Intensive Care Medicine

, Volume 35, Issue 10, pp 1772–1776

Interventions to decrease tube, line, and drain removals in intensive care units: the FRATER study

  • Silvia Calvino Günther
  • Carole Schwebel
  • Aurélien Vésin
  • Judith Remy
  • Geraldine Dessertaine
  • Jean-François Timsit
Brief Report

DOI: 10.1007/s00134-009-1555-8

Cite this article as:
Calvino Günther, S., Schwebel, C., Vésin, A. et al. Intensive Care Med (2009) 35: 1772. doi:10.1007/s00134-009-1555-8

Abstract

Purposes

To evaluate the incidence of unintended tube, line, and drain removals (UTRs) in our ICU, to identify system factors associated with UTRs, and to evaluate interventions designed to decrease UTR occurrence.

Methods

Interventional study in the 18-bed medical ICU of a French general university hospital. We prospectively determined the incidence and circumstances of UTRs in our ICU over a 2-year period. Demographic and clinical data were collected for consecutively admitted patients, and additional information was recorded about patients experiencing UTRs. Investigators analyzed UTR data twice a month to identify possible causes and developed interventions to decrease UTRs (mainly securing tubes and sedation protocol). Conditional logistic regression stratified on length of stay was used to identify risk factors for UTRs and segmented linear regression analysis to test the effects of interventions.

Results

Of 2,007 admitted patients (12,256 patient days), 193 (9.6%) experienced 270 UTRs (22/1,000 patient days). Clinical or therapeutic consequences occurred for 17% of UTRs. Three factors were independently associated with UTR; two were risk factors, namely, admission for coma [OR, 2.68; 95% CI (1.87; 3.84); P < 0.0001] and mechanical ventilation in over 65% of all ICU patients [OR = 1.65 (1.19; 2.29); P = 0.003], and one was protective, namely, mean SAPS II >45 in all ICU patients [OR, 0.54; 95% CI (0.39; 0.75); P = 0.0003]. Segmented regression analysis showed a 67.4% drop [95% CI (17.2%; 117.3%); P = 0.009] in the UTR rate after the first intervention was introduced. System factors played a major role in UTR occurrence.

Conclusion

UTRs are common. A continuous quality-improvement program can reduce UTR rates in the ICU.

Keywords

Tube removalIntensive careInterventionAdverse eventQuality of care

Supplementary material

134_2009_1555_MOESM1_ESM.doc (1.8 mb)
(DOC 1812 kb)

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Silvia Calvino Günther
    • 2
  • Carole Schwebel
    • 2
  • Aurélien Vésin
    • 1
  • Judith Remy
    • 2
  • Geraldine Dessertaine
    • 2
  • Jean-François Timsit
    • 1
    • 2
  1. 1.INSERM U823University Joseph Fourier, Albert Bonniot InstituteLa Tronche CedexFrance
  2. 2.Medical ICUMichallon Teaching HospitalGrenoble Cedex 9France