(304) Correlation Between Midline Catheter Use and Central Line-Associated Bloodstream Infection Rates

Introduction: Critically ill patients often require central venous catheters (CVC) for treatment. The use of CVC is also associated with Central Line Associated Blood Stream Infection (CLABSI), which is associated with significant mortality and morbidity for patients. Recent literature suggested that the use of midline catheters (MLC) would be associated with reduction of CVC uses and lower CLABSI rates, but most studies were single center and small patient populations. We queried a large multi-center database to investigate the trend of MLC use, CVC use and CLABSI. We hypothesized that higher MLC use will also reduce CLABSI.

Methods: We queried data from TriNet X, a large patient database involving 9 large healthcare organizations, 120 million patients in the United States. All patients with procedure codes for CVC, MLC and billing codes for CLABSI between 2018-2023 were eligible. The outcomes were rates of CVC, MLC and CLABSI per million patients (pmp). Data was presented with descriptive statistics while time series with trend analyses were used to investigate the trends of CVC, MLC and CLABSI. Correlations between total CLABSI and total number CVC, MLC were examined via spearman correlation.

Results: The study period involved a total of 630,878,472 patients. There was a total of 449 CVC pmp, 372 MLC pmp and 255 CLBASI pmp, respectively. The trend for total CVC pmp followed a downward quadratic trend from 98 pmp in 2018 to 47 pmp in 2023. In contrast, trend of total MLC followed an upward quadratic trend from 23 pmp in 2018 to 98 pmp in 2023. The total CLABSI trend also followed a quadratic trend. The number of CLABSI in 2018 was 41 ppm, with a highest inflection point in 2021 with 45.4 ppm, followed by 44.9 ppm in 2022. There was no statistically significant correlation between total CVC (r= -0.3, P>0.05 ), total MLC (r= 0.3, P>0.05) and CLABSI between 2018-2023.

Conclusions: Our study suggested downward trends in the total number of CVC, and CLABSI, and an upward trend of MLC use. However, there was no correlation between the number of CVC, MLC and CLABSI during this period, likely due to the sudden surge of CLABSI during the COVID-19 pandemic of 2020, 2021. Future studies with longer trends and different national databases are needed to confirm our observation.