Emergency Department Placed Central Lines for Trauma Patients: A Retrospective Case-Control Study on Central Line-Associated Blood Stream Infection Risk From Central Lines Placed Emergently in the Emergency Department

Objectives: Emergent central line (CL) insertion may be associated with a higher risk of central line-associated blood stream infection (CLABSI). We hypothesized that CLs placed emergently within 2 hours of arrival to the emergency department (ED) for critical trauma patients are associated with a higher risk of CLABSI compared with CLs placed outside the ED. We additionally hypothesized that femoral ED-CLs are associated with a higher risk of CLABSI compared with internal jugular (IJ) vein ED-CLs. Methods: The 2017-2019 Trauma Quality Improvement Program database was queried for critical trauma patients admitted to the intensive care unit or operating suite from the ED who underwent CL insertion. Patients who were transferred, died <72 hours, or hospitalized <2 days were excluded. A total of 27,981 patients met inclusion criteria and 169 of these patients met criteria for a CLABSI. Patients receiving an ED-CL within 2 hours of arrival were compared with patients receiving a CL outside of the ED (non-ED-CL). We performed a subanalysis of only ED-CL patients for risk of CLABSI dependent on insertion site. A multivariable logistic regression analysis was performed. Results: Of 27,981 patients, 7908 (28.3%) received an ED-CL mostly in the subclavian vein (51.5%). After adjusting for risk factors, ED-CL patients had a similar risk of CLABSI (odds ratio [OR], 0.75; CI, 0.51-1.11; P = .15), compared with non-ED-CL patients. Among ED-CL patients, insertion of a subclavian CL (OR, 0.40; CI, 0.18-0.87; P = .02) was associated with a lower risk of CLABSI compared with an IJ CL, whereas femoral and IJ CLs had a statistically nonsignificant difference in risk of CLABSI (OR, 0.46; CI, 0.20-1.05; P = .06). Conclusion: Insertion of ED-CLs within 2 hours of arrival is not associated with a higher risk of CLABSI compared with insertion of a non-ED-CLs. The subclavian vein is the most common site for emergent CL insertion in the ED. For ED-CLs, the subclavian line is associated with the lowest risk of CLABSI and should be considered the optimal site for insertion in critically ill trauma patients with no known history of chronic kidney disease.