Should the CDC’s recommendations for promptly removing unnecessary centrally inserted central catheters be enhanced? Ultrasound-guided peripheral venous cannulation to fully comply

Abstract

Purpose:

In an effort to reduce catheter-related bloodstream infection’s incidence rates in an intensive care unit, several evidence-based procedures recommended by the Centers for Disease Control and Prevention for centrally inserted central catheters were implemented. A failure to fully comply with the recommendation for prompt removal of the centrally inserted central catheters was attributed, mainly to the difficulties and inadequacies raised from establishing peripheral venous access.

Methods:

The ultrasound-guided peripheral venous cannulation method as a supplementary intervention to the Centers for Disease Control and Prevention’s recommendations was incorporated and examined during the subsequent year.

Results:

A significant reduction on catheter-related bloodstream infection incidence rates out of the expected range was found. Centrally inserted central catheters utilization ratios were reduced by 10.7% (p < 0.05; 58%–47%) and the catheter-related bloodstream infection incidence rate was reduced by 11.7 per thousand device–days (15.9–4.16/1000 centrally inserted central catheters days (2015–2016 group, respectively)).

Conclusion:

The reduction of catheter-related bloodstream infection was higher than that described in the published literature. This probably shows that the combination of the five evidence-based procedures recommended by the Centers for Disease Control and Prevention together with that of ultrasound-guided peripheral venous cannulation method can increase the compliance with the Category IA recommendation for removal or avoidance of unnecessary placement of centrally inserted central catheters and decrease the catheter-related bloodstream infections in a more effective way, by affecting the patients’ centrally inserted central catheter exposure.

Keywords

Centers for Disease Control and Prevention centrally inserted central catheters central venous catheter ultrasound bloodstream infection peripheral venous access intensive care catheter-related bloodstream infection

Get full access to this article

View all access options for this article.

References

Maki

Kluger

Crnich

CJ.

The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006; 81(9): 1159–1171.

Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections–United States,2001, 2008, and 2009. Morb Mortal Wkly Rep 2011; 60: 243–248.

O’Grady

Alexander

Dellinger

, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002; 23: 759–769.

Mermel

LA.

Prevention of intravascular catheter-related infections. Ann Intern Med 2000; 132: 391–402.

Pronovost

Needham

Berenholtz

, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355(26): 2725–2732.

O’Grady

Alexander

Burns

, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52: e162–e193.

Rosenthal

Bijie

Maki

, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004–2009. Am J Infect Control 2012; 40(5): 396–407.

Rosenthal

Maki

Mehta

, et al. International nosocomial infection control consortiu (INICC) report, data summary of 43 countries for 2007–2012: device-associated module. Am J Infect Control 2014; 42: 942–956.

Rosenthal

Maki

Mehta

, et al. International nosocomial infection control consortium report, data summary for 2002–2007, issued January 2008. Am J Infect Control 2008; 36(9): 627–637.

10.

Gil

Kruse

Thill-Baharozian

, et al. Triple- vs single-lumen central venous catheters. Arch Intern Med 1989; 149(5): 1139–1143.

11.

Jacobson

Winslow

EH.

Variables influencing intravenous catheter insertion difficulty and failure: an analysis of 339 intravenous catheter insertions. Heart Lung 2005; 34(5): 345–359.

12.

Juvin

Blarel

Bruno

, et al. Is peripheral line placement more difficult in obese than in lean patients. Anesth Analg 2003; 96(4): 1218.

13.

Sebbane

Claret

P-G

Lefebvre

, et al. Predicting peripheral venous access difficulty in the emergency department using body mass index and a clinical evaluation of venous accessibility. J Emerg Med 2013; 44(2): 299–305.

14.

Rupp

Apfelbaum

Blitt

, et al. Practice guidelines for central venous access: a report by the American society of anesthesiologists task force on central venous access. Anesthesiology 2012; 116(3): 539–573.

15.

Freel

Shiloach

Weigelt

, et al. American college of surgeons guidelines program: a process for using existing guidelines to generate best practice recommendations for central venous access. J Am Coll Surg 2008; 207(5): 676–682.

16.

BodenhamChair

Babu

Bennett

, et al. Association of anaesthetists of Great Britain and Ireland: safe vascular access 2016. Anaesthesia 2016; 71(5): 573–585.

17.

Troianos

Hartman

Glas

, et al. Special articles: guidelines for performing ultrasound guided vascular cannulation: recommendations of the American society of echocardiography and the society of cardiovascular anesthesiologists. Anesth Analg 2012; 114(1): 46–72.

18.

Levy

Noble

VE.

Bedside ultrasound in pediatric emergency medicine. Pediatrics 2008; 121: e1404–e1412.

19.

Keyes

Frazee

Snoey

, et al. Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med 1999; 34(6): 711–714.

20.

Doniger

Ishimine

Fox

, et al. Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatr Emerg Care 2009; 25(3): 154–159.

21.

ECDC-NHSN. Infections in Intensive Care Units HAI-ICU protocol. European Surveillance of Healthcare-Associated Infections in Intensive Care Units- ECDC HAIICU Protocol, 2010, pp. 1–68.

22.

Le Gall

Lemeshow

Saulnier

Simplified acute physiology score (SAPS II) based on a European / North American multicenter study. JAMA 1993; 270(24): 2957–2963.

23.

Blaivas

Brannam

Fernandez

Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimate model. Acad Emerg Med 2003; 10(12): 1307–1311.

24.

R Development Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing, 2015, http://www.R-project.org/

25.

Fay

MP.

Two-sided exact tests and matching confidence intervals for discrete data. R J 2010; 2: 53–58.

26.

Martone

Gaynes

Horan

, et al. National nosocomial infections surveillance (NNIS) semiannual report, May 1995: a report from the national nosocomial infections surveillance (NNIS) System. Am J Infect Control 1995; 23(6): 377–385.

27.

Wisplinghoff

Bischoff

Tallent

, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39(3): 309–317.

28.

Gregg

Murthi

Sisley

, et al. Ultrasound-guided peripheral intravenous access in the intensive care unit. J Crit Care 2010; 25(3): 514–519.

29.

Gikas

Roumbelaki

Bagatzouni-Pieridou

, et al. Device-associated infections in the intensive care units of Cyprus: results of the first national incidence study. Infection 2010; 38(3): 165–171.

30.

Dudeck

Horan

Peterson

, et al. National healthcare safety network (NHSN) report, data summary for 2010, device-associated module. Am J Infect Control 2011; 39(10): 798–816.

31.

Richet

Hubert

Nitemberg

, et al. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. J Clin Microbiol 1990; 28(11): 2520–2525.

32.

Heard

Wagle

Vijayakumar

, et al. Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia. Arch Intern Med 1998; 158(1): 81–87.

33.

Moro

Vigano

CozziLepri

Risk factors for central venous catheter-related infections in surgical and intensive care units. Infect Control Hosp Epidemiol 1994; 15(4Pt. 1): 253–264.