Do Clinicians Know Which of Their Patients Have Central Venous Catheters?

Abstract

Background Complications associated with central venous catheters (CVCs) increase over time. Although early removal of unnecessary CVCs is important to prevent complications, the extent to which clinicians are aware that their patients have a CVC is unknown. Objective To assess how often clinicians were aware of the presence of triple-lumen or peripherally inserted central catheters (PICCs) in hospitalized patients. Design Multicenter, cross-sectional study. Setting Three academic medical centers in the United States. Patients Hospitalized medical patients in intensive care unit (ICU) and non-ICU settings. Measurements To ascertain awareness of CVCs, we first determined whether a PICC or triple-lumen catheter was present; clinicians were then queried about device presence. Differences in device awareness among clinicians were assessed by chi-square tests. Results 990 patients were evaluated, and 1881 clinician assessments were done. The overall prevalence of CVCs was 21.1% (n = 209), of which 60.3% (126 of 209) were PICCs. A total of 21.2% (90 of 425) of clinicians interviewed were unaware of the presence of a CVC. Unawareness was greatest among patients with PICCs, where 25.1% (60 of 239) of clinicians were unaware of PICC presence. Teaching attendings and hospitalists were more frequently unaware of the presence of CVCs than interns and residents (25.8% and 30.5%, respectively, vs. 16.4%). Critical care physicians were more likely to be aware of CVC presence than general medicine physicians (12.6% vs. 26.2%; P = 0.003). Limitations Awareness was determined at 1 point in time and not linked to outcomes. Patient length of stay and indication for CVC were not recorded. Conclusion Clinicians are frequently unaware of the presence of PICCs and triple-lumen catheters in hospitalized patients. Further study of mechanisms that ensure that clinicians are aware of these devices so that they may assess their necessity seems warranted. Primary Funding Source None.

Variation in prevalence and patterns of peripherally inserted central catheter use in adults hospitalized with pneumonia

“…Although originally developed for total parenteral nutrition in surgical patients, contemporary reports of PICC use in critical illness, diseases such as cystic fibrosis, and even pregnancy are now common. Although PICCs are clinically invaluable in many of these conditions, growing use of these devices has led to the realization that benefits may be offset by complications . Additionally, recent data suggest that not all PICCs may be used for appropriate reasons.…”

“…In another study at an academic medical center, a substantial proportion of PICCs were found to be “idle” or unjustified . It comes as little surprise, then, that a recent multicenter study found that 1 out of every 5 clinicians did not even know that their patient had a PICC . Although calls to improve PICC use in the hospital setting have emerged, strategies to do so are limited by data that emanate from single‐center reports or retrospective designs.…”

“…Although PICCs are clinically invaluable in many of these conditions, growing use of these devices has led to the realization that benefits may be offset by complications. 9,10,29,30 Additionally, recent data suggest that not all PICCs may be used for appropriate reasons. For instance, in a decade-long study at a tertiary care center, changes in patterns of PICC use including shortened dwell times, multiple insertions in a single patient, and unclear indications for use were reported.…”

Physician awareness of patient cardiac telemetry monitoring

“…Lack of provider awareness has also been found in other spheres where overuse has been demonstrated, such as urinary catheter and central line use. [3,4] Lessons learned from implementation of other line and catheter removal strategies are likely to also be applicable here. Contributing factors to unawareness likely include multiple handoffs, complex pa-tient care decisions which demand providers' attention, and lack of institutional focus on cardiac monitoring.…”

“…Prior research has shown physicians are often unaware of the presence of urinary catheters and central lines. [3,4] We hypothesized that providers are also often unaware of ongoing telemetry monitoring, which may contribute to continuation of unnecessary use. Furthermore, we hypothesized that providers were unfamiliar with the appropriate indications for cardiac monitoring.…”