Hospital-wide survey of the use of central venous catheters

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Summary

There are few data on indications for central venous catheter (CVC) use. We conducted an observational, hospital-wide prospective cohort study to quantify the indications for catheter placement over dwell time and to investigate agreement between healthcare workers (HCWs) on CVC use. Catheter use was observed by on-site visits, HCW interviews, and screening of patient charts. A total of 378 CVCs were inserted in 292 patients, accounting for 2704 catheter-days. Of these, 93% CVCs were multilumen catheters and 70% were placed in the intensive care unit (ICU). Median dwell time (interquartile range) was 5 (2–9) days overall, and 4 (2–7) and 8 (3–15) in the ICU and non-ICU settings, respectively. The mean number of specified indications for CVC use per day was 1.7 (1.9 for ICU and 1.5 for non-ICU; P < 0.001). The most frequent reason (49%) for catheter use was prolonged (>7 days) antibiotic therapy followed by parenteral nutrition (22.3%). A total of 130 catheter-days (4.8%) were unnecessary with a higher proportion in non-ICU settings (6.6%). In 94% of cases, there was agreement among HCWs on indications for CVC use. However, 35 on-site visits (8.3%) in non-ICU settings revealed that neither the nurse nor the treating physician knew why the catheter was in place. ICU catheters have a short dwell time but are utilised more often, whereas catheters in non-ICU settings show a reverse characteristic. Prevention measures targeting catheter care are more likely to be successful in non-ICU settings.

Introduction

Central venous catheters (CVCs) are indispensable medical devices in acute patient care. Their utilisation is high in the intensive care unit (ICU) and lower in the non-ICU setting. However, the overall frequency with which CVCs are used in non-ICU settings is higher than generally accepted and the incidence rates of central line-associated bloodstream infections (CLABSIs) may be similar to the ICU.1, 2, 3, 4 Most data on indications for CVC use originate from the ICU and most interventions for CLABSI reduction were conducted in this setting only.5, 6, 7, 8, 9, 10 By contrast, few data are available on indications for CVC use in non-ICU settings.11, 12 Detailed knowledge on indications for CVC use over time is a necessary step to implement effective quality improvement programmes. In particular, it is important to identify the proportion of unnecessary catheter use as dwell time is associated with CLABSI and CVC-related thrombosis.13, 14

The objectives of this prospective, hospital-wide, observational study were to quantify the indications for CVC use over time, detect differences in CVC use in ICU and non-ICU settings, and investigate agreement on CVC use between healthcare workers (HCWs).

Section snippets

Setting

We conducted an observational, prospective, cohort study at the University of Geneva Hospitals, Geneva, Switzerland, a 2100-bed, university-affiliated, primary and tertiary care centre with 950 acute care and 36 ICU beds.3 All adult patients receiving a non-tunnelled CVC and hospitalised between 1 June and 31 August 2009 in the ICU, in neurology, and in internal medicine and surgery acute care departments were prospectively included. The study was part of a quality improvement project approved

Results

In total, 292 patients harboured 378 catheters, accounting for 2704 catheter-days (1246 in the ICU and 1458 in non-ICU settings). The overall CVC utilisation rate was 5.7 per 100 patient-days, but much higher in the ICU than in non-ICU departments (42.4 and 3.3 per 100 patient-days, respectively). Median catheter dwell time (interquartile range, IQR) was 5 (2–9) days overall, 4 (2–7) for catheters inserted in the ICU, and 8 (3–15) (P < 0.001) for catheters outside the ICU (Table I). In total, 47

Discussion

To the best of our knowledge, this is the first study reporting prospective, individual, detailed data on the use of CVCs. Our hospital-wide, catheter surveillance revealed that although cumulative catheter-days were similar, the type, dwell time, and utilization of CVCs in ICU and non-ICU settings were different. They represent distinct patient populations with different characteristics and hence different risk factors for CLABSI and other adverse outcomes. HCWs do not always recall why a CVC

Acknowledgements

We thank D. Scalia for her support in data collection and R. Sudan for editorial assistance.

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