title: Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care.
abstract: OBJECTIVE
  To identify the prevalence, management and complications associated with central venous access devices (CVADs) within Australian paediatric facilities, providing a map for clinicians, researchers and managers to focus solutions.
  
  
  METHODS
  A point prevalence audit and survey of CVAD practices in Australian tertiary paediatric hospitals between September and November 2015, using validated data collection tools.
  
  
  RESULTS
  Across the six sites, 1027 patients were screened with CVADs prevalent in 26.1% (n = 268), and 261 CVADs in 248 patients available for audit. Variations in management were evident with dressings not meeting the basic criteria of clean, dry and intact for 13.5% of CVADs (n = 35), and non-sterile dressings used to reinforce 26.4% of CVADs (n = 69). Almost half of CVADs (49.4%; n = 132) had no documentation regarding site assessment in the previous 4 h, and 13.4% had no planned use in the next 24 h (35 CVAD). CVAD-associated complications within the previous 7 days were evident in 9.5% of CVADs (n = 27), most commonly catheter blockage (5.7% CVAD, n = 15), and bloodstream infection (1.9% CVAD, n = 5). Peripherally inserted central catheters (16.9%) in comparison to other catheter types (7.4%; P = 0.04), and subsequent CVADs (14.1%) in comparison to initial CVADs (6.5%; P = 0.04), had significantly higher proportions of CVAD-associated complications in the previous 7 days. Variation between the sites' guidelines was evident across many practices.
  
  
  CONCLUSIONS
  CVADs are prevalent and essential for paediatric health care; however, complications remain a significant problem. Areas identified for improvement were local CVAD guidelines, regular documentation of CVAD site assessment and review of dressing products to improve integrity.
authors.affiliation: School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.|NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.|Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.
authors.forename: Amanda J
authors.identifier: http://orcid.org/0000-0001-8860-5319
authors.initials: AJ
authors.lastname: Ullman
authors.affiliation: School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.|NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.|Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Cooke
authors.affiliation: NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.|Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.|Children's Health Queensland, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
authors.forename: Tricia
authors.initials: T
authors.lastname: Kleidon
authors.affiliation: School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.|NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.|Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Rickard
mesh_terms: D001315:Australia; D002406:Catheterization, Peripheral; D062905:Central Venous Catheters / Q000009:adverse effects / Q000592:standards*; D003422:Critical Care; D019317:Evidence-Based Medicine; D006776:Hospitals, Pediatric; D006801:Humans; D008485:Medical Audit; D015995:Prevalence; D058996:Quality Improvement
keywords: audit; central venous catheter; evidence-based care; paediatrics; quality care; survey