Evaluation of unnecessary central venous catheters in critically ill patients: a prospective observational study.
BACKGROUND
Central venous catheters are used commonly in critical care. Evidence-based practices to prevent catheter-related bloodstream infections have been widely promoted. One such practice includes assessing the need for central venous catheters on a daily basis and removing those found to be unnecessary. However, little is known about the adherence to this recommendation. Our objective was to examine the prevalence of unnecessary central venous catheters in our intensive care units.


METHODS
We performed a prospective observational study during 28 consecutive days in two adult intensive care units at an academic medical centre. The principal investigator screened patients daily for the presence of non-tunnelled central venous catheters and assessed whether there was an indication for continued central catheterization. Patients under the age of 18 were excluded, as were those undergoing palliative care. Standardized indications were abstracted from the patient's chart, and the patient's primary nurse was interviewed if there was no indication for central venous catheterization in the chart. If there were multiple catheters or indications, the most appropriate indication was recorded. The end point was to establish whether a patient had an appropriate indication for central catheterization rather than to attribute an indication to each catheter.


RESULTS
Eighty-one patients experienced a total of 614 days with at least one central venous catheter. Forty-one (50.6%; 95% confidence interval [CI], 39.9-61.3%) of these patients had no indication on at least one central venous catheter day. Of all patient days with central venous catheters, 170 (27.7%; 95% CI, 19.5-37.9%) had no apparent indication. The proportion of patient days with central venous catheters without indication was 4.6 (95% CI, 2.6-8.2; P < 0.001) times greater in the level-2 unit than in the level-3 unit.


CONCLUSIONS
In two academic adult intensive care units, a large proportion of patients with central venous catheters lacked an ongoing indication for their use during a significant period of time. Many patients were exposed to complications from unneeded catheters. Our findings will serve as a baseline for determining the success of quality-improvement interventions to prevent complications such as catheter-related infections in our program.
Cload
Bruce
B
Department of Emergency Medicine, Kingston General Hospital and Hotel Dieu Hospital, c/o 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. bcload@rogers.ca
Day
Andrew G
AG
Ilan
Roy
R
D000046:Academic Medical Centers; D000368:Aged; D055499:Catheter-Related Infections / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data*; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013997:Time Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*