CVC utilization in critically ill children
We aimed to describe utilization and indication(s) for long-term central venous catheters (CVCs) in a pediatric intensive care unit (PICU) and identify potential strategies to decrease CVC utilization.
Methods: We conducted a single-center prospective quality improvement initiative at a 30-bed PICU in a large, freestanding, academic children’s hospital. We created an electronic report to identify patients with an indwelling CVC for 7 days and older (defined as long term). We discussed the ongoing need for each long-term CVC with PICU clinicians at weekly interdisciplinary structured “CVC stewardship rounds.” We then made recommendations around expedited removal of CVCs. We conducted multiple Plan-Do-Study-Act cycles to categorize CVC indications, identify modifiable factors, and educate PICU clinicians. We hypothesized that CVC stewardship rounds would decrease long-term CVC utilization in our PICU.
Results: From October 2016 to September 2017, 607 long-term CVCs were eligible for the stewardship intervention. Compared to the preintervention period, we recorded a significant increase in peripherally inserted central catheters and a decrease in nontunneled CVCs (P < 0.001). Most patients had single- or double-lumen CVCs in both the preintervention and intervention periods (86% and 91%, respectively). The utilization of overall long-term CVC devices, and those with modifiable indications, decreased during the intervention period.
Conclusions: A single-center QI intervention focused on PICU CVC stewardship was associated with a decrease in CVC utilization.
Blumenthal JA, Ormsby JA, Mirchandani D, Petti CA, Carpenter J, Geller M, Harding SN, O’Brien M, Sandora TJ, Kleinman ME, Priebe GP, Mehta NM. Stewardship Intervention to Optimize Central Venous Catheter Utilization in Critically Ill Children. Pediatr Qual Saf. 2021 Feb 12;6(2):e389. doi: 10.1097/pq9.0000000000000389. PMID: 34963999; PMCID: PMC8701869.