Outcomes of implementing a central venous catheter bundle

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This study done at All India Institute of Medical Sciences showed improved outcome in terms of catheter infection and mechanical complications” Krishnan et al (2018).

Abstract:

INTRODUCTION: Central venous catheter (CVC) associated infection are many times higher in India compared to western countries. A group of interventions called as CVC bundle, if implemented effectively prevents CVC related complication.

METHODOLOGY: Our study was a prospective quasi-experimental study. The study evaluated the level of compliance with the central venous catheter bundle in the management of patients in our Medicine wards and Intensive care unit (ICU).

RESULTS: In the study, the incidence of central line associated bloodstream infection (CLABSI) was zero and the incidence of pneumothorax was 5%. Most of the patients had higher Acute physiology and chronic health evaluation (APACHE II) at baseline and multi organ dysfunction. The compliance with whole CVC bundle improved from 0% at baseline to 10% in post-intervention phase. Compliance of many components increased significantly in the post intervention period. These were Hand washing before insertion (15% to 72.5%, p<0.001), Maintenance (0% to 52.5%, p<0.001), Prompt removal of catheters (40% to 70%, p=0.007), Skin antisepsis with chlorhexidine increased approaching significance (0% to 12.5%, p=0.055). Avoidance of femoral catheters was done in more than 95% of the cases. The predictors of mortality were higher APACHE II (OR 1.23 , p=0.020) and duration of hospital stay (OR 0.87 , p=0.022). CONCLUSION: This study done at All India Institute of Medical Sciences showed improved outcome in terms of catheter infection and mechanical complications. CVC bundle compliance increased significantly though adherence to full bundle was less. In future, with rectification of barriers to bundle completion, the compliance with CVC bundle can be further improved.

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Reference:

Krishnan, S., Kumar, A., Sethi, P., Soneja, M., Xess, I., Kapil, A., Pandey, R.M., Vikram, N.K., Biswas, A. and Wig, N. (2018) Outcomes of Implementing the Central Venous Catheter Bundle at a Tertiary Care Hospital in North India, at AIIMS, New Delhi. The Journal of the Association of Physicians of India. 66(9), p.26-33.

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