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

• Published in: The journal of vascular access Vol. 21; no. 1; p. 86
• Main Authors: Iordanou, Stelios, Middleton, Nicos, Papathanassoglou, Elisavet, Palazis, Lakis, Raftopoulos, Vasilios
• Format: Journal Article
• Language: English
• Published: United States 01.01.2020
• Subjects: Aged; Catheter-Related Infections - epidemiology; Catheter-Related Infections - microbiology; Catheter-Related Infections - prevention & control; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Catheterization, Central Venous - standards; Catheterization, Peripheral - adverse effects; Catheterization, Peripheral - instrumentation; Catheterization, Peripheral - standards; Catheters, Indwelling; Centers for Disease Control and Prevention, U.S; Central Venous Catheters; Cyprus - epidemiology; Device Removal - adverse effects; Device Removal - standards; Equipment Design; Female; Humans; Incidence; Male; Middle Aged; Practice Guidelines as Topic; Retrospective Studies; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome; Ultrasonography, Interventional - standards; United States; Cyprus; United States; catheter-related bloodstream infection; centrally inserted central catheters; Centers for Disease Control and Prevention; intensive care; peripheral venous access; bloodstream infection; central venous catheter; ultrasound
• ISSN: 1724-6032
• DOI: 10.1177/1129729819863556

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. 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. 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)). 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.