scholarly journals Risky Business: Peripheral and Central Venous Catheters Both Pose Risks

2019 ◽  
pp. 28-39
Author(s):  
Lynette Hathaway ◽  
Mary Magee
Keyword(s):  
Risk Factors ◽  
Patient Safety ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Healthcare Facilities ◽  
Relationship Of

Venous access is an essential method of providing life-saving therapy. As part of intensive efforts to decrease the incidence of central line–associated bloodstream infections (CLABSIs), healthcare facilities may be increasing the use of short (noncentral) peripheral venous catheters (PVCs). To investigate this, the Patient Safety Authority (PSA) sought to explore the relationship of actual to predicted complications per central venous catheters (CVCs) and PVCs over a nine-year period. In addition, as PVCs are not without risk and CVCs pose risks aside from infection, we sought to identify the type and relationship of PVC to CVC complications and to quantify the timing and types of PVC and CVC complications and their associated risk factors. A query of the PSA’s statewide event reporting database, the Pennsylvania Patient Safety Reporting System (PA-PSRS), for venous catheter complication events and a query of the National Healthcare Safety Network (NHSN) database for both primary bloodstream infections (BSIs) and CLABSIs occurring at inpatient facilities from January 1, 2009, through December 31, 2017, yielded 115,937 events. A methodical sampling of PA-PSRS yielded 2,413 PVC and CVC events. These were analyzed for the timing of complications reported, the type of complication reported, and any identified risk factors. Overall reports of PVC complications increased, and the correlation between actual and predicted PVC events over the nine years studied is strong and statistically significant. The slight decrease in the number of reported CVC complications was not statistically significant. The authors used regression analysis to determine the best-fitting line through the predicted and actual observed events during the period of observation. These data are not intended to present a predictive model of future events. No correlation was found between the numbers of PVC and CVC complications. The greatest number of PVC complications, particularly infiltration, occurred during catheter maintenance. Excluding NHSN-reported CLABSIs, the greatest number of CVC complications, particularly pneumothorax, occurred during catheter insertion. Education and training are key to preventing intravascular device–associated complications. Healthcare facilities are encouraged to evaluate policy, procedures, and actual practices to eliminate complications and improve outcomes. In addition, quality improvement efforts aimed at decreasing CLABSIs should include measuring CVC complications and all PVC complications as a balancing metric.

Central Venous Catheter Salvage in Ambulatory Central Line–Associated Bloodstream Infections

PEDIATRICS ◽  
2021 ◽  
Author(s):  
William J.H. Ford ◽  
David G. Bundy ◽  
Suzette Oyeku ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Secondary Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Type Number ◽  
Central Venous ◽  
Medical Centers ◽  
Associated Risk Factors

BACKGROUND Guidelines for treatment of central line–associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients <22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

Risk factors for central line–associated bloodstream infections in children with tunneled central venous catheters

2020 ◽  
Vol 48 (1) ◽  
pp. 33-39
Author(s):  
Paolo Paioni ◽  
Sereina Kuhn ◽  
Yvonne Strässle ◽  
Burkhardt Seifert ◽  
Christoph Berger
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous

Unnecessary Removal of Central Venous Catheters in Cancer Patients with Bloodstream Infections

2018 ◽  
Vol 39 (2) ◽  
pp. 222-225 ◽  
Author(s):  
Anne Marie Chaftari ◽  
Ray Hachem ◽  
Sammy Raad ◽  
Ying Jiang ◽  
Elizabeth Natividad ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Cancer Patients ◽  
Vascular Access ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous Catheters ◽  
Infect Control Hosp ◽  
Physician Education ◽  
Central Venous

We evaluated the rate of central venous catheter (CVC) removal in 283 cancer patients with bloodstream infections (BSIs). Removal of CVCs occurred unnecessarily in 57% of patients with non-central-line-associated BSI (non-CLABSI), which was equivalent to the rate of CVC removal in patients with CLABSIs. Physician education and safe interventions to salvage the vascular access are warranted.Infect Control Hosp Epidemiol 2018;39:222–225

Effect of Nurse Staffing and Antimicrobial-Impregnated Central Venous Catheters on the Risk for Bloodstream Infections in Intensive Care Units

