In the management of critically ill patients, I imagine that they experience cases where two central venous catheters are simultaneously placed for purposes such as dialysis and parenteral nutrition (TPN). However,Multiple detentionsBut how much exactly?Does it increase the risk of central venous catheter-related bloodstream infection (CLABSI)?Do you know any specific numbers?
In this article, we present a study that quantifies the CLABSI risk that is added when the second central venous catheter is used simultaneously.
Documentation information
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2761992
Comparison of rates of central line-associated bloodstream infections in patients with 1 vs 2 central venous catheters
William C. Dube, et al. JAMA Network Open. 2020;3(3):e200396.
Background and purpose
• The CLABSI surveillance methodology by the National Healthcare Safety Network (NHSN) in the United States does not take into account the potential additional risk associated with using two CVCs simultaneously (simultaneous CVCs).
Therefore, facilities that care for many critically ill patients requiring simultaneous CVC use based on medical indications may be unfairly assessed as having a high CLABSI incidence rate and may face penalties.
• The purpose of this study is to quantify the CLABSI risk associated with the simultaneous use of the second CVC.
Research methods
• Research design: Backward Cohort Study (January 1, 2012 – December 31, 2017)
• Target: 50,254 adult patients with CVCs in place for more than 2 days at four general acute care hospitals in the Atlanta area of the United States
• Evaluation method: Using trend-scoring matching to assess the possibility of concomitant use of patients, we compared and evaluated the CLABSI risk with and without concomitant use.
Result
A total of 64,575 CVCs were used, and 647 CLABSI cases were recorded. The same period saw 13.7% CVCs used (6,877 people), with the main indications being nutrition (14.1%) and hemodialysis (43.4%).
• CLABSI incidence rate (after trend score matching):
• Group using CVC at the same time: 1.9%
• Single CVC group: 1.0%
• Risk due to detention period:
• Patients with two CVCs in place for longer than two-thirds of the duration of CVC use had a significantly increased risk of developing CLABSI (adjusted risk ratio 1.62).
• Daily Hazard (risk ratio for a single low-risk CVC):
• Simultaneous use of two low-risk CVCs: 1.78 times
• Simultaneous use of one low-risk CVC and one high-risk CVC: 1.80 times
• Simultaneous use of two high-risk CVCs: 1.78 times
Results from multivariate analysis and survival analysis showed that regardless of the combination of CVCs (severity of risk), simultaneous use increased the daily CLABSI risk by approximately 80% (approximately twice).
Conclusion and summary
The simultaneous use of CVC is associated with approximately twice the CLABSI risk compared to the use of a single low-risk CVC. To prevent bias between facilities, performance metrics should be modified to account for these patient risk variations.
The most important point of this study is that "just having a second CVC exposes patients to about 80% extra infections every day."
A concrete action we can take in the clinical setting is to assess daily whether two CVCs are really needed at the same time. As pointed out in this study, considering increasing the number of catheters instead of increasing the lumen count (number of lumens) may be justified.
The implementation of basic infection control measures, such as removing unnecessary catheters early, is extremely important in preventing serious complications and protecting the safety of patients.
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