Inter-center variation in non-elective removal of central catheters amongst level 4 NICUs.

OBJECTIVE

To quantify inter-center variation (ICV) in non-elective removal (NER) of central venous catheters (CVCs) in level 4 Neonatal Intensive Care Units (NICUs).

STUDY

DESIGN

Using the Children's Hospitals Neonatal Database (CHND), we identified CVCs in infants admitted 2017-2023. The primary outcome was CVC NER, and the primary exposure was CHND center. We quantified unadjusted and adjusted ICV in NER.

RESULT: We analyzed 71,865 patients and 135,671 CVCs. Median gestational age was 36 weeks and birth weight 2450 g. Over 50% infants (28,077) received >1 CVC. Centers placed 196-7120 catheters with a median dwell time of 7 (IQR 4-14) days. The overall NER rate was 11.7%, with significant ICV (unadjusted ICV: 3-19%, p < 0.001; adjusted center-level odds of NER: 0.26-2.03, p < 0.001).

CONCLUSION

There is significant ICV in NER between level IV NICUs. Reducing modifiable NER may increase safety for patients with CVCs. Center-specific NER metrics may serve as clinical benchmarks.