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"This allows the development of a robust tailored care plan, which prolongs the life of a CVAD and in turn preserves venous access" Cole et al (2021).

Extending lifespan of central venous access devices

Abstract:

Aim: To use a web based management platform to prevent occlusions and preserve the lifespan of a central venous access devices (CVAD) for Home Parenteral Nutrition (HPN).

Background: Despite many techniques, adjuncts and pharmaceutical agents there are some CVADs that remain troublesome with frequent partial and full occlusions that require CVAD exchanges. The CVAD for a child or young person that requires HPN can be described as a “lifeline” and all options to maintain long term patency should be utilised. MicrelCare have a web based care management platform that monitors real time infusion pressures relaying information from the home to the hospital.

Methodology: Using one teenage male on HPN (who had experienced 3 CVAD exchanges in 2 years) as a candidate for MicrelCare, we virtually monitored his CVAD pressure’s and infusion alarms via a real time platform. This virtual platform alongside clinical correlation (patient consultations and physical assessment) allowed for the determination of pressure range monitoring and the early detection of line stiffness and pre cursors to occlusion.

Results: We were able to determine that for this patient when the CVAD pressure levels reached 0.2 bar it was imperative that we physically assessed the CVAD and followed the in house protocol of Urokinase/Alteplase instilment followed by an Ethanol treatment if required (including hub inspection and POP technique) to prevent irreversible occlusion.

Interestingly the pressure bar for this young man is lower than MicrelCare would expect and that of our patient cohort.

Conclusion: MicrelCare can be a useful tool to virtually monitor and predict precursors to CVAD stiffness and occlusion when used with clinical correlation.This allows the development of a robust tailored care plan, which prolongs the life of a CVAD and in turn preserves venous access.

Reference:

Cole A, Naik S, Patel M, Shah J, Mcconnell R O-21: Using Virtual Technology to Preserve the Lifespan of Central Venous Access Devices. Transplantation. 2021 Jul 1;105(7S):S11. doi: 10.1097/01.tp.0000757552.66011.4d. PMID: 34792952.