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216 Central Venous Catheter Site Maintenance: Hospital-Wide Assessment of Dressing Integrity

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Mark E. Rupp , University of Nebraska Medical Center, Omaha, NE
Kyle Cassling , University of Nebraska Medical Center, Omaha, NE
Hayley Faber , University of Nebraska Medical Center, Omaha, NE
Elizabeth Lyden , University of Nebraska Medical Center, Omaha, NE
Kate Tyner , Nebraska Medical Center, Omaha, NE
Nedra Marion , Nebraska Medical Center, Omaha, NE
Trevor Vanschooneveld , University of Nebraska Medical Center, Omaha, NE
Background: Proper care of central venous catheter (CVC) insertion sites is thought to be important in preventing central line-associated bloodstream infection (CLA-BSI).

Objective: Determine the hospital-wide level of compliance with CVC site care guidelines and correlate unit-specific CVC site care and CLA-BSI rates.

Methods: In order to determine unit-specific CVC dressing compliance rates, 2 trained observers performed weekly surveys of all inpatients with a CVC on each of 16 inpatient units during June/July 2010. Each dressing was evaluated using a standardized scoring form. CLA-BSI rates were determined by using standard CDC NHSN definitions.

Results: 420 CVC insertion sites were evaluated as follows: 160 (38.2%) antecubital PICCs, 98 (23.4%) non-tunneled (NT) internal jugular (IJ) CVCs, 66 (15.8%) subclavian (SC) CVCs, 52 (12.4%) SC subcutaneous ports, and 43 (10.3%) NT hemodialysis CVCs (site: 67% SC, 30% IJ). Only 2 CVCs (0.48%) were noted in the femoral location.  31% of CVC dressings were suboptimal and in need of change at the time of evaluation.  The most common indications for dressing change need were visible blood under the dressing (69%), marked edge lift or exposed insertion site (25.4%), and moisture under dressing (5.4%).  CVCs at the IJ site were more likely to require dressing change compared to other sites (p=0.007) and 45% of all IJ CVC dressings were graded as suboptimal/need of change. 47% of the dressings had a visible and legible date of last dressing change noted. The unit-specific suboptimal CVC dressing rate ranged from 10.5% to 57.9% (p=0.09).  There was no significant correlation between the unit-specific CLA-BSI rate and the unit-specific suboptimal CVC dressing rate (Spearman correlation 0.007, p =0.98).

Conclusions: Study limitations include conduction at a single institution over a relatively short period of time.  A substantial proportion of CVC dressings (31%) were suboptimal and in need of change at the time of evaluation.  The need for dressing change rate varied with the catheter insertion site and the patient care unit and IJ catheters were more likely to be in need of change.  Unit specific CLA-BSI rate did not directly correlate with compliance with CVC dressing guidelines.