Are Central Lines Placed in the ED Associated with Higher Risk for Bloodstream Infections?
The rate of bloodstream infections for central lines placed in a single emergency department was comparable to the rate for lines placed in the intensive care unit.
On January 1, 2010, The Joint Commission added to its quality measures a National Patient Safety Goal for use of maximum barrier precautions and a checklist and standardized protocol for placement of central venous catheters throughout the hospital, including in the emergency department (ED). In a retrospective chart review, researchers determined the rate of central line–associated bloodstream infections (CLABSIs) in a single urban academic ED in Boston before implementation of the checklist.
During 2007 and 2008, 656 patients underwent placement of central lines in the ED and 7 CLABSIs were reported. The CLABSI rate for lines placed in the ED was 1.93 per 1000 catheter-days. The CLABSI rate for lines placed in the hospital's ICU during 2008 was 1.51 per 1000 catheter-days, and the nationally reported rate for ICU-placed central lines was 2.05 per 1000 catheter-days.
Central lines placed in the ED are perceived as being more prone to infection than those placed in the ICU for myriad reasons, particularly the urgency with which such lines often are placed. However, in this single-hospital study, CLABSI rates were similar for lines placed in the ED and the ICU.
Richard D. Zane, MD, FAAEM
Published in Journal Watch Emergency Medicine January 7, 2011
Citation(s): LeMaster CH et al. Infection and natural history of emergency department–placed central venous catheters. Ann Emerg Med 2010 Nov; 56:492.