TRASH the TUBES!
Complications arising from indwelling devices are now well recognised as a potentially avoidable harm. Most ICUs now have formal care bundles in place governing the care of central venous lines, and through these have dramatically reduced the incidence of infections associated with these lines. These bundles are now spreading beyond critical care into the other areas that care for children with central venous access in situ. More details about the progress being made and care bundles available can be found on the CLABSI pages.
The acquisition of audit data outside the ICU environment is difficult and is only successfully embedded in a few centres to date. However, whilst central lines represent a major risk so does any indwelling line or catheter. They all carry an enhanced risk of infection. In paediatrics we are often reluctant to remove lines because we, quite appropriately, want to avoid putting the children we care for through the discomfort of a further line if we have removed the access too soon. Our membership has observed that this has resulted in lines being left in longer than ideal. We would like to invite you to join our project to try to redress the balance – Trash the tubes!
The primary objective of the project is to raise awareness of the need to assess every line and catheter, in every child, every day and ask the question “Is this still needed?” If it isn’t then it’s time to trash the tubes!
We would like to promote this by performing a series of simple spot audits in collaborating centres. The audit months are August, November, February and May. When you sign up to join this initiative we will ask you to nominate which day of the month you undertake to perform the audit. On that day a simple proforma should be completed (TTT ICU Audit Proforma, TTT General Ward Proforma) noting the number of inpatients and the total number of IV lines (central or peripheral) or a urinary catheters in situ. The completed proformas should then be emailed back to ttt [at] mist-collaborative [dot] net. These will be anonymously collated and the overall numbers will be shown on this website.
Through the above process we anticipate raising the awareness of the need to review lines regularly and believe that we will, as a consequence see a reduction in the total number of lines per in patient. Less lines = less complications. We think a 10% reduction is a realistic goal for all centres.
We are also aware that should any lines be removed too soon this may also cause harm and therefore would request that if any centre encounters a critical incident that is attributed to excessively early line (or catheter) removal that they advise us of this so that we may include the numbers (again anonymously) in the overall data for the project.
Please join us – this is an easy way to raise awareness and reduce harm. Please forward any questions or sign up by emailing ttt [at] mist-collaborative [dot] net