The Incidence of Central Line–Associated Bacteremia After the Introduction of Midline Catheters in a Ventilator Unit Population

Pathak, Rahul; Patel, Anish; Enuh, Hilary; Adekunle, Oluwaseyi; Shrisgantharajah, Vasanthy; Diaz, Keith

doi:10.1097/ipc.0000000000000237

Cited by 32 publications

(33 citation statements)

References 18 publications

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“…7,12 While there is a paucity of information that directly compares PICCs to midlines, some data suggest a lower risk of bloodstream infection and thrombosis associated with the latter. [24][25][26] For example, at one quaternary teaching hospital, house staff who are trained to insert midline catheters under ultrasound guidance in critically ill patients with difficult venous access reported no CLABSI and DVT events. 26 Interestingly, multilumen catheters were used twice as often as single lumen catheters in patients with short-term PICCs.…”

Section: Discussionmentioning

confidence: 99%

Patterns and Predictors of Short‐Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study

Paje

Conlon

Kaatz

et al. 2018

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Patterns and Predictors of Short‐Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study

Paje

Conlon

Kaatz

et al. 2018

Journal of Hospital Medicine

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“… 11 , 13 Another study recently demonstrated a decrease in the rate of CLABSI by introducing a midline program in a ventilator unit. 12 …”

Section: Introductionmentioning

confidence: 99%

A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital

Pathak¹,

Gangina²,

Jairam³

et al. 2018

TCRM

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BackgroundWe propose that substituting central lines with midlines can help reduce the total number of central line catheter-days as well as central line-associated bloodstream infections (CLABSIs), thereby reducing the associated costs and the resulting increased length of stay. A midline or vascular access program in a community hospital can bring about these positive changes.ObjectivesOur objective is to evaluate whether the institution of a midline program for vascular access at a community hospital can reduce the number of central line catheter-days and the associated CLABSI rate, incidence, and cost.Materials and methodsWe collected data on the number of central line catheter-days per year starting from 2012. We also collected data on the total number of patient-days during this period and the number of CLABSIs. We started Centers for Disease Control and Prevention (CDC)-based recommendations to help decrease CLABSIs in June 2014; this included the use of the central venous catheters (CVC) insertion bundles and CVC maintenance bundle. Chlorhexidine baths were also given to all patients with central lines. In June 2015, we started a midline program and tracked data till June 2017. We then compared the infection rates during these periods.ResultsWe conclude that instituting CDC recommendations to decrease CLABSIs did bring down the CLABSI rate; this decrease was not statistically significant. However, the addition of the midline program to replace central lines whenever possible, combined with universal CDC recommendations, did result in a significant decrease in both the number of central line days per patient-day and the CLABSI rate.ConclusionWe recommend hospitals to develop a midline program to help reduce the use of central line catheters when possible to reduce the total number of catheter-days and the CLABSI rate associated with them.

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“…10 Midline catheters with lengths of 6 to 20 cm are a potential solution and have high success rates and longevity, but inserters require specialized training, the costs are significantly higher, and the rate of complications including thrombosis and infection appears far higher. [11][12][13][14][15][16][17][18][19] The recent introduction of 6.35-cm ultralong peripheral intravenous lines may provide the benefits of midline catheters without the costs and complications. We hypothesized that ultralong catheters would have improved survival and a similar safety profile compared with the standard 4.78-cm intravenous catheter.…”

Section: How This Is Relevant To Clinical Practicementioning

confidence: 99%

Ultralong Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasonographically Guided Catheter Survival

Bahl

Hijazi

Chen

et al. 2020

Annals of Emergency Medicine

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Study objective: Ultrasonographically guided intravenous peripheral catheters have dismal dwell time, with most intravenous lines failing before completion of therapy. Catheter length in the vein is directly related to catheter longevity. We investigate the survival of an ultralong ultrasonographically guided intravenous peripheral catheter compared with a standard long one. Methods: We conducted a single-site, nonblinded, randomized trial of catheter survival. Adult patients presenting to the emergency department with difficult vascular access were recruited and randomized to receive either standard long, 4.78-cm, 20gauge ultrasonographically guided intravenous peripheral catheters or ultralong, 6.35-cm, 20-gauge ultrasonographically guided intravenous peripheral catheters. The primary outcome was duration of catheter survival. The secondary outcome was the optimal length of the catheter in the vein to maximize survival. Additional intravenous-related endpoints included first-stick success, time to insertion, number of attempts, thrombosis, and infection. Results: Between October 2018 and March 2019, 257 patients were randomized, with 126 in the standard long ultrasonographically guided intravenous peripheral catheter group and 131 in the ultralong group. Kaplan-Meier estimate of catheter median survival time in the ultralong group was 136 hours (95% confidence interval [CI] 116 to 311 hours) compared with 92 hours (95% CI 71 to 120 hours) in the standard long group, for a difference of 44 hours (95% CI 2 to 218 hours). The optimal catheter length in the vein was 2.75 cm, and intravenous lines with greater than 2.75 cm inserted had a median survival of 129 hours (95% CI 102 to 202 hours) compared with 75 hours (95% CI 52 to 116 hours) for intravenous lines with less than or equal to 2.75 cm, for a difference of 54 hours (95% CI 10 to 134 hours). Insertion characteristics were similar between the groups: 74.1% versus 79.4% first-stick success (95% CI for the difference-2% to 5%), 1.4 versus 1.3 for number of attempts (95% CI for the difference-0.1 to 0.3), and 6.9 versus 5.9 minutes to completion (95% CI for the difference-1.3 to 3.4) with ultralong versus standard long, respectively. There were no cases of infection or thrombosis. Conclusion: This study demonstrated increased catheter survival when the ultralong compared with the standard long ultrasonographically guided intravenous peripheral catheter was used, whereas insertion characteristics and safety appeared similar. [

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The Incidence of Central Line–Associated Bacteremia After the Introduction of Midline Catheters in a Ventilator Unit Population

Cited by 32 publications

References 18 publications

Patterns and Predictors of Short‐Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study

Patterns and Predictors of Short‐Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study

A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital

Ultralong Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasonographically Guided Catheter Survival

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