title: Can the identification of an idle line facilitate its removal? A comparison between a proposed guideline and clinical practice.
abstract: There are 250,000 cases of central line-associated blood stream infections in the United States annually, some of which may be prevented by the removal of lines that are no longer needed.
  
  
  
  To test the performance of criteria to identify an idle line as a guideline to facilitate its removal.
  
  
  
  Patients with central lines on the wards were identified. Criteria for justified use were defined. If none were met, the line was considered "idle." We proposed the guideline that a line may be removed the day following the first idle day and compared actual practice with our proposed guideline.
  
  
  
  One hundred twenty-six lines in 126 patients were observed. Eighty-three (65.9%) were peripherally inserted central catheters. Twenty-seven percent (n= 34) were placed for antibiotics. Seventy-six patients had lines removed prior to discharge. In these patients, the line was in place for 522 days, of which 32.7% were idle. The most common reasons to justify the line included parenteral antibiotics and meeting systemic inflammatory response (SIRS) criteria. In 11 (14.5%) patients, the line was removed prior to the proposed guideline. Most (n = 36, 47.4%) line removals were observed to be in accordance with our guideline. In another 29 (38.2%), line removal was delayed compared to our guideline.
  
  
  
  Idle days are common. Central line days may be reduced by the consistent daily reevaluation of a line's justification using defined criteria. The practice of routine central line placement for prolonged antibiotics and the inclusion of SIRS criteria to justify the line may need to be reevaluated. Journal of Hospital Medicine 2016;11:489-493. © 2016 Society of Hospital Medicine.
authors.affiliation: Inpatient Medicine, Indiana University Health Physicians, and Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Areeba
authors.initials: A
authors.lastname: Kara
authors.affiliation: Indiana University School of Medicine and Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.affiliation: Internal Medicine-Pediatrics residency, Indiana University, School of Medicine, Indianapolis, Indiana.
authors.forename: Michelle
authors.initials: M
authors.lastname: Murray
authors.affiliation: Methodist Hospital, Indiana University Health, Indianapolis, Indiana.
authors.forename: Jill
authors.initials: J
authors.lastname: Dillon
authors.affiliation: Regenstrief Institute, Indianapolis, Indiana.
authors.forename: Siu L
authors.initials: SL
authors.lastname: Hui
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'