Aim
The Cancer Institute NSW Central Venous Access Devices (CVADs) deaccess clinical procedure resource suggests locking lines with sodium chloride 0.9%, a deviation from prior standard procedure of the Western Cancer Centre Dubbo (WCCD) to use heparinised saline 50U/5mL. The aim of this quality improvement project was to investigate complication rates of CVADs during this change in practice.
Methods
All patients attending the infusion suite at the WCCD network in a six week period immediately following the change in procedure in April 2022 were identified. All patients with a CVAD at any time within six months were included. Complications, defined as poor blood return or flow through the CVAD necessitating radiological investigation, were identified by reviewing medical records. Fisher's exact test was performed to compare the incidence of complications in the six months before the change in procedure to six months after.
Results
In the six months prior to and following the change in procedure, 287 individual patients attended the WCCD network for infusions. Of these, 112 patients had at some stage had at least one CVAD device (39% of all patients). 134 devices were used through the 12 month study period. Seven out of 90 devices (7.8%) deaccessed using heparinised saline developed a complication, compared to 15 out of 134 devices (11.2%) deaccessed using sodium chloride 0.9%. This difference was not statistically significant (p=0.495, Fishers Exact test).
Conclusions
The complication rates of CVADs at the WCCD are comparable to those in published data. No significantly statistically significant difference in rates of complications of CVADs were found when changing the procedure, however there was a trend to more imaging of CVADs. Standardising the criteria for pursuing imaging within the region as well as a prospective trial comparing the two procedures are planned.