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Moureau N. Hydrophilic biomaterial intravenous hydrogel catheter for complication reduction in PICC and midline catheters. Expert Rev Med Devices 2024; 21:207-216. [PMID: 38445649 DOI: 10.1080/17434440.2024.2324885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION More than 30% of peripherally inserted central catheters (PICCs) and midline catheters experience complications. Most complications are related to thrombotic cellular adherence to catheter materials. AREAS COVERED This manuscript outlines PICC and midline catheter complications, the need to reduce complications and how hydrogel catheters may provide a solution to address these unmet needs based on available evidence. EXPERT OPINION Patients commonly require PICC or midline catheters for treatment to establish a reliable form of intravenous access. Catheters, while reliable in most cases, are not without complications, including occlusion, thrombosis and infection, each related to cellular adherence to the catheter material. Hydrophilic catheter coatings and composites have been developed to mitigate these thrombotic complications, reduce adherence of blood and bacterial cells to catheters and provide greater patient safety with these devices. Hydrogel materials are highly biocompatible and have been effective in reducing cellular adherence and the formation of biofilms on surfaces. Smooth hydrophilic catheter surfaces are potentially more comfortable for the patient, with reduced friction during insertion and removal. A catheter constructed of hydrophilic biomaterial, a hydrogel composite material, may minimize thrombotic complications in PICC and midline catheters, improving catheter performance and outcomes for patients.
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Affiliation(s)
- Nancy Moureau
- Nursing Research, PICC Excellence,Inc. Griffith University, Brisbane, Queensland, Australia
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Massardier C, Perron J, Chetaille P, Côté JM, Drolet C, Houde C, Vaujois L, Naccache L, Michon B, Jacques F. Right atrial catheter "ghost" removal by cardiac surgery: A pediatric case series report. Pediatr Blood Cancer 2020; 67:e28197. [PMID: 32207557 DOI: 10.1002/pbc.28197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/29/2019] [Accepted: 01/14/2020] [Indexed: 01/02/2023]
Abstract
Fibrin sheath formation around long-term indwelling central venous catheters is common and usually benign. Fibrin sheath can persist after catheter removal and rarely leads to complications. This is a report of three pediatric oncology patients that required cardiac surgery for cardiac embolization of a "ghost" catheter several years after catheter removal. One case required tricuspid valve replacement for complete tricuspid valve destruction and two had erosion through the atrial wall. The severity of these rare complications mandates follow-up of "ghost" catheters in pediatric oncology patients.
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Affiliation(s)
| | - Jean Perron
- Cardiovascular Surgery, CHU de Québec-Laval, Quebec, Canada
| | | | - Jean-Marc Côté
- Pediatric Cardiology, CHU de Québec-Laval, Quebec, Canada
| | | | | | | | - Lamia Naccache
- Department of Oncology, CHU de Québec-Laval, Quebec, Canada
| | - Bruno Michon
- Department of Oncology, CHU de Québec-Laval, Quebec, Canada
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Köllnberger A, Schrader R, Briehn CA. Carboxylic acid mediated antimicrobial activity of silicone elastomers. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 113:111001. [PMID: 32487407 DOI: 10.1016/j.msec.2020.111001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 01/02/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022]
Abstract
Due to their high biocompatibility silicone elastomers are the material of choice in many sensitive health care applications. However, the inherent hydrophobicity of the polymer makes silicones more susceptible to spontaneous protein adsorption and subsequent biofilm formation than more hydrophilic abiotic materials. Hence, the development of antimicrobial silicone elastomers could help to reduce potential biofilm-associated infections when using silicone based medical devices. In this study, we describe carboxylic-acid-modified silicone elastomers that are biocompatible and exhibit a specific antimicrobial activity against clinically relevant pathogens even after being stored in common packaging materials.
