Samantha Keogh1,2,3, Emily Larsen2,3,4,5, Amanda Corley2,3,4,5,6, Mari Takashima6, Nicole Marsh1,2,3,4,5,6, Melannie Edwards7, Health Reynolds2,3, Jayesh Dhanani2,8, Fiona Coyer1,2,6, Kevin Laupland1,2, Claire Rickard2,3,6,8,9
1School of Nursing and Centre for Healthcare Transformation, QUT, Brisbane, Qld, Australia
2Departments of Intensive Care Services, Anaesthesia and Perioperative Medicine, Nursing and Midwifery Research, Royal Brisbane and Women’s Hospital, Brisbane, Qld, Australia
3Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia
4School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia
5Patient Centred Health Services, Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
6School of Nursing, Midwifery and Social Work; Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Qld, Australia
7Intensive Care Unit, The Prince Charles Hospital, Brisbane, Qld, Australia
8UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
9 Herston Infectious Disease Institute (HeIDI), Metro North Health, Brisbane, Qld, Australia
Introduction
Access to arterial circulation through arterial catheters (ACs) is crucial for monitoring and decision-making in intensive care units (ICU), but they carry the risk of complications including bloodstream infection (BSI).
Method
We conducted a secondary analysis of data from four randomised controlled trials in Australian ICUs, investigating the efficacy of AC dressing and securement techniques. De-identified data were combined into a single dataset, and per-patient outcomes analysed. The primary outcome was AC-BSI, defined as laboratory-confirmed bloodstream infection (LCBI) type 1 or 2, with a concurrent local infection. All-cause AC failure was defined as any unplanned removal. AC infection and failure were reported as rates per 1000 catheter days.
Results
Data from 1117 adult patients were analysed. Mean age was 58.8 years (±16.6); and 41% (n=462) were male. Median AC dwell time was 110 hours (IQR 28.3-168.0). Fifteen patients had a confirmed BSI inclusive of one case (<0.1%) of AC-BSI due to Candida parapsilosis (0.18/1000 catheter days [95% CI 0.03-1.29]), and 14 cases of LCBI (1%; 13 LCBI-1 and 1 LCBI-2; 2.54/1000 catheter days [95% CI 1.51-4.30]). LCBI were most commonly Enterococcus faecalis; Escherichia coli and Klebsiella pneumoniae. There were four cases of local infection (<1%). Overall AC failure rate was 13% (n=146) or 26.53/1000 catheter days (95% CI 22.56-31.20).
Conclusion
ACs are frequently used in ICUs, but their associated complications and potential harm receive less attention than other invasive devices. This study highlights the importance of recognising and monitoring the risks associated with ACs to mitigate patient harm.
Biography
Samantha Keogh is a Professor at the QUT School of Nursing and Centre for Healthcare Transformation, as well as a Senior Researcher with the Alliance for Vascular Access Teaching and Research (AVATAR). Her clinical background is in intensive care (adult and paediatric), so she understands the importance of vascular access to deliver essential drugs, fluids and blood products, as well as facilitate vital monitoring and sampling. Samantha and her colleagues’ research and teaching is aimed at promoting safety and excellence in vascular access to optimise patient outcomes.