992: QUALITY IMPROVEMENT PROJECT TO REMOVE UNNECESSARY CENTRAL VENOUS CATHETERS IN THE NON-ICU SETTING

Abstract

Introduction: Indications for the use of central venous catheters (CL) outside the ICU are limited and prolonged use is associated with CL associated infections (CLABSI). This quality improvement study aimed to reduce the number of unnecessary CLs in the non-ICU setting. Methods: A prospective interventional study was performed between April 4 and July 3, 2022, at a large tertiary care center. Daily chart audits were conducted on all non-ICU adult patients who had a non-tunneled CL to include peripherally inserted central catheters (PICC). Discharged patients, CLs removed prior to audit, duplicate documentation, or inaccurately labeled tunneled lines as non-tunneled were excluded. Predetermined non-ICU indications for CL use were need for hemodialysis (HD), chemotherapy, total parenteral nutrition (TPN), long-term antibiotics (ABX), inotropes, and lack of IV access as a last resort. If the CL met indications, the chart was re-audited at one-week intervals to assess for ongoing need. Otherwise, the primary teams were advised to remove CLs. Descriptive statistics were used for analysis. Results: Of 1093 charts audited, 536 CLs were addressed (male: 60.1%; mean age: 60.7 ±14.5). Locations of insertion were the floors (48.5%), the ICUs (24.6%) and the OR (16.6%). PICC lines constituted 62.1% of all CLs. Indications for CL placement were ABX (24.4%), vasopressors (20.9%), TPN (16.9%), inotropes (16.0%) and HD (12.1%). CL use in 9.9% of patients did not meet indications and were removed after prompting. Of 553 CLs placed in the ICU, 23.9% made it to the floor; 18.9% of these did not meet indications. Our intervention rate decreased in time: 16.2% in the first two weeks vs 6.8% in the last week of the study period. There was no significant change in the number of CLABSIs in the study period (n=2) as compared to the three months prior (n=3) and a similar pre-COVID-19 time period (2019: n=2). All CLABSIs during the study period had appropriate indications for use. Conclusions: Approximately 10% of CLs outside the ICU did not have appropriate indications. A daily audit protocol on the floors reduced CL days. A significant proportion of CLs placed in the ICUs were inappropriately continued and should be removed when its use is no longer indicated. Continued education is essential to reduce inappropriate CL use.