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Wang H, Tong H, Liu H, Wang Y, Wang R, Gao H, Yu P, Lv Y, Chen S, Wang G, Liu M, Li Y, Yu K, Wang C. Effectiveness of antimicrobial-coated central venous catheters for preventing catheter-related blood-stream infections with the implementation of bundles: a systematic review and network meta-analysis. Ann Intensive Care 2018; 8:71. [PMID: 29904809 PMCID: PMC6002334 DOI: 10.1186/s13613-018-0416-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background Catheter-related blood-stream infections (CRBSIs) are the most common complication when using central venous catheters (CVCs). Whether coating CVCs under bundles could further reduce the incidence of CRBSIs is unclear. We aimed to assess the effectiveness of implementing the use of bundles with antimicrobial-coated CVCs for preventing catheter-related blood-stream infections. Methods In this systematic review and network meta-analyses, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library in addition to the EMBASE, MEDLINE, CINAHL, and Web of Science databases for studies published before July 2017. The primary outcome was the rate of CRBSIs per 1000 catheter-days, and the secondary outcome was the incidence of catheter colonization. Results Twenty-three studies revealed significant differences in the rate of CRBSIs per 1000 catheter-days between antimicrobial-impregnated and standard CVCs (RR 0.70, 95% CI 0.53–0.91, p = 0.008). Thirty-three trials were included containing 10,464 patients who received one of four types of CVCs. Compared with a standard catheter, chlorhexidine/silver sulfadiazine- and antibiotic-coated catheters were associated with lower numbers of CRBSIs per 1000 catheter-days (ORs and 95% CrIs: 0.64 (0.40–0.955) and 0.53 (0.25–0.95), respectively) and a lower incidence of catheter colonization (ORs and 95% CrIs: 0.44 (0.34–0.56) and 0.30 (0.20–0.46), respectively). Conclusions Outcomes are superior for catheters impregnated with chlorhexidine/silver sulfadiazine or other antibiotics than for standard catheters in preventing CRBSIs and catheter colonization under bundles. Compared with silver ion-impregnated CVCs, chlorhexidine/silver sulfadiazine antiseptic catheters resulted in fewer cases of microbial colonization of the catheter but did not reduce CRBSIs. Electronic supplementary material The online version of this article (10.1186/s13613-018-0416-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongliang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongshuang Tong
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Haitao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yao Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Ruitao Wang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hong Gao
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Pulin Yu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yanji Lv
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Shuangshuang Chen
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Guiyue Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Miao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yuhang Li
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
| | - Changsong Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
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Wallace A, Albadawi H, Patel N, Khademhosseini A, Zhang YS, Naidu S, Knuttinen G, Oklu R. Anti-fouling strategies for central venous catheters. Cardiovasc Diagn Ther 2017; 7:S246-S257. [PMID: 29399528 DOI: 10.21037/cdt.2017.09.18] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Central venous catheters (CVCs) are ubiquitous in the healthcare industry and carry two common complications, catheter related infections and occlusion, particularly by thrombus. Catheter-related bloodstream infections (CRBSI) are an important cause of nosocomial infections that increase patient morbidity, mortality, and hospital cost. Innovative design strategies for intravenous catheters can help reduce these preventable infections. Antimicrobial coatings can play a major role in preventing disease. These coatings can be divided into two major categories: drug eluting and non-drug eluting. Much of these catheter designs are targeted at preventing the formation of microbial biofilms that make treatment of CRBSI nearly impossible without removal of the intravenous device. Exciting developments in catheter impregnation with antibiotics as well as nanoscale surface design promise innovative changes in the way that physicians manage intravenous catheters. Occlusion of a catheter renders the catheter unusable and is often treated by tissue plasminogen activator administration or replacement of the line. Prevention of this complication requires a thorough understanding of the mechanisms of platelet aggregation, signaling and cross-linking. This article will look at the advances in biomaterial design specifically drug eluting, non-drug eluting, lubricious coatings and micropatterning as well as some of the characteristics of each as they relate to CVCs.
