Ms India Lye1,2, Ms Nicole Marsh1,3, Ms Amanda Corley1,2, Professor Claire Rickard1,3
1Griffith University, Brisbane, Australia,
2Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia,
3Royal Brisbane and Women’s Hospital, Brisbane, Australia
Critically ill patients require multiple vascular access devices (VADs) and are therefore at increased risk of VAD-related infection, which can increase ICU and hospital length-of-stay, morbidity and therapy-related costs. Clinicians struggle to diagnose VAD-related infection without removing the VAD to culture the catheter tip. However, up to 91% of VADs removed on suspicion of infection are not actually infected, exposing the patient to potential complications associated with VAD re-insertion. This study determined the prevalence and economic impact of premature and unnecessary central venous catheter (CVC) and intra-arterial line (IAL) removal due to suspected infection.
A secondary data analysis of a pre-existing dataset detailing 1,458 adult ICU patients across Australia. Data extracted from the parent database included patient demographic, VAD-specific and infection-specific data.
Mean patient age was 57 years, and 66% of patients were male. Average VAD dwell time was 7.5 days. Of the 230 VADs removed for suspected infection, 36 catheter tips were cultured, and only ten tips were returned positive growth >15 CFU. This resulted in AUD$67,111 of organisational funds unnecessarily spent on VAD removal. Twenty CVC-related and 16 IAL-related BSIs were identified (3.3 and 0.34 episodes per 1000 catheter days respectively).
Unnecessary VAD removal due to suspected infection presents a substantial clinical problem which is costly for the healthcare organisation, time-consuming for clinicians, and places the patient at increased risk of iatrogenic complications. There is a need for robust clinical practice guidelines to inform clinical decision-making to reduce the impact of unnecessary VAD removal.
India is an adjunct research fellow with Griffith University and also an acting nurse researcher at The Prince Charles Hospital. She is currently undertaking a Master of Critical Care Nursing at Griffith University.