Accidental removal of endotracheal and nasogastric tubes and intravascularcatheters

Objectives: To characterize the rates of accidental removal of endotracheal tubes, nasogastric tubes, central venous catheters, and arterial catheters . To assess the efficacy of corrective measures aimed at reducing the accid ental removal of these devices. Design: Prospective, observational, and interventional study. Setting: Eighteen-bed medical-surgical intensive care unit of a 650-bed ter tiary care hospital. Patients: Patients admitted to the intensive care unit who had any of the f ollowing devices in place for more than 24 hrs: endotracheal tube, nasogast ric tube, central venous catheter, arterial catheter. Measurements and Interventions: Data were collected on the date of placemen t of tubes and catheters, position of vascular catheters, date of removal, and reason for removal. The study involved three consecutive 6-month period s. At the end of the first and the second periods, information about rates of accidental removal was provided to the physicians and nurses. In additio n, the personnel were instructed to be more vigilant and specific measures aimed at reducing the accidental removal were introduced. Main Results: In the first period, 289 endotracheal tubes were placed and 1 3.1% (24.7 per 1000 days) were removed accidentally. In the second and thir d periods, 17.1% (25.5 per 1000 days) and 11.4% (15.1 per 1000 days) were r emoved accidentally, respectively. In the first period, 368 nasogastric tub es were placed and 41% (73.9 per 1000 days) were removed accidentally. In b oth the second and the third period, a significant reduction in the rate of accidental removal was observed (32.4% or 41.2 per 1000 days and 25.8% or 29.8 per 1000 days, respectively). A significant decrease was observed in t he rates of accidental removal of central venous catheters from 7.5% (12.4 per 1000 days) in the first period to 3.6% (5.4 per 1000 days) in the secon d period. The rate of arterial catheters accidentally removed expressed according to the time at risk significantly decreased from 46.5 per 1000 days in the fir st period to 19,1 per 1000 days in the second period and 25.3 per 1000 days in the third period. Conclusions: The information provided by the rates of accidental removal ex pressed by patient-days is helpful to compare results obtained in populatio ns with different times of follow-up. Education of medical personnel and li miting upper-extremity access to within 20 cm from any catheter or tube res ulted in a significant reduction of patient-related removal of tubes and ca theters.