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Affiliation(s)
- Alex Wallace
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Nikasha Patel
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Ali Khademhosseini
- Department of Bioengineering, Department of Chemical and Biomolecular Engineering, Henry Samueli School of Engineering and Applied Sciences, University of California-Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.,Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA, USA.,California NanoSystems Institute (CNSI), University of California-Los Angeles (UCLA), Los Angeles, CA, USA
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Sailendra Naidu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Grace Knuttinen
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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Galy A, Lepeule R, Goulenok T, Buzele R, de Lastours V, Fantin B. Presentation and impact of catheter-associated thrombosis in patients with infected long-term central venous catheters: a prospective bicentric observational study. Ann Med 2016; 48:182-9. [PMID: 27022769 DOI: 10.3109/07853890.2016.1154981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Catheter-associated thrombosis (CAT) in patients with infected long-term central venous catheter (LTCVC) has been poorly studied. METHODS We prospectively included patients with infected LTCVC and collected clinical data. Doppler ultrasound was systematically performed to screen for CAT. Outcome (death or infection relapse) was evaluated 12 weeks after infection diagnosis. RESULTS 90 patients were included and CAT was diagnosed in 27 (30%). Local signs suggesting infection were more frequent in patients with CAT than without (11/27 versus 8/63, p = 0.03). Outcome was similar in patients with and without CAT. However, median duration of antimicrobials was longer (18 versus 14 days, p = 0.02), catheter removal tended to be more frequent (24/27 versus 46/63, p = 0.08), and anticoagulant therapy more often prescribed (17/27 versus 6/63, p < 0.01) in patients with CAT than without. Patients with occlusive thrombosis were more likely to have Staphylococcus aureus infections (4/7 versus 1/17, p = 0.02) and prolonged positivity of blood-cultures (3/7 versus 1/15, p = 0.02), than patients with non-occlusive thrombosis. CONCLUSION CAT is associated with local signs suggesting infection. A more aggressive treatment in CAT cases allowed a similar outcome at 12 weeks between patients with and without CAT. Occlusive thrombosis represented a subgroup of patients at risk of delayed clearance of bacteremia.
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Affiliation(s)
- Adrien Galy
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
| | - Raphaël Lepeule
- b Antimicrobial Stewardship Team, Assistance Publique-Hôpitaux De Paris, University Hospital Henri Mondor , Créteil , France
| | - Tiphaine Goulenok
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
| | - Rodolphe Buzele
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
| | - Victoire de Lastours
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
| | - Bruno Fantin
- a Department of Internal Medicine , Assistance Publique-Hôpitaux De Paris, University Hospital Beaujon , Clichy , France
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Hsu JF, Chang HL, Tsai MJ, Tsai YM, Lee YL, Chen PH, Fan WC, Su YC, Yang CJ. Port type is a possible risk factor for implantable venous access port-related bloodstream infections and no sign of local infection predicts the growth of gram-negative bacilli. World J Surg Oncol 2015; 13:288. [PMID: 26420628 PMCID: PMC4588233 DOI: 10.1186/s12957-015-0707-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implantable venous access port (IVAP)-related blood stream infections (BSIs) are one of the most common complications of implantable venous ports. The risk factors and pathogens for IVAP-related BSIs are still controversial. METHODS We retrospectively reviewed all patients who received IVAPs at a Hospital in Taiwan from January 1, 2011 to June 31, 2014. Two types of venous port, BardPort® 6.6 fr (Bard port) and Autosuture Chemosite® 7.5 fr (TYCO port) were used. All patients with clinically proven venous port-related BSIs were enrolled. RESULTS A total of 552 patients were enrolled. There were 34 episodes of IVAP-related BSIs during the study period for a total incidence of 0.177 events/1000 catheter days. Port type (TYCO vs. Bard, HR = 7.105 (95% confidence interval (CI), 1.688-29.904), p = 0.0075), age > 65 years (HR = 2.320 (95 % CI, 1.179-4.564), p = 0.0148), and lung cancer (HR = 5.807 (95% CI, 2.946-11.447), p < 0.001) were risk factors for port infections. We also found that no local sign of infection was significantly associated with the growth of gram-negative bacilli (p = 0.031). CONCLUSIONS TYCO venous ports, age > 65 years, and lung cancer were all significant risk factors for IVAP-related BSIs, and no sign of infection was significantly associated with the growth of gram-negative bacilli.
