Can the identification of an idle line facilitate its removal? A comparison between a proposed guideline and clinical practice

Areeba Kara, Cynthia S. Johnson, Michael Murray, Jill Dillon, Siu Hui

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: There are 250,000 cases of central line–associated blood stream infections in the United States annually, some of which may be prevented by the removal of lines that are no longer needed. OBJECTIVE: To test the performance of criteria to identify an idle line as a guideline to facilitate its removal. METHODS: Patients with central lines on the wards were identified. Criteria for justified use were defined. If none were met, the line was considered “idle.” We proposed the guideline that a line may be removed the day following the first idle day and compared actual practice with our proposed guideline. RESULTS: One hundred twenty-six lines in 126 patients were observed. Eighty-three (65.9%) were peripherally inserted central catheters. Twenty-seven percent (n= 34) were placed for antibiotics. Seventy-six patients had lines removed prior to discharge. In these patients, the line was in place for 522 days, of which 32.7% were idle. The most common reasons to justify the line included parenteral antibiotics and meeting systemic inflammatory response (SIRS) criteria. In 11 (14.5%) patients, the line was removed prior to the proposed guideline. Most (n = 36, 47.4%) line removals were observed to be in accordance with our guideline. In another 29 (38.2%), line removal was delayed compared to our guideline. CONCLUSIONS: Idle days are common. Central line days may be reduced by the consistent daily reevaluation of a line's justification using defined criteria. The practice of routine central line placement for prolonged antibiotics and the inclusion of SIRS criteria to justify the line may need to be reevaluated. Journal of Hospital Medicine 2016;11:489–493.

Original languageEnglish (US)
Pages (from-to)489-493
Number of pages5
JournalJournal of Hospital Medicine
Volume11
Issue number7
DOIs
StatePublished - Jul 1 2016

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Practice Guidelines
Guidelines
Anti-Bacterial Agents
Hospital Medicine
Catheters
Infection

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Can the identification of an idle line facilitate its removal? A comparison between a proposed guideline and clinical practice. / Kara, Areeba; Johnson, Cynthia S.; Murray, Michael; Dillon, Jill; Hui, Siu.

In: Journal of Hospital Medicine, Vol. 11, No. 7, 01.07.2016, p. 489-493.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: There are 250,000 cases of central line–associated blood stream infections in the United States annually, some of which may be prevented by the removal of lines that are no longer needed. OBJECTIVE: To test the performance of criteria to identify an idle line as a guideline to facilitate its removal. METHODS: Patients with central lines on the wards were identified. Criteria for justified use were defined. If none were met, the line was considered “idle.” We proposed the guideline that a line may be removed the day following the first idle day and compared actual practice with our proposed guideline. RESULTS: One hundred twenty-six lines in 126 patients were observed. Eighty-three (65.9{\%}) were peripherally inserted central catheters. Twenty-seven percent (n= 34) were placed for antibiotics. Seventy-six patients had lines removed prior to discharge. In these patients, the line was in place for 522 days, of which 32.7{\%} were idle. The most common reasons to justify the line included parenteral antibiotics and meeting systemic inflammatory response (SIRS) criteria. In 11 (14.5{\%}) patients, the line was removed prior to the proposed guideline. Most (n = 36, 47.4{\%}) line removals were observed to be in accordance with our guideline. In another 29 (38.2{\%}), line removal was delayed compared to our guideline. CONCLUSIONS: Idle days are common. Central line days may be reduced by the consistent daily reevaluation of a line's justification using defined criteria. The practice of routine central line placement for prolonged antibiotics and the inclusion of SIRS criteria to justify the line may need to be reevaluated. Journal of Hospital Medicine 2016;11:489–493.",
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