Deimplementing CXR After CVC (DRAUP) in the ICU

There are millions of critically ill patients annually who require imaging confirmation after central venous catheter insertion. Emerging literature demonstrates that ultrasound is a faster alternative to historical chest xray, thus serving as the ideal confirmation for catheter use. When able to confirm catheter position, ultrasound decreases the number of unnecessary chest radiographs, cumulative resources (technologist, radiologist, equipment), and patient care delays. However, providers are not adopting this practice. Previously, we developed and initiated a successful evidence-based deimplementation program for ultrasound in lieu of chest xray called DRAUP in the Emergency Department. We now move to adapt the deimplementation bundle in the new environment of the Intensive Care Unit (ICU) with hopeful continued success.

In experiment 1, qualitative analysis will be employ a systematic approach to DRAUP component refinement dosed to the unique context of the Intensive Care Unit and implementation outcomes as well as cost will be evaluated. In experiment 3, mixed methods will be used to evaluate the mechanism of impact of the refined program in the new environment.

-Measure the effectiveness and cost effectiveness of DRAUP on discontinuation of CXRs

Inclusion criteria

for DRAUP training:

(1) ICU faculty, fellows, senior residents (post graduate year 3) and advanced practice practitioners

• ICU inclusion for DRAUP program:
• Availability of ultrasound machines with archiving capability (DICOM)
• A minimum of 100 supradiaphragmatic CVC insertions annually in adult patients (age >18)
• Capacity to access digital archiving (PICOM)
• Patient inclusion for DRAUP program:
• supradiaphragmatic CVC placed
• Patient exclusion for DRAUP program:
• severe instability (cardiac arrest, severe shock) where CVC would be used without CXR,
• level 1 trauma;
• burn patients with no viable skin surface for imaging