Does My Patient Have a Central Line?

Published in Ann Intern Med 2014 Oct 21; 161:607

Authors: Taichman DB.

Many providers are unaware of central lines in their patients.

A key strategy to prevent complications from central venous catheters (CVCs; triple-lumen catheters or peripherally inserted central catheters [PICCs]) is to remove lines when they are no longer needed. The first step in knowing when to remove lines is recognizing their presence.

Investigators at three U.S. academic medical centers examined nearly 1000 patients and identified more than 200 with CVCs in place. Subsequent surveys, given to more than 1800 primary inpatient clinicians (residents, advanced practice providers [e.g., physician assistants, nurse practitioners], and attending physicians) following morning rounds on their patients, showed that 21% of clinicians were unaware of CVCs in their patients. Lack of central line awareness was significantly higher in settings outside of intensive care units (25% vs. 13%) and among attendings (hospitalists who primarily cared for patients or teaching attendings) compared with residents and advanced practice providers (27% vs. 16%).

Comment
With the paramount individual and collective responsibility to provide safe patient care, recognizing that invasive devices are present and removing them when they are no longer needed is essential to prevent line infections and thromboses. This trial documents a larger problem of inertia in medical practice: Clinicians frequently “forget” to stop medications, lab testing, urinary catheters, and other interventions when they no longer benefit the patient. This inertia can be overcome by meticulous daily review of all interventions and orders, backed up by systems solutions such as prompts, checklists, and interdisciplinary rounding.