 per 1000 catheter days [95% CI 17.4-39.8]). Totally implanted devices had the lowest rate of failure per 1000 catheter days (0.15 [95% CI 0.09-0.20]).
The inclusion of nonrandomized and noncomparator studies may have affected the robustness of the research.
CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.
中心静脉置管（CVAD）的故障和并发症会导致患者的医疗中断、发病和死亡。新的 CVAD 的插入会进一步增加风险并消耗额外的资源。
系统回顾现有的儿科 CVAD 类型的 CVAD 故障和并发症发生率的证据。
系统检索了对照试验中央登记册、PubMed 和 Cumulative Index to Nursing and Allied Health 数据库，检索时间截至 2015 年 1 月。
纳入的研究为队列设计，在过去 10 年中检查了儿科 CVAD 类型的 CVAD 故障和并发症的发生率。CVAD 故障定义为在完成必要治疗之前 CVAD 失去功能，并发症定义为 CVAD 相关血流感染、CVAD 局部感染、移位、闭塞、血栓形成和断裂。
由 2 名作者独立提取和评估数据质量。
74 项队列研究符合纳入标准，但报告和方法的质量参差不齐。总体而言，25%的 CVAD 在完成治疗前失败（95%置信区间[CI]20.9%-29.2%），每 1000 个导管日的失败率为 1.97（95%CI1.71-2.23）。血液透析导管的 CVAD 设备失败比例最高（46.4%[95%CI29.6%-63.6%]），每 1000 个导管日的失败率最高（每 1000 个导管日 28.6 个[95%CI17.4-39.8]）。完全植入式装置的每 1000 个导管日的失败率最低（0.15[95%CI0.09-0.20]）。
纳入的非随机和非对照研究可能影响研究的稳健性。
儿科 CVAD 故障和并发症对国际医疗保健系统构成了重大负担。
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