Article

Impact of a formal removal policy for central venous catheters on duration of catheterisation.

The Medical journal of Australia (Impact Factor: 3.79). 04/2005; 182(5):249-50.
Source: PubMed
2 Followers
 · 
78 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Intravascular devices (IVDs) are essential in the management of critically ill patients; however, IVD-related sepsis remains a major complication. Arterial catheters (ACs) are one of the most manipulated IVDs in critically ill patients. When bloodstream infection (BSI) is suspected in a patient with an IVD in situ, clinicians have focused their attention on the central venous catheter (CVC) while largely ignoring the AC. Although it would be routine for the CVC to be cultured and replaced if necessary for suspected IVD or catheter-related sepsis, the AC may not be treated in the same manner. The reasons for this may in part relate to the patient groups studied. In lower acuity patients with short dwell times, AC sepsis rates are indeed low. In the higher acuity patient, earlier studies suggested that ACs had an infective potential at least equal to short term CVCs, a finding that has translated poorly into clinical practice. It has been estimated that there may be up to 48,000 BSIs per year arising from ACs in the USA alone, suggesting a significant clinical problem. Recent evidence now shows that the infective potential of the AC is comparable with that in short term CVCs regarding both colonisation (which precedes BSI) and BSI, consolidating earlier studies. In critically ill patients suspected of catheter-related bloodsteam infection it is suggested that both the AC and CVC must now be assessed together.
    The Journal of hospital infection 03/2010; 75(1):12-8. DOI:10.1016/j.jhin.2010.01.005 · 2.78 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Peripheral arterial catheters are perceived as having low infective potential compared with other catheters and may be overlooked as a cause of catheter-related bloodstream infection. We aimed to measure colonization and rates of catheter-related bloodstream infection in arterial catheters, to investigate risk factors for arterial catheter colonization, and to compare arterial catheter infection rates with those in concurrently sited and managed central venous catheters. Prospective 24-month cohort study. Eight-bed combined general intensive care and high-dependency unit of a 350-bed Australian teaching hospital. Three hundred twenty-one arterial catheters in 252 adult and pediatric patients were observed for 1,082 catheter days, and 618 central venous catheters in 410 patients were observed for 4,040 catheter days. All catheters were inserted in, or presented to, the intensive care unit. Both arterial catheters and central venous catheters were inserted by trained personnel under aseptic conditions, and management was standardized. None. The incidence per 1,000 (95% confidence interval) catheter days of colonization (> or = 15 colonies) and catheter-related bloodstream infection was 15.7 (9.5-25.9) and 0.92 (0.13-6.44) for arterial catheters and 16.8 (13.3-21.3) and 2.23 (1.12-4.44) for central venous catheters. Arterial catheter colonization was not significantly different than that in central venous catheters (hazard ratio, 1.17; 95% confidence interval, 0.41-3.36; p = .77). Arterial catheter colonization increased with dwell time and was similar to central venous catheters over time. Femoral arterial catheters were colonized more often than radial arterial catheters (hazard ratio, 5.08; 95% confidence interval, 0.85, 30.3; p = .075), and colonization was significantly higher when the catheter was inserted in the operating theater or emergency department (hazard ratio, 4.45; 95% confidence interval, 1.42-13.9; p = .01) compared with the intensive care unit. The incidence of catheter-related bloodstream infection from arterial catheters was low. However, both arterial catheter colonization and rates of catheter-related bloodstream infection were similar to those in concurrently sited and identically managed central venous catheters. By inference, the arterial catheter should be accorded the same degree of importance as the central venous catheter as a potential source of sepsis.
    Critical care medicine 03/2008; 36(2):397-402. DOI:10.1097/CCM.0b013e318161f74b · 6.15 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To compare colonization and catheter-related bloodstream infection (CR-BSI) rates among three insertion sites (subclavian, internal jugular, femoral) used for central venous catheter (CVC) placement. Twenty-four-month prospective study, with relative effects analyzed by Cox proportional hazards regression. Eight-bed intensive care unit. Four hundred and ten critically ill patients requiring CVC placement. All short-term multi-lumen CVCs, including antimicrobial-coated devices, were studied with management standardized. Six hundred and five CVCs (4,040 catheter days) were analyzed. Colonization and CR-BSI incidence were, respectively, 15.1 (95% CI 13.5-21.0) and 1.8 (95% CI 1.2-4.2) per 1,000 catheter-days. Colonization was higher at the internal jugular (HR 3.64; 95% CI 1.32-10.00; p=0.01) and femoral (HR 5.15; 95% CI 1.82-14.51; p=0.004) sites than at the subclavian site. The femoral site carried a greater risk of being colonized by non-S. epidermidis species than the subclavian and internal jugular sites combined (HR 4.15; 95% CI 1.79-9.61; p=0.001). CVCs inserted in the Department of Emergency Medicine were more colonized than those inserted in the ICU or operating room (HR 2.66; 95% CI 1.27-5.56; p=0.01), and CVCs were less colonized in females than in males (HR 0.49; 95% CI 0.26-0.89; p=0.02). No difference in CR-BSI rates was noted between the three sites. Colonization was lowest at the subclavian site. Regional differences exist with respect to type of pathogen isolated. Colonization was influenced by insertion location and gender. The incidence of CR-BSI was not different.
    Intensive Care Medicine 07/2008; 34(6):1038-45. DOI:10.1007/s00134-008-1046-3 · 5.54 Impact Factor