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Affiliation(s)
- Jui-Feng Hsu
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan.
| | - Hsu-Liang Chang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan.
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Ying-Ming Tsai
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan.
| | - Yen-Lung Lee
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Pei-Huan Chen
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Wen-Chieh Fan
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Yu-Chung Su
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan.
| | - Chih-Jen Yang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan. .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Effectiveness of silver-impregnated central venous catheters for preventing catheter-related blood stream infections: a meta-analysis. Int J Infect Dis 2014; 29:279-86. [PMID: 25447733 DOI: 10.1016/j.ijid.2014.09.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The purpose of this meta-analysis was to examine the effectiveness of silver-impregnated central venous catheters (CVCs) in preventing catheter bacterial colonization and catheter-related blood stream infections (CRBSIs). METHODS PubMed, Cochrane, and Embase databases were searched up to April 30, 2014. Studies in which other antiseptic reagents were used (e.g., chlorhexidine, octenidine dihydrochloride, urokinase rinses, benzalkonium chloride, rifampin-minocycline) were excluded. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Tests of heterogeneity and publication bias were performed. RESULTS Twelve studies were included in the meta-analysis. The studies enrolled a total of 2854 patients; 1440 received a standard CVC and 1414 received a silver-impregnated CVC. No significant difference in catheter bacterial colonization rates was found between silver-impregnated and standard CVCs (OR 0.907, 95% CI 0.758-1.087, p=0.290). No significant difference in CRBSI rates was found between silver-impregnated and standard CVCs (pooled OR 0.721, 95% CI 0.476-1.094, p=0.124). No significant heterogeneity or publication bias was noted. CONCLUSIONS Silver-impregnated CVCs are not associated with reduced rates of bacterial colonization or CRBSI.
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Cerbasi LLC. Spontaneous tissue regeneration of the Stensen duct in dogs. ACTA ACUST UNITED AC 2009; 108:e11-4. [DOI: 10.1016/j.tripleo.2009.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 05/28/2009] [Accepted: 06/30/2009] [Indexed: 11/27/2022]
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Central venous catheter colonization and catheter-related bloodstream infections in critically ill patients: a comparison between standard and silver-integrated catheters. Eur J Anaesthesiol 2009; 26:752-8. [DOI: 10.1097/eja.0b013e32832a3a84] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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DiCarlo JV, Auerbach SR, Alexander SR. Clinical review: alternative vascular access techniques for continuous hemofiltration. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 10:230. [PMID: 16989669 PMCID: PMC1751070 DOI: 10.1186/cc5035] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obtaining or maintaining vascular access for continuous hemofiltration can sometimes be problematic, especially in the child or adult in multiple organ failure with edema and/or coagulopathy. Problems commonly encountered include obstruction of the femoral vein by the catheter, insertion difficulties, safety concerns when cannulating the subclavian vein in coagulopathy, and catheter and circuit occlusion due to disseminated intravascular coagulation. For access in infants we describe a technique utilizing two single-lumen thin-walled vascular sheaths. For infants and small children initial access to the vein may be difficult due to edema or poor perfusion. For this situation we describe the 'mini-introducer' technique of securing the vein and facilitating subsequent insertion of a relatively large guide wire. At any age an alternative route to the subclavian vein, from above the clavicle, is potentially 'compressible' in the event of hemorrhage during the procedure. We remind the reader of the utility of ultrasound guidance for cannulation of the internal jugular and subclavian veins. And lastly we review the options for venous return via the umbilical vein in infants, and via the antecubital vein in larger children and adults.
