title: Complications of Central Venous Access Devices: A Systematic Review.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics.
  
  
  METHODS
  Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015.
  
  
  METHODS
  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.
  
  
  METHODS
  Data were independently extracted and critiqued for quality by 2 authors.
  
  
  RESULTS
  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]).
  
  
  CONCLUSIONS
  The inclusion of nonrandomized and noncomparator studies may have affected the robustness of the research.
  
  
  CONCLUSIONS
  CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.
authors.affiliation: 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 a.ullman@griffith.edu.au.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ullman
authors.affiliation: 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.
authors.forename: Nicole
authors.initials: N
authors.lastname: Marsh
authors.affiliation: Alliance for Vascular Access Teaching and Research Group, and School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute, Queensland, Australia; and.
authors.forename: Gabor
authors.initials: G
authors.lastname: Mihala
authors.affiliation: 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.
authors.forename: Marie
authors.initials: M
authors.lastname: Cooke
authors.affiliation: 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.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Rickard
mesh_terms: D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans