Unnecessary Use of Central Venous Catheters: The Need to Look Outside the Intensive Care Unit

2004 ◽  
Vol 25 (3) ◽  
pp. 266-268 ◽  
Author(s):  
William E. Trick ◽  
Michael O. Vernon ◽  
Sharon F. Welbel ◽  
Mary F. Wisniewski ◽  
John A. Jernigan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Public Hospital ◽  
Insertion Site ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Icu Patients

AbstractWe developed criteria for justifiable CVC use and evaluated CVC use in a public hospital. Unjustified CVC-days were more common for non-ICU patients compared with ICU patients. Also, insertion-site dressings were less likely to be intact on non-ICU patients. Interventions to reduce CVC-associated bloodstream infections should include non-ICU patients.

An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU

2018 ◽  
pp. 287-292
Author(s):  
Courtney Maxey-Jones ◽  
Edward Bittner
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Hand Washing ◽  
Evidence Based ◽  
Central Venous ◽  
Femoral Site ◽  
Median Rate

As part of the Keystone Intensive Care Unit project a bundle of evidence-based interventions was introduced in ICUs across the state of Michigan with the goal of decreasing catheter-related bloodstream infections (CRBI). The bundle included (1) hand washing, (2) full barrier precautions during placement of central venous catheters, (3) skin cleaning with chlorhexidine, (4) if possible, avoidance of femoral site, and (5) removing unnecessary central venous catheters. Post implementation rates of catheter-related bloodstream infections were compared to baseline data. The results showed a decrease from a baseline median rate of 2.7 infections per 1000 catheter-days to a median rate of 0 infections per 1000 catheter-days, which was sustained over 18 months of follow-up.

Risk factor identification and predictive models for central line requirements for patients on vasopressors

2021 ◽  
pp. 0310057X2110242
Author(s):  
Adrian D Haimovich ◽  
Ruoyi Jiang ◽  
Richard A Taylor ◽  
Justin B Belsky
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Single Agent ◽  
Composite Endpoint ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.

scholarly journals Comparison of mechanical complications of central venous catheter according to the insertion site in an intensive care unit of Bangladesh

2020 ◽  
Vol 10 (2) ◽  
pp. 115-119
Author(s):  
Debasish Kumar Saha ◽  
Suraiya Nazneen ◽  
ASM Areef Ahsan ◽  
Madhurima Saha ◽  
Kaniz Fatema ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Insertion Site ◽  
Venous Catheter ◽  
Arterial Puncture ◽  
Central Venous ◽  
Femoral Site ◽  
Mechanical Complications ◽  
Catheter Tip

Background: Central venous catheter (CVC) insertion is very common in intensive care unit (ICU). CVC is usually inserted in subclavian, internal jugular and femoral veins. However, CVC insertion may lead to significant mechanical complications. Our aim was to detect the occurrence of CVC related mechanical complications according to different insertion site. Methods: This prospective observational study was carried out during the period of May 2016 to July 2019 in Department of Critical Care Medicine, BIRDEM General Hospital, Dhaka, enrolling 349 adult patients requiring new CVC insertion in ICU. Results: Among 349 study subjects, 167 CVC were inserted through subclavian vein, 88 through internal jugular and 94 through femoral vein. There was no significant difference among three groups (subclavian / internal jugular / femoral) in terms of age, gender distribution, presence of co-morbid illness.Total mechanical complicationsin study population was 43 (12.3 %) including pneumothorax (14, 4.0%), arterial puncture (10, 2.9%), hemorrhage (11, 3.2%), catheter tip malposition (6, 1.7%), hemothorax (1, 0.3%) and lost guidewire (1, 0.3%). Pneumothorax was more with internal jugular (9.1%) than subclavian (3.6 %) route, which was statistically significant (p=0.007). Although hemorrhage and arterial puncture events were higher with femoral site than subclavian or internal jugular, which were not significant. Catheter tip malposition occurred in 4 (2.4%) patients with subclavian insertion and 2 (2.3%) patients with internal jugular site, no such event in femoral site. Hemothorax and lost guidewire occurred in only 1 patient with subclavian and internal jugular site respectively. Site-wise total mechanical complications were higher in internal jugular (17.0%) followed bysubclavian (10.8%) site and femoral site (10.6%). Conclusion: In this study, though not statistically significant, CVC related mechanical complications occurred more in subclavian site than in internal jugular or femoral insertion site. Birdem Med J 2020; 10(2): 115-119

