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Temporary Central Venous Catheter Utilization Patterns in a Large Tertiary Care Center Tracking the “Idle Central Venous Catheter”

Published online by Cambridge University Press:  02 January 2015

Sheri Chernetsky Tejedor*
Affiliation:
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Information Services, Emory Healthcare, Atlanta, Georgia
David Tong
Affiliation:
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Jason Stein
Affiliation:
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Information Services, Emory Healthcare, Atlanta, Georgia
Christina Payne
Affiliation:
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Daniel Dressler
Affiliation:
Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Wenqiong Xue
Affiliation:
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
James P. Steinberg
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
*
Division of Hospital Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Box M-7, Atlanta, GA 30322 (scherne@emory.edu)

Abstract

Objectives.

Although central venous catheter (CVC) dwell time is a major risk factor for catheter-related bloodstream infections (CR-BSIs), few studies reveal how often CVCs are retained when not needed (“idle”). We describe use patterns for temporary CVCs, including peripherally inserted central catheters (PICCs), on non-ICU wards.

Design.

A retrospective observational study.

Setting.

A 579-bed acute care, academic tertiary care facility.

Methods.

A retrospective observational study of a random sample of patients on hospital wards who have a temporary, nonimplanted CVC, with a focus on on daily ward CVC justification. A uniform definition of idle CVC-days was used.

Results.

We analyzed 89 patients with 146 CVCs (56% of which were PICCs); of 1,433 ward CVC-days, 361 (25.2%) were idle. At least 1 idle day was observed for 63% of patients. Patients had a mean of 4.1 idle days and a mean of 3.4 days with both a CVC and a peripheral intravenous catheter (PIV). After adjusting for ward length of stay, mean CVC dwell time was 14.4 days for patients with PICCs versus 9.0 days for patients with non-PICC temporary CVCs (other CVCs; P< .001). Patients with a PICC had 5.4 days in which they also had a PIV, compared with 10 days in other CVC patients (P< .001). Patients with PICCs had more days in which the only justification for the CVC was intravenous administration of antimicrobial agents (8.5 vs 1.6 days; P = .0013).

Conclusions.

Significant proportions of ward CVC-days were unjustified. Reducing “idle CVC-days” and facilitating the appropriate use of PIVs may reduce CVC-days and CR-BSI risk.

Infect Control Hosp Epidemiol 2012;33(1):50-57

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1. Climo, M, Diekema, D, Warren, DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the Prevention Epicenter Program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24:942945.Google Scholar
2. Srinivasan, A, Wise, M, Bell, M, et al. Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mort Wkly Rep 2011;60(8):243248.Google Scholar
3. Trick, WE, Miranda, J, Evans, AT, et al. Prospective cohort study of central venous catheters among internal medicine ward patients. Am J Infect Control 2006;34:636641.Google Scholar
4. NINSS reports on surgical site infection and hospital acquired bacteraemia. Commun Dis Rep Wkly 2000;10:213, 216.Google Scholar
5. Moro, ML, Vigano, F, Lepri, AC, et al. Risk factors for central venous catheter-related infections in surgical and intensive care units. Infect Control Hosp Epidemiol 1994;15:253264.Google Scholar
6. McLaws, ML, Berry, G. Nonuniform risk of bloodstream infection with increasing central venous catheter-days. Infect Control Hosp Epidemiol 2005;26:715719.Google Scholar
7. Milstone, AM, Sengupta, A. Do prolonged peripherally inserted central venous catheter dwell times increase the risk of bloodstream infection? Infect Control Hosp Epidemiol 2010;31:11841187.CrossRefGoogle ScholarPubMed
8. O'Grady, N, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52(9):e162e163.Google Scholar
9. Edwards, JR, Peterson, KD, Andrus, ML, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290301.Google Scholar
10. Lederle, FA, Parenti, CM, Berskow, LC, et al. The idle intravenous catheter. Ann Intern Med 1992;116:737738.Google Scholar
11. Parenti, CM, Lederle, FA, Impola, CL, et al. Reduction of unnecessary intravenous catheter use; internal medicine housestaff participate in a successful quality improvement project. Arch Intern Med 1994;154:18291832.Google Scholar
12. Trick, WE, Vernon, MO, Welbel, SF, et al. Unnecessary use of central venous catheters: the need to look outside the intensive care unit. Infect Control Hosp Epidemiol 2004;25:266268.Google Scholar
13. Tiwari, MM, Hermsen, ED, Charlton, ME, et al. Inappropriate intravascular device use: a prospective study. J Hosp Infect 2011;78:128132.Google Scholar
14. Safdar, N, Maki, DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 2005;128:489495.CrossRefGoogle ScholarPubMed
15. Periard, D, Monney, P, Waeber, G, et al. Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy. J Thromb Haemost 2008;6:12811288.Google Scholar
16. Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81(9):11591171.Google Scholar
17. Ajenjo, MC, Morley, JC, Russo, AJ, et al. Peripherally inserted central venous catheter-associated bloodstream infections in hospitalized adult patients. Infect Control Hosp Epidemiol 2011;32(2):125130.Google Scholar
18. Marschall, J, Mermel, LA, Classen, D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29:S22S30.CrossRefGoogle ScholarPubMed
19. Webster, J, Osborne, S, Rickard, C, Hall, J. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2010;3:CD007798.CrossRefGoogle Scholar
20. Milstone, AM, Sengupta, A. Do prolonged peripherally inserted central venous catheter dwell times increase the risk of bloodstream infection? Infect Control Hosp Epidemiol 2010;31:11841187.Google Scholar
21. Stone, B. Ultrasound guidance for peripheral venous access: a simplified Seldinger technique. Anesthesiology 2007;106:195.Google Scholar
22. Brannam, L, Blaivas, M, Lyon, M, et al. Emergency nurses' utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients. Acad Emerg Med 2004;11(12):13611363.CrossRefGoogle ScholarPubMed
23. Blaivas, M, Lyon, M. The effect of ultrasound guidance on the perceived difficulty of emergency nurse-obtained peripheral IV access. J Emerg Med 2006;31(4):407410.Google Scholar
24. Costantino, TG, Parikh, AK, Satz, WA, et al. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005;46(5):456461.Google Scholar
25. Panebianco, NL, Fredette, JM, Szyld, D, et al. What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access. Acad Emerg Med 2009;16:16.Google Scholar