Do I Need to Remove that Line?

Catheter-Related Infection Diagnosis and Management: Summary of IDSA Guidelines

by A. M. Akhter (MS3, UT Southwestern Medical School)

Background:

  • Familiarity with CRBSI guidelines is essential as scenarios like new onset of fever in an ICU patient with a catheter is a near daily challenge encountered by physicians
  • More than 250,000 central-line associated bloodstream infections occur each year
  • In addition to increasing mortality (risk estimated to be 12-25%), such infections independently increase hospital cost and length of stay
  • The extra costs of treating healthcare-associated infections are no longer being reimbursed by CMS
  • Hospitals are mandated to report rates of CRBSI; starting in October 2014 hospitals with high rates of CRBSIs will lose 1% of every Medicare payment for a year
  • Risk of infection is multifactorial, influenced by host factors, treatment setting (hospital ward, ICU, etc.), type of catheter, duration of use, conditions during placement, etc.
  • Definitive diagnosis of a CRBSI requires specific evidence from a set of blood cultures
  • Catheter removal may be beneficial, but should not be a routine practice as most catheters removed from patients with suspected CRBSIs were sterile
  • IDSA guidelines provide straightforward advice for empiric therapy as well as management of serious complications, notably septic thrombophlebitis and infective endocarditis

IDSA Guidelines summary

IDSA Guidelines summary2

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The Physician Charter

Dr. Johnson introduced us to the The Physician Charter. In 2002, the ABIM Foundation, American College of Physicians Foundation and the European Federation of Internal Medicine jointly authored Medical Professionalism in the New Millennium: A Physician Charter, which was published simultaneously in Annals of Internal Medicine, The Lancet and the European Journal of Internal Medicine. The three pain principles of the physician charter are listed below:

Primacy of Patient Welfare

The principle is based on a dedication to serving the interest of the patient. Altruism contributes to the trust that is central to the physician-patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle.

Patient Autonomy

Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patients’ decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.

Social Justice

The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.

What are your thoughts?  Do these statements embody your thoughts on professionalism? Are these attainable goals in today’s American healthcare system? Comment below to let us know what you think!