2003 ◽  
Vol 24 (12) ◽  
pp. 916-925 ◽  
Author(s):  
Juan Alonso-Echanove ◽  
Jonathan R. Edwards ◽  
Michael J. Richards ◽  
Patrick Brennan ◽  
Richard A. Venezia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Risk ◽  
Multivariable Analysis ◽  
Nurse Staffing ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Prevention Measures ◽  
Central Venous ◽  
Central Catheters

AbstractBackground:Defining risk factors for central venous catheter (CVC)-associated bloodstream infections (BSIs) is critical to establishing prevention measures, especially for factors such as nurse staffing and antimicrobial-impregnated CVCs.Methods:We prospectively monitored CVCs, nurse staffing, and patient-related variables for CVC-associated BSIs among adults admitted to eight ICUs during 2 years.Results:A total of 240 CVC-associated BSIs (2.8%) were identified among 4,535 patients, representing 8,593 CVCs. Antimicrobial-impregnated CVCs reduced the risk for CVC-associated BSI only among patients whose CVC was used to administer total parenteral nutrition (TPN, 2.6 CVC-associated BSIs per 1,000 CVC-days vs no TPN, 7.5 CVC-associated BSIs per 1,000 CVC-days;P= .006). Among patients not receiving TPN, there was an increase in the risk of CVC-associated BSI in patients cared for by “float” nurses for more than 60% of the duration of the CVC. In multivariable analysis, risk factors for CVC-associated BSIs were the use of TPN in non-antimicrobial-impregnated CVCs (P= .0001), patient cared for by a float nurse for more than 60% of CVC-days (P= .0019), no antibiotics administered to the patient within 48 hours of insertion (P= .0001), and patient unarousable for 70% or more of the duration of the CVC (P= .0001). Peripherally inserted central catheters (PICCs) were associated with a lower risk for CVC-associated BSI (P= .0001).Conclusions:Antimicrobial-impregnated CVCs reduced the risk of CVC-associated BSI by 66% in patients receiving TPN. Limiting the use of float nurses for ICU patients with CVCs and the use of PICCs may also reduce the risk of CVC-associated BSI.

scholarly journals Impact of Critical Care Consultation Requests for Avoidable Central Venous Catheters on Medical-Surgical Units

2020 ◽  
Vol 41 (S1) ◽  
pp. s258-s258
Author(s):  
Madhuri Tirumandas ◽  
Theresa Madaline ◽  
Gregory David Weston ◽  
Ruchika Jain ◽  
Jamie Figueredo
Keyword(s):  
Critical Care ◽  
High Risk ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
High Risk Population ◽  
Central Venous

Background: Although central-line–associated bloodstream infections (CLABSI) in US hospitals have improved in the last decade, ~30,100 CLABSIs occur annually.1,2 Central venous catheters (CVC) carry a high risk of infections and should be limited to appropriate clinical indications.6,7 Montefiore Medical Center, a large, urban, academic medical center in the Bronx, serves a high-risk population with multiple comobidities.8–11 Despite this, the critical care medicine (CCM) team is often consulted to place a CVC when a peripheral intravenous line (PIV) cannot be obtained by nurses or primary providers. We evaluated the volume of CCM consultation requests for avoidable CVCs and related CLABSIs. Methods: Retrospective chart review was performed for patients with CCM consultation requests for CVC placement between July and October 2019. The indication for CVC, type of catheter inserted or recommended, and NHSN data were used to identify CLABSIs. CVCs were considered avoidable if a PIV was used for the stated indication and duration of therapy, with no anatomical contraindications to PIV in nonemergencies, according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).6Results: Of 229 total CCM consults, 4 (18%) requests were for CVC placement; 21 consultations (9%) were requested for avoidable CVCs. Of 40 CVC requests, 18 (45%) resulted in CVC placement by the CCM team, 4 (10%) were deferred for nonurgent PICC by interventional radiology, and 18 (45%) were deferred in favor of PIV or no IV. Indications for CVC insertion included emergent chemotherapy (n = 8, 44%) and dialysis (n = 3, 16%), vasopressors (n = 3, 16%), antibiotics (n = 2, 11%) and blood transfusion (n = 2, 11%). Of 18 CVCs, 9 (50%) were potentially avoidable: 2 short-term antibiotics and rest for nonemergent indications; 2 blood transfusions, 1 dialysis, 2 chemotherapy and 2 vasopressors. Between July and October 2019, 6 CLABSIs occurred in CVCs placed by the CCM team; in 3 of 6 CLABSI events (50%), the CVC was avoidable. Conclusions: More than half of consultation requests to the CCM team for CVCs are avoidable, and they disproportionately contribute to CLABSI events. Alternatives for intravenous access could potentially avoid 9% of CCM consultations and 50% of CLABSIs in CCM-inserted CVCs on medical-surgical wards.Funding: NoneDisclosures: None

