Do Physicians Know Which of Their Patients Have Central Venous Catheters? A Multi‐Center, Cross‐Sectional Study

1Ann Arbor VA Healthcare System, Ann Arbor, MI
2University of Michigan, Ann Arbor, MI
3Spectrum Healthcare System, Grand Rapids, MI
4University of Washington, Seattle, WA

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 77

Background:

Central venous catheters (CVCs) provide reliable venous access for infusion, phlebotomy, and hemodynamic monitoring. With the advent of the peripherally inserted central catheter (PICC), their use has grown significantly in hospitalized patients. However, CVCs are also associated with bloodstream infection and venous thromboembolism; removal of devices that are clinically no longer indicated is a key strategy in preventing these complications. However, in a national survey of hospitalists, 57% of respondents reported at least once forgetting that their patients had a PICC. Because device removal is predicated on catheter awareness, we designed a clinical study to determine how often physicians were aware of the presence of a CVC – including PICCs – in their hospitalized patients.

Methods:

Between May 2012 and September 2013, we conducted in‐person interviews of hospitalized patients and their assigned physicians at one west coast and two midwestern academic medical centers. Physicians from general internal medicine, hospital medicine, and subspecialty services (cardiology, gastroenterology, critical care) and patients under their care were included. We first interviewed and examined patients to determine whether any type of CVC was present. Following the patient interview, providers responsible for each patient were interviewed to ascertain awareness of device presence. Providers were allowed to refer to materials on their person (notes, cards), but not electronic records. As PICCs are more common in non‐ICU settings and placed in different sites (upper arm), we recorded PICC presence and awareness separately. We excluded hemodialysis, proline and midline catheters as we considered these specialty devices. Differences in device awareness between physicians were analyzed using chi‐square tests (alpha=0.05). Institutional review boards at each site provided approval for the study.

Results:

We evaluated 990 patients and obtained 1,881 unique physician‐patient assessments. Of the 990 patients, 95 (9.6%) were in intensive care settings. Physician responses from interns (454), residents (513), medicine attendings (245), subspecialists (176), intensivists (95), and hospitalists (398) were included.

The prevalence of CVCs was 21% (n=209), of which 60% (126/209) were PICCs. Overall, 21% of surveyed physicians were unaware of the presence of a CVC in their patients. Among patients with PICCs, 27% of providers were not aware of PICC presence. Compared to interns and residents, attending physicians and hospitalists were more often unaware of the presence of a CVC (28% vs. 13%, P=0.02) or PICC (33% vs. 22%, P=0.05). Residents and interns had roughly equal levels of unawareness (16% and 20%, P=0.5). Hospitalists and medical attendings were unaware when their patient had a CVC present 31% of the time.

Conclusions:

Physicians are frequently unaware of the presence of a CVC — especially PICCs – in their patients. While the extent to which such practice may lead to preventable harm is unknown, reminder systems to alert physicians to the presence of a CVC appear necessary.

To cite this abstract:

Chopra V, Govindan S, Sweis R, Teply M, Kuo S, Barron J, Thompson R, Saint S. Do Physicians Know Which of Their Patients Have Central Venous Catheters? A Multi‐Center, Cross‐Sectional Study. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 77. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/do-physicians-know-which-of-their-patients-have-central-venous-catheters-a-multicenter-crosssectional-study/. Accessed May 23, 2019.

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