From CVC Standards to Bedside Practice: Using a Structured ICU Audit to Improve Safety

Central venous catheters (CVCs) are essential in intensive care, supporting haemodynamic monitoring, medication delivery, and advanced supportive therapies. However, their use is also associated with recognised risks, including bleeding, pneumothorax, malposition, and catheter-related bloodstream infections. Improving safety, therefore, depends not only on clinical expertise but on consistent adherence to standards and reliable documentation.

To support this, we use a structured CVC audit template that translates evidence-based standards into measurable data captured at the point of care. The audit focuses on CVC insertion and immediate post-procedural safety, providing actionable insights for ICU, emergency, and peri-operative teams while supporting education, governance, and quality improvement. You can view the audit template here.

Why a Structured CVC Audit Is Needed

Despite well-established guidelines, variation in CVC practice remains common in high-acuity environments. Documentation is often fragmented across various notes, imaging systems, and procedure records, making it difficult to conduct a meaningful review.

Our CVC audit addresses this by:

• Standardising documentation of patient context, coagulation status, and medications

• Capturing procedural details that influence complication risk

• Recording post-insertion confirmation and early complications

• Enabling aggregation of data for audit cycles, feedback, and re-audit

This shifts CVC governance from passive record-keeping to active quality surveillance.

How the Audit Reflects CVC Standards in Practice

The audit mirrors the real-world workflow of CVC insertion and early review.

Patient and procedural context

The template records demographics, location (ICU, ED, operating theatre), and timing of the procedure, enabling analysis by clinical setting and workload context.

Bleeding and medication risk assessment

Key laboratory values (haemoglobin, platelet count, INR/APTT) and the presence and timing of antiplatelet or anticoagulant therapy are documented, supporting retrospective review of bleeding risk stratification and alignment with local guidance

Insertion technique and procedural details

The audit captures insertion site and side, number of attempts, catheter length, ultrasound use, and confirmation that the guidewire was removed—variables closely linked to procedural success and complications.

Line security and confirmation

Method of fixation, confirmation of catheter position on chest X-ray, and relevant central venous blood gas parameters are recorded, ensuring post-insertion verification before clinical reliance.

Early complications

Immediate complications such as bleeding or pneumothorax are documented, allowing monitoring of procedural safety trends over time

Mapping the Audit to CLABSI Prevention Bundles

CLABSI bundle element	Where it appears in the audit
Appropriate patient assessment	Coagulation parameters and antithrombotic therapy documented
Optimal site selection	Site and side recorded
Ultrasound guidance	Explicit field for ultrasound use
Minimising attempts	Number of attempts captured
Securement	Fixation method recorded
Post-insertion verification	Chest X-ray confirmation documented
Early complication surveillance	Immediate complications captured

---