Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the "idle central venous catheter".
Infect Control Hosp Epidemiol. 2012 Jan;33(1):50-7
Authors: Chernetsky Tejedor S, Tong D, Stein J, Payne C, Dressler D, Xue W, Steinberg JP
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; [Formula: see text]). Patients with a PICC had 5.4 days in which they also had a PIV, compared with 10 days in other CVC patients ([Formula: see text]). 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; [Formula: see text]). 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.
PMID: 22173522 [PubMed - in process]