PHS Research Study: Central Lines in Children
Roy C. Maynard, M.D., is the Medical Director for PHS. He serves as PHS’s clinical leader, working with the team to provide consultation and advice to ensure quality and effective care to children and their families in their own homes. He also leads implementation of clinical policies, procedures and programs to further enhance the best possible care for each child. He is a Neonatologist and Pediatric Pulmonologist, and serves as a staff physician at Children’s Hospitals and Clinics in Minneapolis, Minn.
Therapy at Home for Infusion Needs
Long-term intravenous access is often needed to manage pediatric patients with chronic diseases. Cystic fibrosis patients will often require multiple courses of intravenous (IV) antibiotics to treat worsening symptoms of their underlying lung disease. Children with short gut syndrome may require years of parenteral nutrition or IV hydration for nutritional support. Gamma globulin infusions may improve the health of patients with selected immunodeficiency or autoimmune disorders. Infectious diseases such as osteomyelitis may require weeks of IV antibiotics to be curative. The common denominator for these patients is home IV therapy through central lines.
Tracking CLABSIs for Safety
Central lines include peripherally inserted central venous lines (PICCs), Port-a-Cath®, Broviac and Hickman lines. Consistent monitoring is needed to help identify potential risk factors for infections and complications associated with central venous lines. The majority of studies published to date involving pediatric patients focused on inpatients or on outpatients with PICCs.
Pediatric Home Service has been tracking the incidence of central line associated bloodstream infections (CLABSIs) in referred outpatients and has demonstrated a consistently low incidence of these infections. However, very little is known about the incidence of complications associated with central lines in pediatric outpatients and the success or failure rate of interventions. A specific example would be documentation on the incidence of line occlusion and the success of altepase (Cathflo®) to restore line function.
Clinical Study to Answer Questions
Starting September 1, PHS infusion nurses will embark on an observational prospective clinical study to answer some of these questions. An Institutional Review Board approved study will be initiated tracking complications such as CLABSI’s, line occlusion, thrombophlebitis, leaks, wound dressing issues, and the success or failure of interventions to treat these complications. Patients referred to PHS for infusion services and who give informed consent will be followed for the duration their line is present during the 48 month long study period. PHS hopes that information learned from this study may help with further efforts to prevent and treat complications of central lines while taking care of the child.Originally published: July 25, 2014