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Infection and natural history of emergency department-placed central venous catheters
Christopher H LeMaster1, Jeremiah D Schuur, Darshan Pandya
1Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. lemasterchris@gmail.com
Insights
Central line-associated bloodstream infections (CLABSI) from emergency department (ED) central venous catheters occur at a rate similar to intensive care units. These catheters remain in patients for a significant duration after admission.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Critical Care Medicine
Background:
- Central line-associated bloodstream infection (CLABSI) is a significant hospital-acquired infection.
- No prior studies have specifically assessed CLABSI rates for central venous catheters placed in the emergency department (ED).
Purpose of the Study:
- To determine the rate of bloodstream infection (BSI) for central venous catheters placed in the ED.
- To evaluate the duration of catheterization for ED-placed central venous catheters.
Main Methods:
- A retrospective chart review was conducted using hospital infection control, administrative, and ED billing data.
- Identified patients with central venous catheters placed in the ED between January 2007 and December 2008.
- Confirmed BSIs and catheterization duration through structured chart review.
Main Results:
- The study identified 656 patients with ED-placed central venous catheters, totaling 3,622 catheter-days and 7 BSIs.
- The rate of BSI was 1.93 per 1,000 catheter-days (95% CI 0.50 to 3.36).
- Mean catheter duration was 5.5 days, with infected catheters remaining for a mean of 8.6 days.
Conclusions:
- The bloodstream infection rate for central venous catheters placed in the ED is comparable to rates observed in intensive care units (ICUs).
- Central venous catheters inserted in the ED are often retained in admitted patients for extended periods.
Study Objectives:
Central line-associated bloodstream infection (CLABSI, hereafter referred to in this paper as "bloodstream infection") is a leading cause of hospital-acquired infection. To our knowledge, there are no previously published studies designed to determine the rate of bloodstream infection among central venous catheters placed in the emergency department (ED). We design a retrospective chart review methodology to determine bloodstream infection and duration of catheterization for central venous catheters placed in the ED.
Methods:
Using hospital infection control, administrative, and ED billing databases, we identified patients with central venous catheters placed in the ED between January 1, 2007, and December 31, 2008, at one academic, urban ED with an annual census of 57,000. We performed a structured, explicit chart review to determine duration of catheterization and confirm bloodstream infection.
Results:
We screened 4,251 charts and identified 656 patients with central venous catheters inserted in the ED, 3,622 catheter-days, and 7 bloodstream infections. The rate of bloodstream infection associated with central venous catheters placed in the ED was 1.93 per 1,000 catheter-days (95% confidence interval 0.50 to 3.36). The mean duration of catheterization was 5.5 days (median 4; range 1 to 29 days). Among infected central venous catheters, the mean duration of catheterization was 8.6 days (median 7; range 2 to 19 days). A total of 667 central venous catheters were placed in the internal jugular (392; 59%), subclavian (145; 22%), and femoral (130; 19%) veins. The sensitivity of using ED procedural billing code for identifying ED-placed central venous catheters among patients subsequently admitted to any ICU was 74.9% (95% confidence interval 71.4% to 78.3%).
Conclusion:
The rate of ED bloodstream infection at our institution is similar to current rates in ICUs. Central venous catheters placed in the ED remain in admitted patients for a substantial period.
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