Surveillance of the ‘idle’ central venous catheter in the hospital setting

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Intravenous literature: Tejedor, S., Tong, D., Stein, J., Payne, C., Dressler, D., Xue, W. and Steinberg, J.P. (2012) Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “idle central venous catheter”. Infection Control & Hospital Epidemiology. 33(1), p.50-7.

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; [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.

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