Hospital-wide survey of the use of central venous catheters
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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2013, Journal of Global Antimicrobial ResistanceCitation Excerpt :These guidelines examine the usefulness of various practices such as the choice of CVC, site of insertion, observance of an adequate aseptic technique, care and replacement of the catheter, and the choice of appropriate antibiotic therapy. An initial and crucial step in preventing CRBSIs is to weight and consider the risks and benefits of using a CVC in order to avoid unnecessary placements; indeed, in a recent hospital survey it was calculated that among a total of 378 CVCs inserted in 292 patients, accounting for 2704 catheter-days, 130 catheter-days (4.8%) were unnecessary, with a higher proportion in non-ICU settings (6.6%) [69]. Various risk factors involving insertion or catheter handling have been described in the literature.