Background:

Although central line (CVC) dwell time is a major risk factor for central line‐associated bloodstream infections (CLABSIs), there is little information about how often CVCs are retained when not needed (“idle”). We describe the use patterns of CVCs on medical wards.

Methods:

A retrospective chart review focused on daily CVC justification was obtained on a random sample of patients with a temporary CVC, including peripherally inserted central catheters (PICCs). An idle day was defined as a day with a CVC that did not meet the justification criteria in Figure 1. Each ward day, an eligible CVC was in place and was scrutinized for CVC necessity.

Results:

We analyzed 89 patients, 151 CVCs (80% were PICCs), and 1433 ward line days. Three hundred and sixty‐one CVC days (25%) were idle. Patients had a mean of 4.06 (SD 6.6) idle days if IV antimicrobials were considered a justification for the CVC, and 10.83 (SD 10.87) days if they were not. At least 1 and ≥2 idle days were seen in 63% and 48% of patients, respectively. Patients had an average of 7.37 (SD (8.3) days (median, 5 days) on the ward with a peripheral IV (PIV) and a mean of 3.43 days with both a CVC and PIV. Eighty‐one percent of patients had at least 1 day with a PIV. Compared to those without a PICC, PICC patients had 1.61 times longer CVC dwell times (95% CI, 1.37–1.89; P < 0.0001) adjusting for ward days and 1.47 times more idle days (95% CI, 1.19–1.82; P = 0.0004) adjusting for ward CVC days. Patients without a PICC had 1.84 times more PIV days than the PICC group (95% CI, 1.54–2.19; P < 0.0001) adjusting for ward days. However, most patients (77%) in the PICC group had at least 1 day with a PIV, and PICC patients had a mean of 6.88 days with a PIV and 3.5 days with both a CVC and a PIV. Patients with a PICC often retained their CVC until the day of discharge. PICC patients who did not go home with their CVC were 3.11 times more likely to have their CVC removed on the day of discharge than non‐PICC patients (95% CI, 0.97–9.97; P = 0.0526); see Table 1.

Conclusions:

A quarter of ward CVC days were idle among medical‐floor patients. PIVs were possible for most patients, even those with PICCs. PICC use was associated with longer CVC dwell time, more idle days, and less PIV use, and PICCs lines were often retained until the day of discharge. The combination of the above factors may adversely affect CLABSI rates.

Disclosures:

S. Chernetsky Tejedor ‐ Baxter Healthcare, research grant; C. Payne ‐ none; J. Stein ‐ none; D. Dressler ‐ none; D. Tong ‐ none