(612) Use of Peripheral Versus Central Vasopressors and the "Idle" Central Venous Catheter

Introduction: The most common definition of an ‘idle’ central venous catheter (CVC) was one left in situ without any medication or infusion. However, the operational definition for duration without infusion varies substantially in the literature (24 hours to >7 days). Characterizing the prevalence, risk factors, and cost of the ‘idle’ CVC on health care systems is critical given the serious complications associated with duration of CVC use, including central line-associated bloodstream infections (CLABSI). The goal of our study was to characterize ‘idle’ CVCs at our institution.

Methods: We examined all vasoactive infusions initiated in the emergency department (ED) at a regional, quaternary care center over an interval of 6-months from January 2024 to June 2024. We subsequently performed structured chart review to determine if these vasoactive medications were infused peripherally versus via a CVC. We also determined the incidence of ‘idle’ CVCs using the criteria of no vasoactive medications administered for >48 hours. We then evaluated which services had the highest number of ‘idle’ CVCs, and if there was variability by site of catheterization. Finally, we evaluated whether an ‘idle’ CVC was an independent risk factor of CLABSI using a Fisher’s exact test with the threshold for statistical significance set at p ≤ 0.05.

Results: We identified 83 ED who received vasoactive medications in the specified time period. Our data demonstrated that most vasoactive medications at the research site were infused peripherally (74.7%) rather through a CVC (25.3%). We found that a cumulative incidence of ‘idle’ CVCs of 28.6%. We found that critical care units had the highest rate of ‘idle’ CVCs, and that most common site of ‘idle’ CVCs was the right internal jugular vein (83.3%). During this period, there were three CLABSI events. Further, these preliminary data suggest that an ‘idle’ CVC is an independent risk factor for central line associated infections (CLABSI), (p ≤ 0.002).

Conclusions: At our institution, nearly 1/3 CVC placed in the ED for vasoactive medication administration were ‘idle’ during downstream care. Although these data are preliminary and from a single institution, our findings support expanding this work to further characterize the relationship between ‘idle’ CVCs and CLABSI.