J. R. MacDermott1, C. H. Cook3, J. Flaherty1, C. Jones2 1Ohio State University,Wexner Medical Center,Columbus, OH, USA 2Ohio State University,Department Of Surgery, Division Of Trauma, Critical Care, And Burn,Columbus, OH, USA 3Beth Israel Deaconess Medical Center,Department Of Surgery,Boston, MA, USA
Introduction: Central venous catheters (CVCs) are often necessary during critical illness, but are associated with higher rates of blood stream infections than peripheral intravenous catheters (PIVs). To augment ongoing efforts to reduce central line-associated bloodstream infections (CLABSIs), we sought to limit durations that CVCs are in place by placing PIVs and removing CVC as quickly as possible. Because PIV placement in critically ill patients is often difficult, we developed a team of surgical intensive care unit (SICU) nurses trained to use ultrasound (US) to place PIVs in SICU patients. We hypothesized that training SICU nurses to use US guidance for PIV placement in critically ill patients would reduce CVC catheter days and thereby reduce the rate of CLABSI.
Methods: We retrospectively reviewed data gathered prospectively from 2011 through 2014 regarding individual attempts by the nursing team at US-guided PIV (US-PIV) placement and further evaluated pre-existing SICU quality databases of central line usage, patient census, and incidence of CLABSI from 2009 to 2014. Monthly rates of central line usage were calculated from central line days and patient days. Rates of CLABSI were evaluated quarterly as infections per 1000 central line days. Differences between rates before and after implementation of the US-PIV team were analyzed via Kruskal-Wallis testing.
Results: From 2011 to 2014, 2748 attempts at US-PIV placement were recorded, with placement of 2440 PIVs in 1646 patients (success rate 89%). Rates of central line usage trended down from 61.8 central line days per 100 patient days before US-PIV team implementation (monthly range 49.6-76.0) to 58.7 central line days per 100 patient days after its implementation (38.6-81.5, p=0.208). CLABSI incidence decreased substantially from a rate of 2.40 per 1000 patient days prior to US-PIV team creation (quarterly range 1.48-3.46) to 0.85 per 1000 patient days thereafter (0-2.43, p=0.0009).
Conclusion: Properly trained SICU nurses can be highly successful at US guided PIV placement. Implementation of this technology was associated with decreased central line usage and CLABSI when used in conjunction with other infection-reducing efforts. Effective CLABSI prevention requires a multifaceted approach; creation of a nursing team trained to place PIVs using ultrasound may be a useful adjunct to standard practices in improving these quality measures.