1Division of Infectious Diseases,Department of Medicine,Vanderbilt University School of Medicine,Nashville,Tennessee.
4Vanderbilt Home Care Services,Nashville,Tennessee.
Infect Control Hosp Epidemiol. 2018 Apr;39(4):439-444. doi: 10.1017/ice.2018.8. Epub 2018 Feb 15.
OBJECTIVE Outpatient central venous catheters (CVCs) are being used more frequently; however, data describing mechanical complications and central-line-associated bloodstream infections (CLABSI) in the outpatient setting are limited. We performed a retrospective observational cohort study to understand the burden of these complications to elucidate their impact on the healthcare system. METHODS Data were retrospectively collected on patients discharged from Vanderbilt University Medical Center with a CVC in place and admitted into the care of Vanderbilt Home Care Services. Risk factors for medically attended catheter-associated complications (CACs) and outpatient CLABSIs were analyzed. RESULTS A CAC developed in 143 patients (21.9%), for a total of 165 discrete CAC events. Among these, 76 (46%) required at least 1 visit to the emergency department or an inpatient admission, while the remaining 89 (54%) required an outpatient clinic visit. The risk for developing a CAC was significantly increased in female patients, patients with a CVC with >1 lumen, and patients receiving total parenteral nutrition. The absolute number of CLABSIs identified in the study population was small at 16, or 2.4% of the total cohort. CONCLUSIONS Medically attended catheter complications were common among outpatients discharged with a CVC, and reduction of these events should be the focus of outpatient quality improvement programs. Infect Control Hosp Epidemiol 2018;39:439-444.
门诊中心静脉导管(CVC)的使用频率越来越高;然而,描述门诊环境下机械并发症和与中心静脉导管相关的血流感染(CLABSI)的数据有限。我们进行了一项回顾性观察队列研究,以了解这些并发症的负担,阐明它们对医疗系统的影响。
回顾性收集范德比尔特大学医学中心出院并接受范德比尔特家庭护理服务的患者的 CVC 置管数据。分析了与医疗相关的导管相关并发症(CAC)和门诊 CLABSI 的危险因素。
143 名患者(21.9%)发生了 CAC,总计发生了 165 例离散的 CAC 事件。其中,76 例(46%)至少需要 1 次急诊就诊或住院治疗,而其余 89 例(54%)需要门诊就诊。女性患者、CVC 有>1 个腔和接受全胃肠外营养的患者发生 CAC 的风险显著增加。研究人群中确定的 CLABSI 绝对数量较少,为 16 例,占总队列的 2.4%。
门诊出院带管患者中常见 CAC,应将减少这些事件作为门诊质量改进计划的重点。