The Science Journal of the American Association for Respiratory Care
BACKGROUND: An internal quality assurance program was started in response to RCP placement of arterial lines. The authors hypothesized the risk of infection in comparison to length of insertion. Arterial lines were monitored for accuracy, complications and septicemia. In the beginning of the program, lines were changed every 72 hours according to CDC guidelines and then the frequency was increased to every 96 hours. Currently arterial lines remain in place as long as they continue to function properly without sign of infection. METHOD: Each line was monitored for infection through site checks every 8 hours. Sites were redressed if the occlusive dressing became loose. A site with any sign of infection, such as swelling, redness or bruising, was discontinued. Fluids would be changed as needed without changing the line and transducer. Catheter tips were randomly cultured. The charts of all patients receiving arterial lines were reviewed monthly for length of arterial line insertion, accuracy of the line in comparison to noninvasive readings and any positive blood cultures.
Results: In the first year, all changes were at 72 hours, 97 arterial lines placed resulted in 8 positive blood cultures. The second year, with changes increased to 96 hours, 157 arterial lines were inserted resulting in no positive blood cultures. These results prompted the Critical Care committee to approve a 6-month study to monitor arterial lines left in as long as they were viable. Results were 1 positive blood culture of the 94 lines reviewed in the 6-month trial. CONCLUSION: Critical, immunosuppressed patients are at risk for complications from infection. Hemodynamic lines placed to monitor critical patients were once thought to increase infectious risk if not changed according to CDC guidelines. The study shows no direct correlation between the length of insertion and risk of infection. Average length of insertion for the 6-month trial was 112 hours, 16 hours greater than the recommended time.