scholarly journals Guidelines for the Prevention of Intravascular Catheter–Related Infections

2002 ◽  
Vol 23 (12) ◽  
pp. 759-769 ◽  
Author(s):  
Naomi P. O'Grady ◽  
Mary Alexander ◽  
E. Patchen Dellinger ◽  
Julie L. Gerberding ◽  
Stephen O. Heard ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Venous Catheter ◽  
Education And Training ◽  
Blood Stream ◽  
Central Venous Catheters ◽  
Successful Implementation ◽  
Central Venous ◽  
Catheter Related Infection ◽  
Skin Antisepsis ◽  
And Training

Background:Although many catheter-related blood-stream infections (CRBSIs) are preventable, measures to reduce these infections are not uniformly implemented.Objective:To update an existing evidenced-based guideline that promotes strategies to prevent CRBSIs.Data Sources:The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles.Studies Included:Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiologic investigations.Outcome Measures:Reduction in CRBSI, catheter colonization, or catheter-related infection.Synthesis:The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).Conclusion:Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.

scholarly journals Guidelines for the Prevention of Intravascular Catheter–Related Infections

2002 ◽  
Vol 23 (12) ◽  
pp. 759-769 ◽  
Author(s):  
Naomi P. O'Grady ◽  
Mary Alexander ◽  
E. Patchen Dellinger ◽  
Julie L. Gerberding ◽  
Stephen O. Heard ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Venous Catheter ◽  
Education And Training ◽  
Blood Stream ◽  
Central Venous Catheters ◽  
Successful Implementation ◽  
Central Venous ◽  
Catheter Related Infection ◽  
Skin Antisepsis ◽  
And Training

Background:Although many catheter-related blood-stream infections (CRBSIs) are preventable, measures to reduce these infections are not uniformly implemented.Objective:To update an existing evidenced-based guideline that promotes strategies to prevent CRBSIs.Data Sources:The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles.Studies Included:Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiologic investigations.Outcome Measures:Reduction in CRBSI, catheter colonization, or catheter-related infection.Synthesis:The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).Conclusion:Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.

Conventional central venous catheters as tunnelled mid-clavicular midline catheters: Description of novel application and outcome analysis

2020 ◽  
pp. 112972982098287
Author(s):  
Sivashanmugam Thiyagarajan ◽  
Charulatha Ravindran
Keyword(s):  
Blood Stream Infection ◽  
Venous Catheter ◽  
Venous Access ◽  
Blood Stream ◽  
Central Venous Catheters ◽  
Successful Outcome ◽  
Outcome Analysis ◽  
Clinical Report ◽  
Central Venous ◽  
Cost Constraints

Background: Long peripheral catheters are the ideal devices for intermediate venous access (1–4 weeks). However due to non-availability and cost constraints, these lines are not widely adapted in developing countries. In this clinical report we describe a technique of using conventional Central Venous Catheters as Midclavicular midlines for intermediate venous access and present the outcome analysis of such catheters in the last 2 years from our institute. Methods: A single lumen conventional central venous catheter (5 Fr, 20 cm) was introduced through the deep veins of the upper arm, 1 to 1.5 cm distal to the axillary crease. The catheter was tunnelled for a distance of 5 to 7 cm to exit from Dawson’s green zone to reduce the incidence of Midline Associated Blood Stream Infection. Patients were followed up by trained staff nurses and outcome parameters were recorded. Results: Seventy six patients were enrolled and 72 patients underwent successful cannulation and completed the outcome analysis. Administration of intravenous antibiotics and chemotherapy were the commonest indications. The device served the intended duration of therapy in 66 (92%) patients for a median number of 12 (6–20) catheter days. Device related blood stream infection was 1.24/1000 catheter days and catheter related thrombosis rate was 8.3%. Conclusion: Conventional Central Venous Catheters can be effectively used as tunnelled Midclavicular midline catheters in low resource settings. The successful outcome analysis has to be confirmed by larger studies.

