Impact of Changes in Catheter Management on Infectious Complications among Children with Central Venous Catheters

Objectives: To characterize and enumerate central venous catheter (CVC)-related complications among children with chronic illnesses, and to reduce the complication rate through changes in CVC management and education. Design: A prospective observational study followed by an educational program and a nonrandomized interventional trial. Setting: The Children's Hospital of Philadelphia, a tertiary, pediatric facility. Patients: 268 children with Broviac, Hickman, or Infusaport catheters in place during 58,290 catheter days. Interventions: Development and implementation of protocols for cleaning insertion site and hub, use of nonocclusive dressings, and manipulation of access; formal staff and parental education about protocols. Results: CVC-related infections fell from 4.58/1,000 catheter-days preintervention to 3.83 postintervention (risk ratio [RR], 0.20; 95% confidence interval [$CI_{95}$], 0.89-1.622; P=.25); exit-site infections fell from 0.58 to 0.11 ($CI_{95}$, 1.22-45.64; P=.02); rates among infants on the surgical service fell from 15.46 to 6.67 (RR, 2.31; $CI_{95}$, 1.10-4.30; P=.02). Conclusions: Education and changes in management protocols reduced the incidence of exit-site infections among all patients and reduced the overall infectious complication rate among the infants receiving parenteral nutrition on the surgical service. Other interventions are needed to decrease further the infectious complications in these children.