6068 Delayed short term central venous access in children: a costly waiting game

Objectives Percutaneous intravascular central catheter (PICC) is the preferred means of access in children for >15 day courses of antibiotics, or who have undergone at least two unsuccessful peripheral cannula attempts.¹ Almost all children require a general anaesthetic (GA), which relies on theatre access and time apportionment by the inserting team. Currently, there is no agreed pathway to access this service or agreed timeframe. This study's objective is to assess the impact of delayed PICC insertion on patients and service, and identify barriers to accessing timely insertion. Methods Individual electronic medical record review of all paediatric patients who had a PICC line request/insertion requiring GA over a 12 month period in a large tertiary hospital. The impact of delay is assessed by quantifying the number of children requiring repeated cannulation, delayed discharge, unplanned treatment (either IM/oral antibiotic changes or intravenous fluids instead of parental nutrition etc.), being kept nil by mouth (NBM), or requiring additional GA. Results 83 patients (excluding oncology) over a 12 month period were identified with a mean age of 4.34 years. Split across 9 specialities: orthopaedics, general surgery, neurosurgery, respiratory, neonatal, gastroenterology, neurology, haematology and ophthalmology. These specialities were grouped as surgical or medical, with 60.24% and 39.76% respectively. The mean delay from decision to insertion was 3.48 days overall, with large disparity between surgical and medical subspecialties (1.6 days to 6.4 days respectively). Overall, 68.7% of PICCs were inserted within 48 hours of decision. The longest delay was 42 days. 15.7% had unplanned treatment, 15.7% required repeated cannulation, 12% were kept NBM unnecessarily, 3.6% required an additional GA and 7.2% delayed discharge with an additional 27 days in hospital collectively. Conclusion The impact of delays is twofold, patient related and impacting on the organisation. Most delays are due to reliance on emergency theatre slots therefore provision of GA access of alternative facilities for sedation for children are most likely to help resolve this issue. Another unexpected source of delay is in the inconsistencies in requesting line insertion. A guideline outlining the process of requesting and obtaining a PICC needs to be agreed with all parties involved and published, with an aim of having all lines inserted within 48 hours. This will eliminate confusion and consequently reduce the delay in requesting and aims to give each child equal opportunity for PICC insertion. Reference Amanda J. Ullman, et al. The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC, 2020.