Intraoperative Central Venous Catheter Usage in Elective Neurosurgery: A Quality Improvement Initiative

Abstract Central venous catheters (CVCs) are routinely used in neurosurgical procedures despite an estimated incidence of line-related complications exceeding 15%. Our quality improvement initiative studied the usage and choice of CVCs and assessed the effect of feedback-based optimization of catheter choice without compromising safety. This 3-phase study was conducted at a tertiary care hospital in South India. It included all patients admitted to the neuro-intensive care unit following elective cranial surgery with intraoperative CVC insertion. Phase 1 (3 months) studied the indication, choice of CVC, and duration of retention. Feedback was provided to the Neuroanaesthesia team, whose independent interpretation and practice modification constituted phase 2. In phase 3, the change in practice was documented. Comparative and subgroup analyses were performed using χ 2, Fisher's exact, and Mann–Whitney U tests. In phase 1, 143 of 769 elective neurosurgical cases (19%) were included, compared with 210 of 869 cases (24%) in phase 3. Despite the significant increase in inotrope and transfusion need in phase 3, peripherally inserted central catheter (PICC) use significantly rose from 58 to 82%, effectively managing such cases with no documented complications. Anticipated blood loss was the most common indication (43%) for line insertion in phase 3. One catheter-related bloodstream infection occurred in phase 1 with a centrally inserted CVC. PICC are safe, cost-effective alternatives to CVCs in elective neurosurgical procedures. A feedback-based quality improvement intervention significantly increased acceptance of PICC without compromising safety or perioperative management of complications.