Skip to main content

Advertisement

SpringerLink
Log in

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

  • Brief Report
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Buckley TA, Short TG, Rowbottom YM, Oh TE (1997) Critical incident reporting in the intensive care unit. Anaesthesia 52:403–409

    Article  PubMed  CAS  Google Scholar 

  2. De Lassence A, Alberti C, Azoulay E, Le Miere E, Cheval C, Vincent F, Cohen Y, Garrouste-Orgeas M, Adrie C, Troche G (2002) Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: a prospective multicenter study. Anesthesiology 97:148–156

    Article  PubMed  Google Scholar 

  3. Garrouste Orgeas M, Timsit JF, Soufir L, Tafflet M, Adrie C, Philippart F, Zahar JR, Clec’h C, Goldran-Toledano D, Jamali S, Dumenil A-S, Azoulay E, Carlet J (2008) Impact of adverse events on outcomes in intensive care unit patients. Crit Care Med 36:2041–2047

    Article  PubMed  Google Scholar 

  4. Needham DM, Sinopoli DJ, Thompson DA, Holzmueller CG, Dorman T, Lubomski LH, Wu AW, Morlock LL, Makary MA, Pronovost PJ (2005) A system factors analysis of “line, tube, and drain” incidents in the intensive care unit. Crit Care Med 33:1701–1707

    Article  PubMed  Google Scholar 

  5. Rose DK, Cohen MM, Wigglesworth DF, DeBoer DP (1994) Critical respiratory events in the postanesthesia care unit, patient, surgical, and anesthetic factors. Anesthesiology 81:410–418

    Article  PubMed  CAS  Google Scholar 

  6. Sinopoli DJ, Needham DM, Thompson DA, Holzmueller CG, Dorman T, Lubomski LH, Wu AW, Morlock LL, Makary MA, Pronovost PJ (2007) Intensive care unit safety incidents for medical versus surgical patients: a prospective multicenter study. J Crit Care 22:177–183

    Article  PubMed  Google Scholar 

  7. Vincent C (2003) Understanding and responding to adverse events. N Engl J Med 348:1051–1056

    Article  PubMed  Google Scholar 

  8. Vincent C, Taylor-Adams S, Chapman EJ, Hewett D, Prior S, Strange P, Tizzard A (2000) How to investigate and analyse clinical incidents: clinical risk unit and association of litigation and risk management protocol. BMJ 320:777–781

    Article  PubMed  CAS  Google Scholar 

  9. Auriant I, Reignier J, Pibarot M, Bachat S, Tenaillon A, Raphael J (2002) Critical incidents related to invasive mechanical ventilation in the ICU: preliminary descriptive study. Intensive Care Med 28:452–458

    Article  PubMed  CAS  Google Scholar 

  10. Giraud T, Dhainaut JF, Vaxelaire JF, Joseph T, Journois D, Bleichner G, Sollet JP, Chevret S, Monsallier JF (1993) Iatrogenic complications in adult intensive care units: a prospective two-center study. Crit Care Med 21:40–51

    Article  PubMed  CAS  Google Scholar 

  11. Tominaga GT, Rudzwick H, Scannell G, Waxman K (1995) Decreasing unplanned extubations in the surgical intensive care unit. Am J Surg 170:586–589 discussion 589-590

    Article  PubMed  CAS  Google Scholar 

  12. Ursprung R, Gray JE, Edwards WH, Horbar JD, Nickerson J, Plsek P, Shiono PH, Suresh GK, Goldmann DA (2005) Real time patient safety audits: improving safety every day. Qual Saf Health Care 14:284–289

    Article  PubMed  CAS  Google Scholar 

  13. Ferraris VA, Propp ME (1992) Outcome in critical care patients: a multivariate study. Criti Care Med 20:967–976

    Article  CAS  Google Scholar 

  14. Betbese AJ, Perez M, Bak E, Rialp G, Mancebo J (1998) A prospective study of unplanned endotracheal extubation in intensive care unit patients. Crit Care Med 26:1180

    Article  PubMed  CAS  Google Scholar 

  15. Epstein SK, Nevins ML, Chung J (2000) Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med 161:1912–1916

    PubMed  CAS  Google Scholar 

  16. Pesiri AJ (1994) Two-year study of the prevention of unintentional extubation. Crit Care Nurs Q 17:35–39

    PubMed  CAS  Google Scholar 

  17. Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D (2002) Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 27:299–309

    Article  PubMed  CAS  Google Scholar 

  18. Mion LC, Minnick AF, Leipzig R, Catrambone CD, Johnson ME (2007) Patient-initiated device removal in intensive care units: a national prevalence study. Crit Care Med 35:2714–2720 quiz 2725

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. INSERM U823, University Joseph Fourier, Albert Bonniot Institute, 38706, La Tronche Cedex, France

    Aurélien Vésin & Jean-François Timsit

  2. Medical ICU, Michallon Teaching Hospital, BP 217, 38043, Grenoble Cedex 9, France

    Silvia Calvino Günther, Carole Schwebel, Judith Remy, Geraldine Dessertaine & Jean-François Timsit

Authors
  1. Silvia Calvino Günther
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carole Schwebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aurélien Vésin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Judith Remy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Geraldine Dessertaine
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean-François Timsit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-François Timsit.

Additional information

The article was written on behalf of the FRATER study group. FRATER is the acronym for French Risk Assessment for TubE Removal, whose participants are listed in the appendix.

Electronic supplementary material

Below is the link to the electronic supplementary material.

(DOC 1812 kb)

Appendix

Appendix

Members of the FRATER study group

Scientific committee

Rebecca Hamidfar-Roy MD, Medical ICU, Michallon Teaching Hospital, Grenoble.

Patricia Peurois, Medical ICU, Michallon Teaching Hospital, Grenoble.

Alexis Tabah, Medical ICU, Michallon Teaching Hospital, Grenoble.

Alexandra Michel-Herzberg RN, Medical ICU, Michallon Teaching Hospital, Grenoble.

Laure Hammer MD, Medical ICU, Michallon Teaching Hospital, Grenoble.

Nadège Oudart RN, Medical ICU, Michallon Teaching Hospital, Grenoble.

Agnès Bonadona MD, Medical ICU, Michallon Teaching Hospital, Grenoble.

Maria Dacosta RN, Medical ICU, Michallon Teaching Hospital, Grenoble.

Biostatistical and informatics expertise

Adrien Francais M.Sc, Outcomerea, Inserm U823, Team Outcome of Cancer and Critical Illness, Grenoble, France.

Aurélien Vesin M.Sc, Outcomerea, Inserm U823, Team Outcome of Cancer and Critical Illness, Grenoble, France.

Timsit Jean-Francois, Outcomerea, Inserm U823; University Joseph Fourier (Grenoble 1); Grenoble, France.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Calvino Günther, S., Schwebel, C., Vésin, A. et al. Interventions to decrease tube, line, and drain removals in intensive care units: the FRATER study. Intensive Care Med 35, 1772–1776 (2009). https://doi.org/10.1007/s00134-009-1555-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-009-1555-8

Keywords

Search

Navigation