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Doctors Often Unaware Their Patients Have Catheters
Small tubes reduce needle sticks, but can increase infection risk if left too longThursday, October 23, 2014
THURSDAY, Oct. 23, 2014 (HealthDay News) -- Hospital patients often have tubes placed in their veins to deliver medication or take blood samples. But a new study suggests their doctors don't always know about it.
The study, of doctors at three large U.S. hospitals, found that 21 percent were unaware that a patient under their care had a central venous catheter -- a tube placed in a large vein in the neck, chest, arm or groin.
Those catheters are often needed to provide medication, fluids or nutrition; they may also be used to get blood samples, so patients can avoid repeated needle sticks.
But the longer catheters are left in place, the greater the risk of problems -- including potentially serious infections and blood clots.
"So you should pull them out when you no longer need them," said study leader Dr. Vineet Chopra, an assistant professor of internal medicine at the University of Michigan Medical School in Ann Arbor.
"But to do that," Chopra added, "you need to know they're there."
He stressed that his study did not look at a key question: Did doctors' lapses affect patients' welfare? But that is a concern, said Chopra, who reported the findings in the Oct. 21 issue of the Annals of Internal Medicine.
Dr. Darren Taichman, who wrote an editorial published with the study, agreed.
"One worries that a catheter that was no longer medically necessary was left sitting there, putting a patient at greater risk of complications," said Taichman, an editor of the journal and an adjunct associate professor at the University of Pennsylvania in Philadelphia.
Plus, Taichman added, "it bothers me, philosophically, that some clinicians do not know what's going on with a patient's care."
The findings are based on 990 patients treated at three university-affiliated medical centers. Chopra's team surveyed doctors at the end of their morning rounds, to see whether they knew which of their patients had central venous catheters.
More than one-fifth of patients had catheters in place, and most of the time their doctors knew it. But 21 percent of physicians were unaware.
What's going on? One possibility, Chopra said, is that some doctors just temporarily forgot when they were asked on the spot.
But it could also have to do with how hospital care works: "There are a lot of people involved on the care team," Chopra noted. "This could be related to lack of communication."
That could be particularly true of catheters that are placed in the arm -- which are commonly inserted by a specially trained nurse or radiologist. Chopra's team found that doctors were more likely to be unaware of that type of catheter, versus other types.
The study did not survey nurses, Taichman noted, so it's not clear whether nurses were aware of the catheter in cases where doctors were not. They probably were, he said, but that can't be "assumed."
According to Taichman, the findings might be a symptom of a wider shift: Doctors these days are less involved with the daily care of hospital patients than they used to be -- which includes fewer physical exams.
"I'm not saying we should go back to the days when patients had every orifice prodded every day," Taichman said. For one, rates of catheter-related blood infections are actually lower now than in days of yore, he noted.
But, Taichman said, doctors should at least know when a patient has a medical device in place.
According to Taichman, patients and families should feel free to question whether a catheter has overextended its stay. "It's completely appropriate to ask, each day, 'Do I still need this?'" Taichman said. "Most of the time, the answer will be 'yes,' but there's nothing wrong with asking."
Chopra agreed. "I think patients often trust that (the catheter) is still necessary," he said. "But you can absolutely question it."
Taichman said it's also important for patients to know that catheters can cause infections and blood clots. "Patients often, understandably, want the catheter because it makes them more comfortable," he said.
"But," he added, "they need to be aware that catheters also come with very real risks."
SOURCES: Vineet Chopra, M.D., assistant professor, internal medicine, University of Michigan Medical School, and research scientist, VA Ann Arbor Healthcare System, Ann Arbor, Mich.; Darren Taichman, M.D., Ph.D., adjunct associate professor, medicine, University of Pennsylvania School of Medicine, Philadelphia; Oct. 21, 2014, Annals of Internal Medicine
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