Removing nonessential central venous catheters: evaluation of a quality improvement intervention

Abstract

Introduction Nonessential central venous catheters (CVCs) should be removed promptly to prevent adverse events. Little is known about effective strategies to achieve this goal. The present study evaluates the effectiveness of a quality improvement (QI) initiative to remove nonessential CVCs in the intensive care unit (ICU).Methods A prospective observational study was performed in two ICUs following a QI intervention that included a daily checklist, education, and reminders. During 28 consecutive days, all CVCs were identified and the presence of ongoing indications for CVC placement was recorded. The proportions of nonessential CVCs and CVC days were compared with pre-intervention proportions and between the participating units. Rates of central line-associated bloodstream infections (CLABSI) were measured separately through Ontario's Critical Care Information System. Results One hundred and ten patients and 159 CVCs were reviewed. Eighty-eight (11%) of 820 catheter days showed no apparent indication for CVC placement, and compared with the pre-intervention period, the proportion of patients with any number of nonessential CVC days decreased from 51% to 26% (relative risk 0.51; 95% confidence interval 0.34 to 0.74; P \ 0.001). There was no significant difference in the proportion of nonessential catheter days between participating units. Reported rates of CLABSI decreased substantially during the intervention. Discussion A checklist tool supported by a multifaceted QI intervention effectively ensured prompt removal of nonessential CVCs in two ICUs. RésuméIntroduction Les cathe´ters veineux centraux (CVC) non essentiels doivent eˆtre retire´s rapidement afin de pre´venir les effets inde´sirables. On ne sait que peu de choses sur les strate´gies efficaces permettant d'atteindre cet objectif. La pre´sente e´tude e´value l'efficacite´d'une initiative d'ame´lioration de la qualite´pour supprimer les CVC non essentiels dans une unite´de soins intensifs (USI). Méthode Une e´tude observationnelle prospective a e´te´mene´e dans deux USI suite a`une intervention

Interventions to reduce unnecessary central venous catheter use to prevent central-line–associated bloodstream infections in adults: A systematic review

“…The 14 included studies were published between 2010 and 2018 and were performed in the United States, [15][16][17][18][19][20][21][22][23][24] Canada, 25,26 France, 27 and Thailand. 28 Of the eligible studies, 1 (7.1%) was a cluster RCT, 28 4 (28.6%) were cohort studies, [22][23][24]26 and 9 (64.3%) were QESs, including 5 before-and-after QESs, 15,16,18,25,27 3 interrupted time-series studies, [19][20][21] and 1 pilot study. 17 These studies were all conducted in adult departments; all patients were ≥18 years old.…”

“…16,18 Most studies included only a specific department: 5 studies implemented the intervention in the medical and/or surgical wards, 19,20,23,25,28 2 studies were performed in the emergency departments, 22,24 and 5 studies focused on patients in intensive care units only. 15,17,21,26,27 Only 4 studies (28.6%) specified the type of CVC used. [18][19][20]25 Morata, 18 Swaminathan, 20 and Reeves 19 included only peripherally inserted central venous catheters (PICCs).…”

Using Incentives to Improve Resource Utilization

“…51 Finally, this study evaluated the sustainability of the intervention over a one-year follow-up period, which is similar or longer than post-intervention observations in many other multifaceted critical care studies. 34–36,40,52,53 …”

A survey of Preventive Measures Used and their Impact on Central Line-Associated Bloodstream Infections (CLABSI) in Intensive Care Units (SPIN-BACC)

“…The use of a ready-to-use kit for CVC insertion, also containing a full body size drape, should improve compliance, as it would no longer rely on the operator’s judgement. The implementation of daily assessment of CVC need is simple, requires little resource and should thus be reinforced [14]. …”