Central lines are commonly used in the care of hospitalized patients. Each day a central line is in place the risk of complications such as bloodstream infection rises. Yet central lines often remain in place after they are no longer clinically useful. Preliminary data suggests one obstacle to the timely removal of central lines may be physician being unaware–as was demonstrated in the case of urinary catheters. The goal of this study is to determine the extent of physician awareness of their patients’ central lines.
We interviewed intern, resident, and attending physicians on inpatient medical services at an academic hospital. Patients hospitalized on the medicine non‐ICU, medicine ICU, cardiology and hospitalist services were included. Physicians were read a list of patients for whom they had direct responsibility and asked whether each had (1) a central venous catheter (CVC) or (2) a peripherally inserted central catheter (PICC). “Yes” or “no” responses were recorded for both types of central line. Physician responses were cross‐checked with the hospital’s validated daily central line report for accuracy.
Summary of Results:
375 patient records were accessed and their providers interviewed regarding awareness of presence of a CVC or PICC. There were 218 interviews with interns, 264 with senior residents and 347 with attendings. 52 cases had a CVC and 23 a PICC. Of those with either a CVC or PICC, overall provider recall accuracy ranged from 82‐93 percent. On teaching teams, attendings were significantly more likely to miss a central line than residents or interns (p<0.01). There was no significant difference in missed lines between teaching attendings and hospitalists. Of the ICU attending interviews, lines were present in 36% compared to only 13% among non‐ICU. Attendings with work that included ICU care were less likely to miss a line (13.9 v 36.1%, p <0.05). These attendings were also more likely to falsely recall a line when no line was present than the non‐ICU attendings (15.4% v 5.3%, p <0.01).
Our results demonstrate that many physicians are not aware of whether their patient has a central line. Errors in recall occurred in both directions, potentially suggesting a deep‐rooted unawareness. The frequency of lines among patients may influence the direction of recall error. The overall greater awareness observed among interns could relate to smaller case‐loads.
Each day a physician fails to remove an unnecessary line unjustly exposes the patient to an increasing risk of complications. It is important to target awareness of central lines to improve patient safety.
To cite this abstract:Melin N, Chopra V, Thompson R. Awareness of Central Venous Catheters: A Patient Safety Survey. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 141. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/awareness-of-central-venous-catheters-a-patient-safety-survey/. Accessed April 7, 2020.