Incidence and Mechanism for Decreasing Central Catheter Contamination of Calcineurin Inhibitors in Stem Cell Transplant Patients Utilizing an Educational Intervention

Background: Stem cell transplant patients at this institution receive calcineurin inhibitors (CINs) intravenously (IV) via double lumen central catheters for the first 100 days post transplant and drug levels are obtained at regular intervals to maintain therapeutic dosing. In the out-patient setting, these levels are drawn by patient families or home health nurses. CINs are known to bind to central catheters, and if the samples are drawn from the incorrect catheter lumen or improper technique is used in obtaining samples, the lumen will become contaminated and result in falsely high drug levels. As a result, the patient will necessitate frequent peripheral blood draws that are often traumatic to this pediatric population.

Purpose: The aim of this performance improvement project is to determine the effectiveness of an educational intervention in decreasing contamination rates.

Methods: Since improper technique results in contamination, a multi-pronged approach was used to educate caregivers and healthcare practitioners caring for this population. A central catheter educational tool was developed and distributed to caregivers and healthcare providers involved with drug level monitoring and drug administration. This consisted of laminated cards with a step-wise listing of the procedure.  In addition, oral presentations and practical training sessions were conducted throughout the hospital with relevant staff. 

Drug levels were monitored weekly or more often if clinically indicated. If a high drug level was reported, a peripheral level and a central catheter level were obtained simultaneously and compared. The catheter was determined to be contaminated if the levels differed by a significant margin.

Prior to obtaining data, approval from the Washington University IRB was sought. It was determined that because the project evaluated an educational intervention, it qualified for IRB exemption. 

Results: The preliminary effectiveness of the educational intervention was evaluated three months after initiation and compared to previous contamination rates. Prior to the intervention, 63% of patients demonstrated contaminated specimens. Following the educational intervention, the rate decreased to 56% of post-transplant patients.   

Recommendation: Preliminary data suggested that educational intervention was able to decrease central catheter contamination rates. This educational intervention is being continued to reach an expanded pool of healthcare providers.  However, because the decrease was not as significant as expected additional interventions, such as catheter lumen labeling, are being developed. We will continue to track the effectiveness of this and any accompanying interventions to assess the impact on contamination rates.