PURPOSE: Central venous catheters (CVC) are frequently used in the ICU. The use of ultrasound guidance, use of antimicrobial-impregnated catheters, and avoidance of femoral vein cannulation are practices recommended to improve patient safety. Guidelines for management of CVCs in the critically ill febrile patient exist. To learn more about physician practices related to CVC management, we performed surveys at recent medical meetings.
METHODS: A fourteen item survey including questions regarding respondent characteristics, insertion site selection, use of ultrasound, use of antimicrobial catheters, and management of CVC in febrile patients with various clinical scenarios was completed by attendees of CVC-related lectures given by one author (CNS) at the 2002 Virginia Thoracic Society meeting and the 2003-2005 CHEST meetings.
RESULTS: A total of 140 respondents who manage CVCs completed surveys. The internal jugular (45.5%), subclavian (39.7%), and femoral (14.2%) vein insertion sites were used most often. Ultrasound guidance was personally utilized by only 25.7% of respondents, and only 4% used ultrasound for most of their catheter insertions. 48.5% of respondents used antimicrobial catheters for at least some patients. There were no significant differences in responses for these parameters over the survey years. Catheter management was variable for a febrile non-shock patient with low (Scenario A) or high (Scenario B) risk for mechanical complications from CVC (i.e. among 5 management strategies, no single choice was selected by >50% of respondents). However, for a febrile patient in shock (Scenario C), 67% of respondents selected CVC removal and insertion a new CVC at a different site.
CONCLUSION: There is variability in physician practice regarding preferred insertion site and antimicrobial catheters, and underutilization of ultrasound guidance. There is little consensus among physicians when faced with different clinical scenarios involving CVC management in the critically ill febrile patient. CVC practice changed little over the years surveyed.
CLINICAL IMPLICATIONS: Further investigation is needed to determine the factors that influence physician practice and decision-making regarding CVCs in the ICU setting.
DISCLOSURE: Deborah Rowlands, None.