Abstract
BACKGROUND: Patients with haematological malignancies require urgent and reliable venous access for the administration of systemic anticancer therapies (SACTs) commonly via central venous access devices (CVADs). Disease pathophysiology and side effects of SACTs increase the risk of complications during the dwell time and premature removal. CVAD complications are associated with treatment disruption, increased morbidity and mortality. This study aimed to comprehensively describe CVAD performance over a 12-month period in patients with haematological malignancies. METHODS: A multi-site cohort study at four tertiary hospitals in Melbourne, Australia was undertaken using multidisciplinary data from patient health records and administrative datasets including patient, device, insertion, maintenance, complication and removal data. Cases of interest were CVADs, ascertained using lists provided by the insertion services. FINDINGS: A total of 1078 CVADs were inserted in 673 patients between 1 September 2020 and 31 August 2021. Of the 1078 CVADs, 197 (18%) remained in situ, and 881 (82%) were removed, of which 369 (42%) were removed prematurely due to infection (n = 208, 57%) and non-infection related reasons (n = 201, 54%). Most CVADs (n = 919, 85%) had documented complications during their dwell time and the proportion of premature removals in these CVADs was over two-fold higher than CVADs with no documented complications. Multivariable Cox regression results indicated that CVAD type, urgency of the procedure, concurrent CVADs and insertion technology were associated with an increased risk of premature removal. Clinical variations in insertion and management care throughout the life of a CVAD and current evidence were identified. CONCLUSION: An unacceptably high proportion of CVADs had complications documented during the dwell time and were prematurely removed. Inconsistencies in current evidence and clinical practice highlight opportunities to positively impact CVAD outcomes in this cohort. TRIAL REGISTRATION: The authors have confirmed clinical trial registration is not needed for this submission.