Table 1. Characteristics of Included Studies Source (Country)
Rattanaumpawan, 201628 (Thailand)
Arora, 201415 (USA) RCT
Data Design Participants, No.
General medicine ward patients (N=874)
QES (Pre–Post) Adult ICU patients (N=3,302)
Chandramohan, 201816 (USA) QES (Pre–Post) All patients in a LTACH (N=32,099 patient days)
Deutsch, 201317 (USA) Grady, 201527 (Canada) Morata, 201718 (USA) Reeves, 201719 (USA) Seguin, 201027 (France) QES SICU patients (N=31)
QES (Pre–Post) Medical inpatients (N=2,782 patient days)
COLLECTION 2013.2–7
Interventions
CARE program: Daily reminders from nurses to physicians to document an appropriate indication for CVC use
2008.10–2012.1 IDT Rounds: Daily discussion for the presence or absence of CVCs
2015.1–2017.3 A MIPT made weekly recommendations to remove unnecessary CVCs
2011.6–12
USGPIVs program: use of USGPIVs in patients with DIVA to prevent unnecessary CVCs
2013.1–2014.12 Reminders: Online tool used for physician audits of CVCs
QES (Pre–Post) All inpatient and observation patients 2014.10–2016.6 USGPIVs; CVC approval: requiring manager approval for placement of CVCs
QES (ITS)
Patients in the medical–surgical and step-down units
QES (Pre–Post) SICU patients (N=1,271) Swaminathan, 201820 (USA) QES (ITS)
General medicine ward or ICU patients who receive a PICC (N=7,576)
Weeks, 201421 (USA)
AU, 201222 (USA) Galen, 201823 (USA)
Ilan, 201226 (Canada) Mccarthy, 201324 (USA) QES (ITS) Adult ICUs (N=792 hospitals)
Cohort study EM patients with DIVA (N=100) Cohort study Adult medical patients
Cohort study Adult ICU patients (N=191) Cohort study ED patients (N=401,532) 2012–2015 USGPIV program
2005.8–2007.4 Reminders: Daily use of red square added to the patient’s daily care sheet, questioned the physician about the utility of the CVCs.
2014.8–2016.7 MAGIC-based appropriateness tool of PICC placement; dedicated training on peripheral venous access alternatives; EMR incorporated MAGIC; provider education
2008.5–2012.9 Use of a daily goals instrument to set daily goals of care for each patient. One question on the daily goals form is, “Can catheters/tubes be removed?”
2010.11–2011.6 USGPIV program 2011.6–12
USGPIV program
2010.4–5 (28d) Reminders: Daily use of a checklist by the IDT to remove any CVC if it is no longer necessary.
2006–2011 USGPIV program Outcome measures
Compliance, mean duration of CVC days, LOS, mortality, CLABSI rate
Total CVC days, CLABSI rate CVC utilization rate, CLABSI rate CVC days avoided, Cost analysis Compliance, CVC use PICC reduction rate, cost analysis
PICC reduction rate, inappropriate PICC reduction rate
Mean duration of CVC days, CLABSI rate
LOS, PICC use, inappropriate PICC reduction rate, PICC-related complications, CLABSI rate
Total CVC days, CLABSI rate CVC use, cost analysis
Newly placed central venous catheters per day
Inappropriate CVC reduction rate, CLABSI rate
CVC use
NOTE. RCT, randomized controlled trial; QES, quasi-experimental study; ITS, interrupted time series; ICU, intensive care units; LTACH, long-termacute-care hospital; SICU, surgical intensive care units; PICC, peripherally inserted central venous catheters; EM, emergency department; DIVA, difficult intravenous access; CVC, central venous catheter; CARE, the catheter reminder and evaluation; MIPT, multidisciplinary infection prevention team; IDT, interdisciplinary team; USGPIV, ultrasound-guided peripheral intravenous catheter; MAGIC: Michigan Appropriateness Guide for Intravenous Catheters; EMR, electronic medical record; LOS, length of stay; CLABSI, central-line–associated bloodstream infection.
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Zhaoyu Xiong and Haiyan Chen
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