Sepsis is a common condition associated with high mortality. Abundant literature, including the Dillinger guidelines, suggests that prompt placement of a central venous catheter (CVC) is essential in treating sepsis effectively. Numerous barriers prevent the prompt placement of CVCs, including a lack of physician comfort, perceived inadequate physician compensation, lack of expertise, and lack of availability of physicians proficient in CVC placement. We developed a multidisciplinary central line schedule (MCLS) at our community teaching hospital to overcome these barriers to CVC placement.
To expedite the prompt placement of a central venous catheter in patients diagnosed with sepsis.
We developed a multidisciplinary central line schedule (MCLS) at our community teaching hospital (Fig. 1). Participating disciplines included hospital medicine, general surgery, vascular surgery, anesthesiology, and pulmonary critical care medicine. Responsibilities of being on call included returning calls within 30 minutes, and attempting the placement of a central venous catheter within 4 hours of being called, if the patient had sepsis with refractory hypotension or lactic acidosis. Using a retrospective cohort design, all hospitalizations with a principle diagnosis coded as sepsis in 2009 at our 110‐bed community teaching hospital were analyzed. Patient charts were reviewed by 2 physician reviewers, who abstracted the charts for lactic acidosis, refractory hypotension, and central venous pressure assessment. Refractory hypotension was defined as a systolic blood pressure less than 90 mm Hg after 1L of intravenous fluid administration. Lactic acidosis was defined as a lactic acid level greater than 4 mmol/L. The presence of either lactic acidosis or refractory hypotension signifies severe sepsis or septic shock. The MCLS was active only in the last 6 months of 2009. Eighty‐eight patients admitted to community teaching hospital in 2009 were diagnosed with sepsis. Of these, 42 had either lactic acidosis or refractory hypotension. 22 of 42 patients were hospitalized in the first 6 months, and 20 were hospitalized in the last 6 months. Seven of 22 patients had CVCs placed before the MCLS, and 7 of 20 patients had CVCs placed afterwards (see Table 1). Of the 14 patients who had CVCs placed, only 3 were placed within 6 hours of diagnosis.
Prompt placement of CVCs in patients with sepsis is recommended but carried out infrequently. A novel multidisciplinary central line call schedule failed to improve the rate of placement of CVCs for patients with sepsis. We suspect clinical inertia combined with insufficient knowledge resulted in the underuse of the MCLS. Further research and innovation rectifying poor rates of CVC placement are warranted.
H. Shabbir ‐ none; M. Yousefzadeh ‐ none
To cite this abstract:Shabbir H, Yousefzadeh M. A Multidisciplinary Central Line Schedule Did Not Improve the Rate of Central Venous Catheter Placement in Septic Patients. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 204. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/a-multidisciplinary-central-line-schedule-did-not-improve-the-rate-of-central-venous-catheter-placement-in-septic-patients/. Accessed May 26, 2019.