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

The Effect of Multiple Concurrent Central Venous Catheters on Central Line–Associated Bloodstream Infections

2014 ◽  
Vol 35 (9) ◽  
pp. 1140-1146 ◽  
Author(s):  
Cathleen Concannon ◽  
Edwin van Wijngaarden ◽  
Vanessa Stevens ◽  
Ghinwa Dumyati
Keyword(s):  
Risk Factor ◽  
Disease Severity ◽  
Independent Risk Factor ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Central Line ◽  
Central Venous Catheters ◽  
Apache Ii ◽  
Central Venous

ObjectiveThe current central line–associated bloodstream infection (CLABSI) surveillance rate calculation does not account for multiple concurrent central venous catheters (CVCs). The presence of multiple CVCs creates more points of entry into the bloodstream, potentially increasing CLABSI risk. Multiple CVCs may be used in sicker patients, making it difficult to separate the relative contributions of multiple CVCs and comorbidities to CLABSI risk. We explored the relative impact of multiple CVCs, patient comorbidities, and disease severity on the risk of CLABSI.DesignCase-control study.SettingA total of 197 case patients and 201 control subjects with a CVC inserted during hospitalization at a tertiary care academic medical center from January 1, 2008, to December 31, 2010.MethodsMultiple CVCs was the exposure of interest; the primary outcome was CLABSI. Multivariable logistic regression was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) describing the association between CLABSI and multiple CVCs with and without controlling for Acute Physiology and Chronic Health Evaluation (APACHE) II and Charlson comorbidity index (CCI) scores as measures of disease severity and patient comorbidities, respectively.ResultsPatients with multiple CVCs (n = 78) showed a 4.2 (95% CI, 2.2–8.4) times greater risk of CLABSI compared with patients with 1 CVC after adjusting for CLABSI risk factors. When including APACHE II and CCI scores, multiple CVCs remained an independent risk factor for CLABSI (OR, 3.4 [95% CI, 1.7–6.9]).ConclusionsMultiple CVCs is an independent risk factor for CLABSI even after adjusting for severity of illness. Adjustment for this risk may be necessary to accurately compare rates between hospitals.Infect Control Hosp Epidemiol 2014;35(9):1140-1146

scholarly journals Medically Attended Catheter Complications Are Common in Patients With Outpatient Central Venous Catheters

2018 ◽  
Vol 39 (4) ◽  
pp. 439-444 ◽  
Author(s):  
Steven S. Spires ◽  
Peter F. Rebeiro ◽  
Mickie Miller ◽  
Katie Koss ◽  
Patty W. Wright ◽  
...  
Keyword(s):  
Medical Center ◽  
Bloodstream Infections ◽  
Home Care Services ◽  
Absolute Number ◽  
Central Line ◽  
Clinic Visit ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Catheter Complications ◽  
Improvement Programs

OBJECTIVEOutpatient central venous catheters (CVCs) are being used more frequently; however, data describing mechanical complications and central-line–associated bloodstream infections (CLABSI) in the outpatient setting are limited. We performed a retrospective observational cohort study to understand the burden of these complications to elucidate their impact on the healthcare system.METHODSData were retrospectively collected on patients discharged from Vanderbilt University Medical Center with a CVC in place and admitted into the care of Vanderbilt Home Care Services. Risk factors for medically attended catheter-associated complications (CACs) and outpatient CLABSIs were analyzed.RESULTSA CAC developed in 143 patients (21.9%), for a total of 165 discrete CAC events. Among these, 76 (46%) required at least 1 visit to the emergency department or an inpatient admission, while the remaining 89 (54%) required an outpatient clinic visit. The risk for developing a CAC was significantly increased in female patients, patients with a CVC with >1 lumen, and patients receiving total parenteral nutrition. The absolute number of CLABSIs identified in the study population was small at 16, or 2.4% of the total cohort.CONCLUSIONSMedically attended catheter complications were common among outpatients discharged with a CVC, and reduction of these events should be the focus of outpatient quality improvement programs.Infect Control Hosp Epidemiol 2018;39:439–444

The Effect of Multiple Concurrent Central Venous Catheters on Central Line Associated Bloodstream Infections

2013 ◽  
Vol 41 (6) ◽  
pp. S54-S55
Author(s):  
Cathleen Concannon ◽  
Edwin van Wijngaarden ◽  
Vanessa Stevens ◽  
Kelly Thevenet-Morrison ◽  
Ghinwa Dumyati
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous

Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

2009 ◽  
Vol 28 (3) ◽  
pp. 151-155 ◽  
Author(s):  
Sabra Curry ◽  
Michele Honeycutt ◽  
Gail Goins ◽  
Craig Gilliam
Keyword(s):  
High Risk ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Skin Antisepsis ◽  
Neonatal Population

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

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

Impact of number of lumens in central-venous catheters on central-line bloodstream infection (CLABSI) and venous thromboembolism (VTE) risk in patients with acute leukemia

2021 ◽  
pp. 1-3
Author(s):  
Alina Varabyeva ◽  
Christabel Pui-See Lo ◽  
Adamo Brancaccio ◽  
Anthony J. Perissinotti ◽  
Twisha Patel ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Venous Thromboembolism ◽  
Acute Leukemia ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Central Venous ◽  
Double Lumen

Abstract This retrospective study was conducted to determine whether the number of peripherally inserted central-catheter lumens affected the rate of central-line associated bloodstream infections (CLABSIs) in adult patients with acute leukemia. The results show that CLABSI rates were not significantly different between patients with triple-lumen or double-lumen PICCs (22.1% vs 23.4%; P = .827).

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