Inpatient Peripherally Inserted Central Venous Catheter Complications: Should Peripherally Inserted Central Catheter Lines be Placed in the Intensive Care Unit Setting?

2017 ◽  
Vol 83 (8) ◽  
pp. 925-927 ◽  
Author(s):  
Michael Martyak ◽  
Ishraq Kabir ◽  
Rebecca Britt
Keyword(s):  
Intensive Care Unit ◽  
Interventional Radiology ◽  
Intensive Care ◽  
Infection Rate ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Complication Rates ◽  
Central Venous ◽  
Icu Patients

Peripherally inserted central venous catheters (PICCs) are now commonly used for central access in the intensive care unit (ICU) setting; however, there is a paucity of data evaluating the complication rates associated with these lines. We performed a retrospective review of all PICCs placed in the inpatient setting at our institution during a 1-year period from January 2013 to December 2013. These were divided into two groups: those placed at the bedside in the ICU and those placed by interventional radiology in non-ICU patients. Data regarding infectious and thrombotic complications were collected and evaluated. During the study period, 1209 PICC line placements met inclusion criteria and were evaluated; 1038 were placed by interventional radiology in non-ICU patients, and 171 were placed at the bedside in ICU patients. The combined thrombotic and central line associated blood stream infection rate was 6.17 per cent in the non-ICU group and 10.53 per cent in the ICU group (P = 0.035). The thrombotic complication rate was 5.88 per cent in the non-ICU group and 7.60 per cent in the ICU group (P = 0.38), whereas the central line associated blood stream infection rate was 0.29 per cent in the non-ICU group and 2.92 per cent in the ICU group (P = 0.002). This study seems to suggest that PICC lines placed at the bedside in the ICU setting are associated with higher complication rates, in particular infectious complications, than those placed by interventional radiology in non-ICU patients. The routine placement of PICC lines in the ICU settings needs to be reevaluated given these findings.

scholarly journals Bloodstream infections among patients using central venous catheters in intensive care units

2007 ◽  
Vol 15 (3) ◽  
pp. 453-459 ◽  
Author(s):  
Eni Rosa Aires Borba Mesiano ◽  
Edgar Merchán-Hamann
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Analytical Study ◽  
Hospital Costs ◽  
Bloodstream Infections ◽  
Federal District ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Catheter Group ◽  
The Right

Central Venous Catheters (CVC), widely used in Intensive Care Units (ICU) are important sources of bloodstream infections (BSI). This prospective cohort epidemiological analytical study, aimed to infer the incidence of BSI, the risk factors associated and evaluate the care actions related to the use of these catheters in seven ICU in the Federal District - Brasília, Brazil. From the 630 patients using CVC, 6.4% developed BSI (1.5% directly related to the catheter and 4.9% clinic BSI). The hospitalization term was 3.5 times greater among these patients. Different modalities of catheter insertion and antiseptic substances use were observed. Time of CVC permanence was significantly associated to infection incidence (p<1x10-8) as well as the right subclavian access and double-lumen catheters. Patients with neurological disorders and those submitted to tracheotomy were the most affected. We suggest the organization of a "catheter group" aiming to standardize procedures related to the use of catheters in order to reduce the hospitalization term and hospital costs.

scholarly journals Central venous catheter-related bloodstream infections in the intensive care unit

2011 ◽  
Vol 15 (4) ◽  
pp. 213-223 ◽  
Author(s):  
Virendra C. Patil ◽  
Harsha V. Patil ◽  
M. N. Ramteerthkar ◽  
R. D. Kulkarni
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous
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