Tracking via online tool leads to 46% reduction in CVC usage

By using an online tool to track central venous catheters (CVCs), physicians reduced the use of CVCs by 46 percent at two internal medicine teaching clinics.

Researchers Emily G. McDonald, MD, and Todd C. Lee, MD, MPh, of the Division of General Internal Medicine at the McGill University Health Center in Montreal, published their findings online in JAMA Internal Medicine on May 4.

They cited a previous study that found 21.2 percent of physicians did not know their patients had CVCs, which have been associated with adverse events such as thromboembolism and bloodstream infections.

In this analysis, the researchers collected data from Jan. 21, 2013 through March 27, 2013 and conducted their intervention from June 1, 2013 through Dec. 1, 2014. They defined CVCs as nontunneled, nondialysis catheters in jugular, subclavian or femoral veins or peripherally inserted central catheters.

Senior residents at the clinics recorded the number of CVCs once weekly and the indications they used them for such as bloodwork, intravenous antibiotics, total parenteral nutrition or chemotherapy.  The adherence rate was 70 percent.

The researchers found that the rate of CVCs per 100 patient days significantly decreased from 13.1 before the intervention to seven after the intervention. The annual rates of infections did not differ before and after the intervention.

The residents recorded 107 indications for the use of CVCs. The most popular indications were antibiotic administration (48.5 percent), ease of drawing blood for testing (20.6 percent), chemotherapy (12.1 percent), venous access in case of patient deterioration (11.2 percent) and parenteral nutrition (5.6 percent).

The researchers wrote that they did not perform a time-series analysis because they did not gather enough data at baseline, which could be a limitation of the study. They also wrote that the single-center design and including only inpatients could limit the study’s generalizability.

However, they noted the intervention was inexpensive and did not put patients at risk.