- In this report
- Overview
- March 2010 Ratings
- Central lines
- The checklist revolution
- Freeing the data
- Does reporting help?
- This checklist might save your life
- What you can do
Central lines: Boon and peril
This article appeared in 
Photograph Robert A. Ripps
Most adults have probably had a standard intravenous line at some point in their lives. Central lines are nothing like those.
"When people are as sick as they are in intensive care, you need a way to get things into them in large volumes, and very fast, such as nutrition, fluids or a blood transfusion," explained John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. "If you put medication into a central line, it gets into the system much faster than if you put it into a regular IV."
The lines are long, flexible catheters that thread through a large vein that leads to the heart. Unlike regular IVs, which usually stay in for only a few days, central lines can stay put for weeks or even months. It's not unusual for a patient to have something put into a central line many times a day.
The problem is that every time a doctor, nurse, or medical technician touches that line or the skin surrounding it, or the catheter's dressing is dislodged, there's a risk of introducing bacterial contamination unless the strictest sterile conditions are observed. If that happens, the central line's biggest virtue—the ability to spread its cargo throughout the body quickly—becomes its biggest vice. Bacteria, including the antibiotic–resistant "superbugs" present in most hospitals, can quickly multiply, causing sepsis, an infection of the entire bloodstream.
"Sepsis produces high fevers, rigors—violent shaking chills—and the high fever could induce delirium," says Peter Pronovost, M.D., Ph.D., critical–care specialist at the Johns Hopkins School of Medicine in Baltimore. "Imagine the worst you ever felt from the flu, multiplied by 10."
And it is deadly: Sepsis kills up to 50 percent of its victims.
Pearl Gelman, 91, was admitted to a Florida hospital in May 2007 with bronchitis symptoms, according to her daughter, Susan Denenberg of Merrick, N.Y. "She couldn't get antibiotics through her arms because the veins were very bad," Denenberg said. "That's why they had to do it through the neck." Later, she said, the hospital called for permission to replace the central line. "She was getting weaker and weaker, and then they told us she had the MRSA," Denenberg said, referring to the superbug methicillin–resistant staphylococcus aureus. "And it was just downhill. She couldn't fight back. She died at the hospital."
