Accidental catheter removal in the intensive care unit: a prospective observational study

Introduction

Accidental catheter removal (ACR) is associated with complications caused by the removal itself and by catheter reinsertion. Hence determining the incidence is important to implement preventive measures. The objective of the present study was to analyse the incidence of ACR for all types of catheters in the ICU.

Methods

A prospective observational study in a 22-bed medical/surgical ICU-HDU in a 550-bed tertiary cancer care center on all consecutive adult ICU patients between 1 October 2004 and 30 November 2004. ACR was considered to be accidental removal of a catheter either by the patient or by the ICU staff. The incidences of ACR for all types of catheters per 100 catheters (%) and per 100 catheter-days (%cds) were determined. Complications arising due to the ACR were noted. The nurse–patient ratio during the ACR and daily was noted.

Results

A total of 913 catheters were inserted in 147 patients for a total of 3614 catheter-days. ACR occured in 43 catheters (4.7%, 1.19%cds) in 25 patients. The incidence of ACR was higher for arterial than for central venous catheters (2.4 vs 0.7%cds). The incidence of ACR for nonvascular catheters (%cds) was: endotracheal tube 1.65; nasogastric tube 2.9; urinary catheter 0.17; thoracic drain 0.56; abdominal drain 0.53; epidural catheters 1.1; and neck drains 0. Four patients (9.3%) with accidental ETT removal had transient arterial hypoxemia necessitating reintubation. Twenty-six catheters (60%) – six ETT, seven arterial, 10 nasogastric, one thoracic and two others – needed reinsertion. The daily median nurse–patient ratio was 0.36 (range 0.27–0.57), and during ACR it was 0.38 (0–1).

Conclusion

Our incidence of ACR was high for nasogastric tubes, arterial lines and ETTs. Development and implementation of improved protocols are essential to reduce the incidence of ACR in these catheters. There was no obvious correlation between ACR and nurse–patient ratio. To minimize ACR, it is necessary to monitor its incidence carefully and to implement preventive measures.