L. Epstein1, J. Nahmias2, S. Schubl2, K. Inaba1, K. Matsushima1, M. Lekawa2, M. Dolich2, A. Grigorian2 1University Of Southern California, Division Of Trauma, Emergency Surgery, And Surgical Critical Care, Los Angeles, CA, USA 2University Of California – Irvine, Division Of Trauma, Burns, Critical Care, & Acute Care Surgery, Orange, CA, USA
Introduction:
Emergent central venous catheter (CVC) insertion may be associated with a higher risk of central line blood stream infections (CLABSI). We hypothesized that CVCs placed emergently within two-hours of arrival to the emergency department (ED) for critically ill trauma patients are associated with a higher risk of CLABSI compared to CVCs placed outside of the ED. We additionally hypothesized that ED placed femoral CVCs are associated with a higher risk of CLABSI compared to ED placed internal jugular (IJ) CVCs.
Methods:
The 2017-2019 Trauma Quality Improvement Program (TQIP) database was queried for critically ill trauma patients admitted to either the intensive-care-unit (ICU) or operating-room from the ED who underwent CVC insertion. Transfers, deaths < 72-hours, or hospitalization < two-days were excluded. Patients receiving a CVC placed in the ED (ED-CVC) within two-hours of arrival were compared to patients receiving a central line outside of the ED (non-ED-CVC). We performed a sub-analysis for risk of CLABSI dependent on site of insertion for all ED-CVC patients. A multivariable logistic regression analysis was performed.
Results:
From 27,981 patients, 7,908 (28.3%) received an ED-CVC with most placed in the subclavian vein (51.5%). After adjusting for known risk factors, ED-CVC patients had a similar risk of CLABSI (OR 0.75, CI 0.51-1.11, p=0.15), compared to non-ED-CVC patients. Among ED-CVC patients, insertion of a subclavian CVC (OR 0.40, CI 0.18-0.87, p=0.02) was associated with a lower risk of CLABSI compared to an IJ CVC. Femoral and IJ CVC had a similar risk of CLABSI (OR 0.46, CI 0.20-1.05, p=0.06).
Conclusion:
The subclavian vein is the most common site for CVCs placed emergently in the ED. Contrary to popular belief, insertion of an ED-CVC placed within two-hours of arrival is not associated with a higher risk of CLABSI compared to insertion of a non-ED-CVC. For ED-CVCs, the subclavian line is associated with the lowest risk of CLABSI and should be considered the optimal site in terms of infection risk in critically ill trauma patients with no known history of chronic kidney disease.