P10 Evaluation of existing line-locking practice in central venous catheters of paediatric patients on home parenteral nutrition

2018 ◽  
Vol 103 (2) ◽  
pp. e1.14-e1
Author(s):  
Tustin Amy ◽  
Hartley Karen ◽  
Derry David ◽  
Thomas Julian
Keyword(s):  
Parenteral Nutrition ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Venous Catheters ◽  
Home Parenteral Nutrition ◽  
List Type ◽  
Central Venous ◽  
Paediatric Patients

AimTo review current line-locking practice of central venous catheters (CVCs) to reduce catheter related blood stream infections (CRBSIs) and preserve line integrity in paediatric patients on home parenteral nutrition (HPN), with the secondary aim of producing a concise, evidence-based guideline for use in this cohort and inpatient PN patients as well.MethodAll 19 paediatric HPN patients were reviewed retrospectively over 6 months (January–June 2017). Data was collected from clinic letters, HPN prescriptions and blood cultures. Information gathered per patient:Line lock(s)Infective episode(s)CVC replacement(s)Establishment of current practice: All patients use TaurolockTM first-line. If CVC is stiff or stops bleeding back switch to TauroLockTM-Hep100. Should problems persist introduce alcohol 70% on alternate days or alone if recurrent infections occur on TaurolockTM. Blocked CVCs are instilled with urokinase or alteplase and CVC replaced if unsuccessful.Results18/19 patients were prescribed line locks as per above practice. One patient is prescribed heparin 10units/ml – due to a documented TauroLockTM allergy – and remained infection- free throughout. 7 infections occurred overall in 6 patients with 13 patients infection-free. 2.2 infections/1000 catheter days occurred in patients on TauroLockTM with 2 patients requiring CVC changes due to infection and broken CVC respectively.1 infection/1000 catheter days occurred on TauroLockTM- Hep100 with 2 CVC changes required due to occlusion. 11 infections/1000 catheter days occurred in 1 patient on daily alcohol 70%, although result validity is uncertain due to potential contamination of blood culture specimen from skin organisms during sampling. No infections occurred in 248 catheter days in patients alternating TauroLockTM-Hep100 and alcohol 70% with one line change required as CVC moved position.ConclusionCRBSIs pose a serious problem in paediatric HPN patients.1,2 Taurolidine has proven efficacy at preventing CRBSIs and proven superiority to heparin.3 The effectiveness of alcohol at reducing CRBSI rates and preventing CVC replacement has been proven when compared to heparin4 however, due to adverse effects (thrombosis and CVC degradation)4 use is limited to ensure benefits outweigh risks. These studies, although limited, and results in our patient cohort support the continued use of these line locks as per existing practice. Future work includes need to formalise written guideline and discuss clear pathway if patients have multiple CRBSIs on their existing line lock as presently information is unclear.ReferencesKoletzko B, Agostoni C, Ball P, et al. ESPEN/ESPGHAN guidelines on paediatric parenteral nutrition. Journal of Paediatric Gastroenterology and Nutrition2005;41:S76–S84.Candusso M, Faraguna D, Sperli D, et al. Outcome and quality of life in paediatric home parenteral nutrition. Current Opinion in Clinical Nutrition and Metabolic Care2005;5:309–14.Chu HP, Brind J, Tomar R, et al. Significant reduction in central venous catheter-related bloodstream infections in children on HPN after starting treatment with taurolidine line lock. J Pediatr Gastroenterol Nutr2012;55:403–7.Oliveira C, Nasr A, Brindle M, et al. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: A meta-analysis. Paediatrics2012;129:318–329.

Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

2009 ◽  
Vol 28 (3) ◽  
pp. 151-155 ◽  
Author(s):  
Sabra Curry ◽  
Michele Honeycutt ◽  
Gail Goins ◽  
Craig Gilliam
Keyword(s):  
High Risk ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Skin Antisepsis ◽  
Neonatal Population

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

scholarly journals Guidelines for the Prevention of Intravascular Catheter–Related Infections

2002 ◽  
Vol 35 (11) ◽  
pp. 1281-1307 ◽  
Author(s):  
Naomi P. O'Grady ◽  
Mary Alexander ◽  
E. Patchen Dellinger ◽  
Julie L. Gerberding ◽  
Stephen O. Heard ◽  
...  
Keyword(s):  
Health Care ◽  
Interventional Radiology ◽  
Critical Care ◽  
Infection Control ◽  
Working Group ◽  
Central Venous Catheters ◽  
Evidence Based ◽  
Central Venous ◽  
Skin Antisepsis ◽  
And Training

Abstract These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device–Related Infections published in 1996. These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

Managing Central Venous Catheter Dressings: A Short Gut Syndrome Case Study

2021 ◽  
Author(s):  
Melissa Langford ◽  
Maria Leal ◽  
Lindsey Patton
Keyword(s):  
Best Practice ◽  
Pediatric Patients ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Short Gut Syndrome ◽  
Multiple Risk Factors ◽  
Skin Conditions

Highlights Abstract Central venous catheters are necessary in treatment and care of pediatric patients with short gut syndrome. Despite necessity, central venous catheters come with the risk of developing central line associated blood stream infections (CLABSI). This manuscript describes a complex, pediatric gastroenterology patient with multiple risk factors who developed a CLABSI. Short gut syndrome patients can develop skin conditions and complications that may challenge nursing practice to mitigate CLABSI. Further research is needed on preventing CLABSIs in complex pediatric patients to provide the best practice implications for nursing.

scholarly journals Do You Know Your Lines?

