A retrospective chart review was conducted of 91 patients admitted with sepsis between 2013-2014 to examine outcomes of central venous catheters (CVCs) and arterial catheters (ACs). 52 CVCs were placed in 36 patients and 48 ACs in 37 patients, with 32 receiving both. Of those with CVCs, 7 complications occurred in 10 patients (19% rate). Of those with ACs, 3 complications in 4 patients (8.1% rate). Logistic regression found no significant difference in mortality between those who received lines and those who did not, including among patients with higher illness scores. The study concludes that CVC and AC placement confers no significant improvement in survival for sepsis patients and can lead to unnecessary complications

1. Thus far, 91 patient charts have been reviewed revealing a total of 52
CVCs placed in 36 patients and 48 ACs placed in 37 patients. Thirty-two
patients received both an AC and a CVC. Twelve patients experienced
in-hospital mortality. Of the 52 CVCs, we observed three hematomas
and four line misplacements, a total complication rate of 13.5%. Of
patients receiving a CVC, 19% experienced a CVC-related complication.
Of the 48 ACs, we observed two hematomas and one line infection, a
total complication rate of 6.3%. Of patients receiving an AC, 8.1%
experienced an AC-related complication. No CVC-related infections or
pneumothoraces were found; however, we expect to see higher rates
of pneumothorax and CVC-related infection as more charts are
examined. Patients with SOFA score greater than four who received
CVC experienced increased survival compared to those not receiving
CVC; however, this difference is not significant (log odds=-0.06,
p=0.95). Patients with SOFA score greater than four who received AC
also experienced increased survival compared to those not receiving
AC; however, this difference is also not significant (log odds=-0.76,
p=0.42).
Questioning the Utility of Central Venous and Arterial Catheters in the
Management of Sepsis
Stephen Pape, Andrey Skripnikov , Jason Chertoff M.D., Jorge Lascano M.D.
University of Florida College of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine
Gainesville, FL
Background
Methods
Results
Conclusions
With the advent of the ProCESS, ARISE, and ProMISe
trials, the utility of central venous catheters (CVC) and
arterial catheters (AC) in the treatment of early sepsis
amongst patients with equivalent peripheral venous
access has become unclear. Our study aims to show
that early placement of CVCs and ACs in the setting of
sepsis does not confer additional diagnostic or
therapeutic benefit over blood pressure cuff placement,
serum lactate clearance, and adequate large bore
peripheral IV placement. We intend to show CVC and
AC placement lead to unnecessary complications such
as catheter-related blood stream infection (CRBSI),
hematoma, pneumothorax, and prolonged ICU and
hospital stays, without conferring any mortality benefit.
We performed a retrospective chart review examining
outcomes and complication rates among patients
admitted to the hospital with a primary diagnosis of
sepsis between September 1st, 2013 and June 30th, 2014.
Inclusion criteria required patients meet at least two
SIRS criteria with a source of infection on admission.
Both medical and surgical patients were examined. The
primary outcome measures were in-hospital mortality
and complications secondary to CVC and AC placement.
We ran a logistic regression to account for SOFA score
continuously when comparing in-hospital mortality
rates among all patients that received or did not receive
CVC or AC. Logistic regression was also used to compare
mortality among groups that received or did not receive
AC or CVC for patients with SOFA score greater than 4.
Survival curves were generated comparing in-hospital
mortality among patients who received and did not
receive CVC or AC (Figures 1 & 2). The survival curves
were stratified by SOFA score.
Our study shows that CVC and AC placement confer no significant
improvement in in-hospital mortality among patients admitted with
sepsis. These conclusions are consistent with recent literature, which
has shown no mortality benefit from strict adherence to physiologic set
points obtained from invasive hemodynamic monitoring when compared
to physician-guided care. Complications arising from invasive
hemodynamic monitoring add additional support to the idea that
physician-guided care is superior to protocol based care.
Discussion
Iatrogenic harm is a major cause of in-hospital morbidity and mortality.
Although our study is limited in size and scope, we believe this study has
important clinical implications in the management of sepsis. Many of
these patients are subjected to numerous interventions, and thus
iatrogenic harm. The primary limitation affecting this study is size. With
only 91 patients and 12 in-hospital deaths, it is difficult to report
outcomes with statistical significance. After the completion of this study,
we hope to investigate the financial cost associated with unnecessary
CVC and AC placement.
Figure 1: Survival probability of entire patient cohort plotted against SOFA score. CVC/AC
cohorts represented by dotted blue line. Patients not receiving CVC/AC represented by solid
red line.
Figure 2: Survival probability among patients with SOFA score > 4 plotted against SOFA score.
CVC/AC cohorts represented by dotted blue line. Patients not receiving CVC/AC represented by
solid red line.Figure 1: Survival probability with/without line placement
Figure 2: Survival probability with/without line placement, SOFA > 4