Objective
Formulation of a clinical practice guideline (CPG) for the use of thromboprophylaxis (TP) in pediatric patients with a central venous catheter (CVC).
Participants
The development team consisted of five experts and a doctoral candidate acting as the primary author.
Evidence
The guideline was developed utilizing the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework. A systematic review of the evidence was performed and evidence was graded using the American Academy of Pediatrics (2004) evidence classifications for CPG recommendations. An appraisal team evaluated the guideline quality utilizing the AGREE Plus platform rating the guideline as “highest quality.”
Consensus
Employing a modified Delphi methodology, members of the development team reviewed available evidence and voted on proposed Key Action Statements (KAS). Consensus is defined as 80% rating the KAS “usually appropriate.”
Conclusion
Five KAS are included in the final CPG. Each KAS indicates level of evidence, benefit-harm relationship, and level of recommendation.
KAS 1. Providers of hospitalized children (0-18 years of age) may assess for VTE risk factors using the Skrocki VTE risk stratification tool if the patient has a CVC. (Evidence Quality:C, Rec. Strength: Option).
KAS 2. Providers of hospitalized children should initiate targeted pharmacologic thromboprophylaxis (tpTP) at the time of CVC insertion or hospital admission (if CVC present on admission). (Evidence Quality: B, Rec. Strength: Strong Recommendation)
KAS 3. Providers of hospitalized children with a CVC should implement mechanical thromboprophylaxis (mTP) if the child is immobile (Braden Q score <2) or moderate/ high risk for VTE using the Skrocki VTE risk stratification tool and have no contraindications to mTP. (Evidence Quality: B, Rec. Strength: Recommendation).
KAS 4. Providers of hospitalized children with a CVC may prescribe systemic pharmacologic thromboprophylaxis (spTP) if the patient is found to be at high risk for VTE using Skrocki VTE risk stratification tool and the patient has no contraindications to spTP. (Evidence Quality: C, Rec. Strength: Option).
KAS 5. Providers of hospitalized children should avoid femoral CVCs, multilumen CVCs and/or percutaneous insertion technique if their benefit does not clearly outweigh their risks. (Evidence Quality: B, Rec. Strength: Recommendation).
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/626319 |
| Date | January 2017 |
| Creators | Skrocki, Emily Therese, Skrocki, Emily Therese |
| Contributors | Peek, Gloanna, Peek, Gloanna, Pacheco, Christy, Bagley, Leslie |
| Publisher | The University of Arizona. |
| Source Sets | University of Arizona |
| Language | en_US |
| Detected Language | English |
| Type | text, Electronic Dissertation |
| Rights | Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. |
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