Society of Critical Care Medicine
View all recommendations from this societyReleased January 29, 2021
Don’t retain catheters and drains in place without a clear indication.
Patients in intensive care units typically require insertion of catheters and drains for fluid and medication delivery, pressure and flow monitoring, and fluid and gas evacuation. The majority of hospital-acquired infections and unintended safety events are associated with such devices. Daily assessment of need for invasive devices should be an essential element of critical care workflow, to reduce time of exposure by identifying the earliest opportunity for their discontinuation.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
A diversified, multiprofessional task force of 17 critical care quality and clinical experts was formed with an aim to identify five new Choosing Wisely for Critical Care recommendations. The task force included practicing clinicians representing community, military and academic centers. A priori three domains were deemed important: 1) patient safety and quality of care; 2) strength of evidence to support the recommendation; and 3) potential improvement in patient outcomes. Using a modified Delphi consensus building methodology and a quantitative survey analysis, eight novel recommendations were identified and deemed representative of wasteful critical care practices. Following a quantitative survey of the SCCM membership and review by the SCCM Council, the five highest ranked recommendations established SCCM’s next five Choosing Wisely for critical care were approved. The five recommendations address invasive devices, proactive liberation from mechanical ventilation, antibiotic stewardship, early mobilization, and providing goal-concordant care.
Sources
Bell T, O’Grady NP. Prevention of Central Line-Associated Bloodstream Infections. Infect Dis Clin North Am. 2017;31(3):551-559. doi:10.1016/j.idc.2017.05.007
Hooten TM, Bradley, SF, Cardenas DD, et al. Diagnosis, prevention and treatment of catheter associated urinary tract infection in adults; 2009 International Clinical Practice Guidelines.
