Central venous catheter: uses in a public hospital in the Province of Córdoba, according to the new version of its protocol

Abstract

The Pharmacy and Therapeutics Committee (CPT) of the Hospital Nacional Clínicas (HNC) develops pharmacological treatment guidelines, communicates policies/regulations for the use of medications and medical devices (MD) and evaluates their use. Central Venous Catheters (CVC) are devices that are inserted into large venous vessels for diagnostic and therapeutic purposes. In 2018, the CPT-HNC elaborates a protocol for the use of the CVC, updated in Nov-2023 due to the demand of critical services to incorporate other uses to the CVC-Double Lumen (DL) for the co-administration of medications in addition to parenteral nutrition and to minimize administration errors. In the period prior to its update (January-June/2023) 71 CVC-DL were dispensed.

After the protocol update, a descriptive, retrospective and observational study was carried out in January-June 2024 to explore the use of the CVC-DL in HNC. Data were collected from the inpatient census and CVC request forms. The following data were recorded: number of CVC-DLs dispensed, number of service requesters, patient age, type of placement (scheduled/urgent), vein used (subclavian/internal jugular/femoral), and reasons for use.

From January to June 2024, 2,694 patients were admitted, 96 (3.6%) to the ICU. 170 CVC-DLs were dispensed, of which 98/30/42 were for ICU/coronary care unit/other ward patients respectively. The mean age of patients was 72.79 years (SD ± 11.57 years). 61.2% of CVC-DLs were placed urgently and 64% were placed in the jugular vein. The main reasons for use were: vasopressor/inotrope requirement (117), infusion of multiple medications simultaneously (112), sedation-analgesia (70) and parenteral nutrition (53). 97/53/8 CVC-DLs were requested for 2, 3 and 4 simultaneous uses, respectively. 100% of ICU patients required CVC-DLs. 100% of CVC-DLs dispensed to critical units were for the first 3 reasons for concomitant use and 100% of the use for parenteral nutrition occurred in non-critical services, due to digestive system problems.

The study showed which hospital services requested CVC-DLs and for which uses they were requested. The protocol update is part of the ongoing process of improving the quality and safety of critical patient care, highlighting the role of TPC in the hospital setting.