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 Risk factors for unplanned removal of central venous catheters in hospitalized children with hematological and oncological disorders

2020 ◽  
Author(s):  
Moe Miyagishima ◽  
Hamada Motoharu ◽  
Yuji Hirayama ◽  
Hideki Muramatsu ◽  
Takahisa Tainaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Pediatric Patients ◽  
Cohort Analysis ◽  
Multivariable Analysis ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Subdistribution Hazard ◽  
Significant Difference

Background: Central venous catheters (CVCs) have been essential devices for the treatment of children with hematological and oncological disorders. Only few studies investigated the complications and selections of different types of CVCs in these pediatric patients. This study aimed to compare risk factors for unplanned removal of two commonly used CVCs, i.e., peripherally inserted central catheters (PICCs) and tunneled CVCs, and propose better device selection for the patient. Procedure: This retrospective, single center cohort analysis was conducted on pediatric patients with hematological and oncological disorders inserted with either a PICC or a tunneled CVC. Results: Between January 1, 2013, and December 31, 2015, 89 patients inserted with tunneled CVCs (total 21,395 catheter-days) and 84 with PICCs (total 9,177 catheter-days) were followed up until the catheter removal. The median duration of catheterization was 88 days in PICCs and 186 days in tunneled CVCs (p = 1.24×10-9). PICCs at the 3-month cumulative incidence of catheter occlusion (5.2% vs. 0%, p = 4.08×10-3) and total unplanned removal (29.0% vs 7.0%, p = 0.0316) were significantly higher, whereas no significant difference was observed in the cumulative incidence of central line-associated bloodstream infection (11.8% vs. 2.3%, p = 0.664). Multivariable analysis identified younger age (<2 years) (subdistribution hazard ratio [SHR], 2.29; 95% confidence interval [CI], 1.27–4.14) and PICCs (SHR, 2.73; 95% CI, 1.48–5.02) were independent risk factors for unplanned removal. Conclusion: Our results suggest that tunnel CVCs would be a preferred device for children with hematological and oncological disorders requiring long-term, intensive treatment.

Reducing central catheter-associated infections in pediatric surgery clinic: Implementation of a care bundle

2021 ◽  
Vol 11 (1) ◽  
pp. 57-65
Author(s):  
Eda Dolgun ◽  
Okgün Alcan Aliye ◽  
Ayşe Islamoğlu ◽  
Birsen Eroğlu ◽  
Meltem Polat ◽  
...  
Keyword(s):  
Pediatric Surgery ◽  
Healthcare Professionals ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Recovery Process ◽  
Central Line ◽  
Care Bundle ◽  
Central Venous ◽  
Implementation Period ◽  
Bundle Compliance

Purpose: Central line care bundle comprises a few evidence-based interventions for improving patients' outcomes and recovery process. This semi-experimental study aimed to determine the effect of pediatric central line care bundle implementation on central line-associated bloodstream infections (CLABSI) rates. Materials and methods: A central line care bundle was implemented for pediatric surgery patients (n=70). Baseline observations were made to determine the central line care bundle compliance of healthcare professionals for 435 catheter days. Subsequently, physicians and nurses were educated about the central line care bundle. After the implementation period, 722 catheter days were observed to determine post-implementation compliance. Baseline CLABSI rates were compared with post-implementation CLABSI rates. Results: It was found that the entire central line care bundle compliance was 32.4% pre-implementation and 86.3% post-implementation. After education, the physicians' and nurses' central line care bundle compliance showed statistically significant improvement (p= 0.0001). There were five CLABSI events in the pre-implementation period and three CLABSI events in the post-implementation period. It was determined that the number of CLABSI decreased in the post-implementation period compared to the pre-implementation period, but this difference was not statistically significant (p= 0.207). Conclusions: Central line care bundle implementation decreased the CLABSI rates. It is recommended the Implementation of a central line care bundle on the care of pediatric surgery patients with the central venous catheter.

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