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Unnecessary removal of vascular access devices due to suspected infection in Australian intensive care units

  • India Pearse
    Correspondence
    Corresponding author at: Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia.
    Affiliations
    Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia

    School of Nursing and Midwifery, Griffith University, Queensland, Australia

    School of Nursing, Midwifery and Social Work, University of Queensland, Queensland, Australia
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  • Amanda Corley
    Affiliations
    Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia

    School of Nursing and Midwifery, Griffith University, Queensland, Australia

    School of Nursing, Midwifery and Social Work, University of Queensland, Queensland, Australia
    Search for articles by this author
  • Claire M. Rickard
    Affiliations
    Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia

    School of Nursing and Midwifery, Griffith University, Queensland, Australia

    School of Nursing, Midwifery and Social Work, University of Queensland, Queensland, Australia
    Search for articles by this author
  • Nicole Marsh
    Affiliations
    Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia

    School of Nursing and Midwifery, Griffith University, Queensland, Australia

    School of Nursing, Midwifery and Social Work, University of Queensland, Queensland, Australia
    Search for articles by this author
Published:October 25, 2021DOI:https://doi.org/10.1016/j.aucc.2021.09.005

      Abstract

      Background

      Vascular access devices suspected of infection are often removed unnecessarily and frequently require replacement. The aim of this study was to identify the prevalence and economic impact of premature, unnecessary device removal due to suspected infection in adult patients admitted to the intensive care unit.

      Methods

      Secondary data analysis of a prospectively collected data set detailing central venous catheters and peripheral arterial catheters in 1458 adult patients was conducted in nine Australian intensive care units. Data extracted from the parent database included patient demographics, device, and infection-specific data including the reason for device removal. Cost estimates were based on a recently published review of device utilisation and associated costs in Queensland public hospitals.

      Results

      A total of 6144 central venous catheter days and 4696 arterial catheter days were studied. Median device dwell time was 7.2 (interquartile range: 5.6–9.0) days for central venous catheters and 6.5 (interquartile range: 4.8–8.5) days for arterial catheters. Device removal due to suspected infection occurred at a rate of 25.7 and 15.3 episodes/1000 catheter days in central venous and arterial catheters, respectively. Central venous and arterial catheter–related bloodstream infections occurred at a rate of 1.8 and 0.2 episodes/1000 catheter days, respectively. Central line–associated bloodstream infection occurred at a rate of 3.3 episodes/1000 catheter days. Local central venous and arterial catheter infection occurred at 0.16 and 0.02 episodes/1000 catheter days, respectively. The difference in incidence between devices suspected of infection and those responsible for infection resulted in AUD$67,087 unnecessarily spent on device replacement.

      Conclusions

      Unnecessary device removal due to suspected infection presents a substantial clinical problem which is costly for the healthcare organisation and time-consuming for clinicians and places the patient at an increased risk of iatrogenic complications. There is a need for robust evidence and clinical practice guidelines to inform clinical decision-making to reduce unnecessary device removal.

      Keywords

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