Student - ICU central line access frequency

Specialties Critical

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Hi everybody, hope all is well =]

I'm a student working on a medtech project examining central line catheters. While they're not ideal, sometimes a central line needs to be inserted.

I want to better understand how ICU central lines are used and manipulated. I have a pretty good understanding of how central lines in say, hemodialysis patients, are used, and I want to compare the differences between the two.

Based off your experience, how many times is the average ICU central line (CVC or PICC) accessed a day? I could see how this number can vary, from the condition the patient has to the severity of said condition. From a family friend who's a NP in San Diego, she said it can be anywhere between 6-10 times a days, with patients having a CVC for up to 10 days (in extreme cases) and PICCs for 30 days. Is this something that y'all have seen?

Thanks a lot for everybody's valuable input. Your insight is extremely helpful and I hope it'll help me better understand how catheters are used in an ICU setting.

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Great question. So we do try to limit how many times we access the central line to decrease the risk of a CLABSI. We *try* to access it no more than x3/24 hours. However as you said, often the need to more frequently access an invasive line increases as a patient's acuity changes/increases...eg q4hr labs results in x6 times/day. Trying to "cluster" your lab draws/invasive line interventions helps to cut down on the number of times you access the line. We also utilize green Curos disinfecting caps, daily CHG baths, and meticulous dressing changes/line care to try to cut down on CLABSI rates.

A key issue is that often we have multiple types of invasive lines & devices in one patient eg: trialysis, double lumen CVC, MAC or venous sheath with swan ganz, arterial lines, arterial-sheaths with a balloon pump/Impella/etc, PICC's, IO, ports, permacaths, etc...so infection concern applies when accessing all of the invasive lines in a patient.

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Specializes in Critical Care and ED.

I think that very much depends what kind of unit you're on. I worked in an open heart cardiac ICU and we access central lines multiple times a day. I couldn't even count how many times. We'd constantly be starting new drips, hanging blood, giving antibiotics, one-off meds, sedation, FFP etc. It was unlimited and endless. Sometimes they'd have more than one central line and we still didn't have enough access so there would be a constant shuffling of drips rotating through various lines because of compatibility issues.

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Specializes in ICU.

I agree. It depends on the unit but in the ICU, the chances are they have a central line because they are sick enough that they need one. And usually in those cases, you access it when you need it, which can be multiple times in an hour. I can't think of an instance where I would hold a medication because I didnt want to increase to risk of infection from accessing the line.

Typically, there is an effort to remove them as soon as possible. If they've had it around 10 days, that is usually when they try to figure out a different way. Some ICU's do not use piccs because research shows they clot more often in the ICU, but I've also worked in ICU's that use them more than IJ's.

If the patient is that sick and there is no other way to access, the IJ will usually stay put for as long as we need it, unfortunately. The alternative is insufficient access or inappropriate access (as in the case of PIV and caustic medication), which if they are very sick could actually be more harmful than a high risk for central line infection. Admittedly I have also seen PICCs in people for months on end... like more than 3.

Naturally, central lines are used more frequently than HD lines, because those are for one primary purpose while we use central lines for all kinds of things (drips, pushes, fluids, etc). Most nurses are very careful when accessing lines.

To be honest, more than the accessing of the line, I personally think that the problem with high infection rates comes down to the dressing. In the ICU, people are sweaty, hairy, vomitting, and all kinds of things. And the placement location of some of these lines make it easy for the dressing to come off or not be entirely sealed properly to maintain a sterile site. In the instance of an IJ, the neck can be difficult to dress. The hair from the scalp line gets in the way, people's beards start to grow over time, sweat accumilates, if someone vomits it gets all over the dressing. In the instance of a PICC on the arm, I've seen a patient poop so much diarrhea that is went all the way up his back and all over his arm where the access sites sit on.

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I could not even count how many tones a day a central line is accessed. It all depends on the patient, why they need it, what all we are using it for....

People get them because they are sick enough that they need them. I absolutely hate peripherals in the icu. We have multiple labs being drawn daily. Certain gtts cannot go peripherally as they are extremely irritating to veins. If a person were to code, you need good access to push meds. Peripherals can go bad in a matter of hours.

Sometimes I have a patient with cerebral edema and we are trying to prevent more swelling. They get a 3% gtts and q4 sodium labs. Another may have out if co troll and need nicardipine which always needs a central line. Potassium should go through a central line.

Let's not even get into long term antibiotics and dialysis. Art lines too.

We try to prevent CLABSIS by doing daily CHG baths, IV lines are changed every 72 hours, anything lipid based gets changed q12. Dressing are changed weekly and prn. Claves are changed q96 hours and prn.

We also flush lumens q8 hours to help prevent clotting.

There are patients that can have a triple lumen ij and 2 peripherals and I still have so many incompatible meds that I don't have enough access.

Lines are pulled when they are no longer indicated. And if certain ones are in too long, I will ask to have a patient relined.

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If some patients need so many draws, why not just put an a line in? That's a legitimate use for one.

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