Clinicians frequently unaware of the presence of central venous catheters

1. Overall, 21.2% of clinicians did not know that their patient had a central venous catheter.

2. Housestaff and critical care physicians were most likely to know if their patients had a central venous catheter compared to hospitalists and teaching attendings.

Evidence Rating Level: 2 (Good)

Study Rundown: Central venous catheters (CVCs), such as peripherally inserted central catheters (PICCs) and non-tunneled triple lumen catheters are traditionally reserved for patients requiring intensive care, and complications related to CVCs like venous thromboembolisms and central-line bloodstream infections can be mitigated by removing idle catheters. In this cross-sectional study of intensive care unit (ICU) and non-ICU hospitalized patients at academic medical centers, clinicians in the care of the study participants were asked to determine, without using the electronic medical records, which of their patients had a CVC. Many clinicians, about one in five, did not know that their patient had a CVC, and a small number of clinicians incorrectly reported patients without CVCs that did have one present. Clinicians more closely involved with direct patient care (i.e., interns, residents and physician extenders) were more likely to be aware of CVC presence than attending physicians and hospitalists who oversee the management of many patients. Similarly, critical care specialists responsible for fewer patients were significantly more often aware of patients who had CVCs. This study shows that proximity to direct patient care and lower patient to provider ratios are associated with increased awareness of CVC presence. The major limitation of this study is inherent to cross-sectional studies in that the effect on patient outcomes is unknown.

Click to read the study in the Annals of Internal Medicine

Relevant Reading: Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “idle central venous catheter”.

In-Depth [cross-sectional study]: During morning rounds, 1,880 clinician interviews were conducted with clinicians involved in the care of the 990 participating patients to determine which of their patients had a CVC. The prevalence of CVCs was 21.1% of study participants (209/990 patients). Across all 425 clinician interviews regarding the 209 patients with CVCs, 21.2% knew their patient had a CVC. This ranged from 16.3% to 31.1% across medical centers, levels of training of the clinician, and clinician specialties. Lack of awareness of CVC presence was common; 19.1% of interns, 13.8% of residents, 25.8% of general medicine teaching attendings, 30.5% of hospitalists and 12.6% of critical care specialists did not know that their patient had a CVC. Housestaff (i.e., interns, residents and physician extenders) were significantly more frequently aware of CVCs than teaching attendings and hospitalists (16.4% vs. 27.3%; p=0.006). Critical care specialists were significantly more often aware of CVCs than attendings and hospitalists (16.4% vs. 30.5%; p=0.014).

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