Accidental catheter removal in critically ill patients: a prospective and observational study

Leonardo Lorente, María S Huidobro, María M Martín, Alejandro Jiménez, María L Mora, Leonardo Lorente, María S Huidobro, María M Martín, Alejandro Jiménez, María L Mora

Abstract

Introduction: The importance of accidental catheter removal (ACR) lies in the complications caused by the removal itself and by catheter reinsertion. To the best of our knowledge, no studies have analyzed accidental removal of various types of catheters in the intensive care unit (ICU). The objective of the present study was to analyze the incidence of ACR for all types of catheters in the ICU.

Methods: This was a prospective and observational study, conducted in a 24-bed medical/surgical ICU in a university hospital. We included all consecutive patients admitted to the ICU over 18 months (1 May 2000 to 31 October 2001). The incidences of ACR for all types of catheters (both per 100 catheters and per 100 catheter-days) were determined.

Results: A total of 988 patients were included. There were no significant differences in ACR incidence between the four central venous access sites (peripheral, jugular, subclavian and femoral) or between the four arterial access sites (radial, femoral, pedal and humeral). However, the incidence of ACR was higher for arterial than for central venous catheters (1.12/100 catheter-days versus 2.02/100 catheter-days; P < 0.001). The incidences of ACR/100 nonvascular catheter-days were as follows: endotracheal tube 0.79; nasogastric tube 4.48; urinary catheter 0.32; thoracic drain 0.56; abdominal drain 0.67; and intraventricular brain drain 0.66.

Conclusion: We found ACR incidences for central venous catheter, arterial catheter, endotracheal tube, nasogastric tube and urinary catheter that are similar to those reported in previous studies. We could not find studies that analyzed the ACR for thoracic, abdominal, intraventricular brain and cardiac surgical drains, but we believe that our rates are acceptable. To minimize ACR, it is necessary to monitor its incidence carefully and to implement preventive measures. In our view, according to establish quality standards, findings should be reported as ACR incidence per 100 catheters and per 100 catheter-days, for all types of catheters.

References

    1. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995;274:639–644. doi: 10.1001/jama.274.8.639.
    1. Nyström B, Larsen SO, Dankert J. Bacteremia in surgical patients with intravenous devices: a European multicenter incidence study. The European Working Party on Control of Hospital Infections. J Hosp Infect. 1983;4:338–349. doi: 10.1016/0195-6701(83)90004-X.
    1. Vallés J, León C, Alvarez F, Working Group of Infectious Diseases Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Clin Infect Dis. 1996;24:387–395.
    1. Collignon PJ. Intravascular catheter associated sepsis, a common problem: the Australian Study on Intravascular Catheter Associated Sepsis. Med J Aust. 1994;161:374–378.
    1. Moro ML, Vigano EF, Cozzi A. Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter Related Infections Study Group. Infect Control Hosp Epidemiol. 1994;15:253–264.
    1. Richet H, Hubert B, Nitemberg G, Andremont A, Buu-Hoy A, Ourba C, Veron M, Boisivon A, Bouvier AM. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter culture in intensive care unit patients. J Clin Microbiol. 1990;28:2520–2525.
    1. The National Nosocomial Infections Surveillance System National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from October 1986–April Issued June 1998. Am J Infect Control. 1998;26:522–533.
    1. Marcos M, Ayuso D, González B, Carrión MI, Robles P, Muñoz M, de la Cal MA. Analysis of the accidental withdrawal of tubes, probes and catheters as a part of the program of quality control [in Spanish] Enfermería Intensiva. 1994;3:115–120.
    1. García MP, López P, Eseverri C, Zazpe C, Asiain MC. Quality of care in intensive care units. Retrospective study on long-term patients [in Spanish] Enfermería Intensiva. 1998;9:102–108.
    1. Carrión M, Ayuso D, Marcos M, Robles P, de la Cal MA, Alía I, Esteban A. Accidental removal of endotracheal and nasogastric tubes and intravascular catheters. Crit Care Med. 2000;28:63–66. doi: 10.1097/00003246-200001000-00010.
    1. Valls C, Sanz C, Jover C, Sola N, Sola M, Saez E, Ingles T, Delgado P, Cerezales J, Blasco M. Assistance quality program in intensive care units. Analysis of the effectiveness of correcting measures [in Spanish] Enfermería Intensiva. 1994;5:109–114.
    1. Goni C, Perez A, Ruiz R, Carrascosa MC, Vazquez MS, Martinez A. Central venous access by the Seldinger technic in neonatology. Cir Pediatr. 1999;12:165–167.
    1. Fratino G, Mazzola C, Buffa P, Torre M, Castagnola E, Magillo P, Molinari AC. Mechanical complications related to indwelling central venous catheter in pediatric hematology/oncology patients. Pediatr Hematol Oncol. 2001;18:317–324. doi: 10.1080/088800101300312582.
    1. Coppolo DP, May JJ. Self-extubations: a 12-month experience. Chest. 1990;98:165–169.
    1. Vassal T, Anh NGD, Gabillet JM, Guidet B. Prospective evaluation of self-extubations in a medical intensive care unit. Intensive Care Med. 1993;19:340–342.
    1. Whelan J, Simpson SQ, Levy H. Unplanned extubation. Predictors of successful termination of mechanical ventilatory support. Chest. 1994;105:1808–1812.
    1. Giraud T, Dhainaut JF, Vaxelaure JF. Iatrogenic complications in adult Intensive Care Units: a prospective two-center study. Crit Care Med. 1993;21:40–50.
    1. Tindol GA, DiBenedetto RJ, Kosciuck L. Unplanned extubations. Chest. 1994;105:1804–1807.
    1. Rovira I, Heering CH, Zavala E, Mancebo J, Aldalia R, Alcón A. Incidence of unplanned extubation in a surgical intensive care unit [abstract] Intensive Care Med. 2001;27:s269. doi: 10.1007/s001340000796.
    1. Solsona JF, Marrugat J, Vázquez A, Miró G, Martínez R, Nolla J. Quality assurance in critically ill patients: recording of complications related to mechanical ventilation [in Spanish] Medicina Intensiva. 1998;22:91–95.
    1. Betbesé AJ, Pérez M, Bak E, Ballús J, Net A, Mancebo J. Incidence and consequences of unplanned endotracheal extubation [in Spanish; abstract] Medicina Intensiva. 1994;18:s46.
    1. Miró G, Solsona JF, Marrugat J, Nolla J, Vázquez A, Alvarez F, Albert I. Self-extubation and mortality [abstract] Medicina Intensiva. 1995;19:s76.
    1. Chiang AA, Lee KC, Lee JC, Wei CH. Effectiveness of a continuous quality improvement program aiming to reduce unplanned extubation: a prospective study. Intensive Care Med. 1996;22:1269–1271. doi: 10.1007/s001340050250.

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