2017 ◽  
Vol 01 (03) ◽  
pp. 161-167
Author(s):  
Vamsidhar Rachapalli ◽  
Pankaj Sharma ◽  
Sheo Kumar ◽  
Mangerira Uthappa
Keyword(s):  
Interventional Procedure ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Due Diligence ◽  
Central Venous ◽  
Skin Antisepsis ◽  
Catheter Tip ◽  
Patient Preparation ◽  
Tip Position ◽  
The Right

AbstractThe use of central venous catheters has become ubiquitous in the clinical practice. While a majority of them are easy to insert, many consider it a mundane interventional procedure. However, it is important to ensure that the right catheter is selected for the right patient. In addition, due diligence should be observed during site selection and catheter securement. This article briefly but concisely covers various aspects of venous catheter insertion ranging from catheter selection, patient preparation, choice of skin antisepsis to catheter tip position. This article, however, does not deal with the actual steps involved in the insertion of various catheters.

Central Venous Catheter–Related Infection: A Prospective, Observational Study to Assess the Incidence Rate at a Teaching Hospital in Argentina

2002 ◽  
Vol 23 (12) ◽  
pp. 757-758 ◽  
Author(s):  
Carlos Bantar ◽  
José Luis Bustos ◽  
Eduardo Vesco ◽  
Graciana Morera ◽  
Keyword(s):  
Central Venous Catheter ◽  
Observational Study ◽  
Incidence Rate ◽  
Infection Rate ◽  
Teaching Hospital ◽  
Prospective Observational Study ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Catheter Related Infection

AbstractOne hundred fifty-one central venous catheters (CVCs) were observed for development of infection. The infection rate was higher for CVCs with a duration of less than 6 days than for those with a longer duration. Our data suggest that scheduled replacement of CVCs is not necessary.

A bedside rescue method for retrieving retained guidewires: The ‘Suck Out’ technique

2020 ◽  
pp. 112972982094345
Author(s):  
Maryanne Z A Mariyaselvam ◽  
Vikesh Patel ◽  
Adam Sawyer ◽  
James A Richardson ◽  
Jonathan Dean ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Patient Harm ◽  
Central Venous ◽  
Exact Test ◽  
The United Kingdom ◽  
Catheter Tip ◽  
Never Event ◽  
Benchtop Model

Background: Central venous catheter guidewire retention is classed as a ‘never event’ in the United Kingdom, with the potential for significant patient harm. If the retained guidewire remains within the central venous catheter lumen, bedside techniques may facilitate guidewire retrieval. However, these techniques may be ineffective if the guidewire has already passed below skin level. We investigated a novel ‘suck out’ technique for bedside guidewire retrieval and compared this against traditional retrieval methods. Methods: Simulation 1: in a benchtop model, seven different central venous catheters had their corresponding guidewire placed in the last 2 cm of the catheter tip which was immersed horizontally in fluid. A 50-mL syringe was attached to the distal lumen central venous catheter hub and suction applied for 5 s, and the distance of guidewire retraction was recorded. Simulation 2: a central venous catheter guidewire was intentionally retained within the catheter at either 5 cm above or below skin level in a pigskin model. Simple catheter withdrawal, catheter clamping withdrawal and the ‘suck out’ method were compared for efficacy using Fisher’s exact test. Results: Simulation 1: retained guidewires were retracted by 13 cm on average. Simulation 2: when guidewires were retained 5 cm above skin level, all retrieval methods were 100% effective; however, when retained 5 cm below skin level, simple catheter withdrawal was ineffective, clamping and withdrawal was only 10% effective and the ‘suck out’ technique was 90% effective (p < 0.001). Conclusion: The ‘suck out’ technique can effectively retract guidewires retained within central venous catheter lumens and demonstrates superiority over traditional methods of retained guidewire extraction in simulated models.

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