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Affiliation(s)
- Joseph V DiCarlo
- Division of Pediatric Critical Care Medicine, Stanford University School of Medicine, Welch Road, Palo Alto, California 94304, USA
| | - Scott R Auerbach
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Welch Road, Palo Alto, California 94305, USA
| | - Steven R Alexander
- Division of Pediatric Nephrology, Stanford University School of Medicine, SUMC G306A, Stanford, California 94305, USA
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Bacuzzi A, Cecchin A, Del Bosco A, Cantone G, Cuffari S. Recommendations and reports about central venous catheter-related infection. Surg Infect (Larchmt) 2006; 7 Suppl 2:S65-7. [PMID: 16895510 DOI: 10.1089/sur.2006.7.s2-65] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Central venous catheters (CVCs) are used to deliver a variety of therapies, as well as for measurement of hemodynamic parameters. The major associated complication is catheter-related blood stream infection (CRBSI). METHOD Review of the pertinent English-language literature. RESULTS The incidence of CRBSI depends on how such infections are defined. Generally, the term includes all BSIs in patients with CVCs when other sources can be excluded, and if a culture of the catheter tip demonstrates a substantial number of colonies of the organism found in the blood stream. Important pathogenic determinants of catheter-related infection are the material of which the device is made and the intrinsic virulence of the organism. The site at which a catheter is placed influences the risk of infection. The types of organisms that most commonly cause hospital-acquired BSIs have changed over time. Migration of skin organisms at the insertion site into the cutaneous catheter tract with colonization of the catheter tip is the most common route of infection. Good hand hygiene before catheter insertion, combined with proper aseptic technique during its manipulation, provides protection against infection; maximal sterile barrier precautions during insertion reduce the incidence of CRBSI. Catheters that are coated or impregnated with antimicrobial or antiseptic agents can decrease the risk and the associated hospital costs. No studies have demonstrated that oral or parenteral antibacterial or antifungal drugs reduce the incidence of CRBSI in adults. Use of anticoagulants might have a role in the prevention of CRBSI. Catheter replacement at scheduled intervals has not lowered rates of local or systemic complications. CONCLUSIONS Central venous catheters are used commonly to deliver a variety of therapies, such as large amounts of fluid or blood products during surgery or in intensive care units, chemotherapy, and parenteral nutrition, as well as for measurement of hemodynamic variables. The major complication associated with CVCs is CRBSI.
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Affiliation(s)
- Alessandro Bacuzzi
- Anaesthesia and Palliative Care, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
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13
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Keller JE, Hindman JW, Mehall JR, Smith SD. Enoxaparin inhibits fibrin sheath formation and decreases central venous catheter colonization following bacteremic challenge. Crit Care Med 2006; 34:1450-5. [PMID: 16540961 DOI: 10.1097/01.ccm.0000215832.40827.71] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Inhibition of fibrin sheath formation by enoxaparin decreases catheter colonization. Fibrin-binding radioactive tracer and catheter weights quantify fibrin reduction. DESIGN Controlled experimental study of central venous line colonization. SETTING Animal laboratory. SUBJECTS Adult male Sprague-Dawley rats. INTERVENTIONS Central venous lines were introduced into right external jugular veins of 254 animals in three groups: enoxaparin, Fibrimage, and catheter weight. The enoxaparin group (n = 196) received daily enoxaparin injections (n = 97) or catheter implantation only (n = 99); 176 received tail vein injections of Staphylococcus epidermidis on postoperative day (POD) 10. Twenty rats received saline injections as a control. On POD 13, catheters were removed and incubated in broth at 37 degrees C for 48 hrs. Turbid samples were plated. In the Fibrimage group (n = 39), 20 rats receiving enoxaparin were compared with 19 controls without enoxaparin; all received S. epidermidis injections on POD 10. Fibrimage, fibrin-binding radiolabeled tracer, was given 1 hr before catheter removal. In the weight group (n = 19), six rats received enoxaparin; 13 did not. All received injections of S. epidermidis on POD 10. MEASUREMENTS AND MAIN RESULTS Positive plates underwent analytic profile index testing, ensuring correlation with inoculum. Results were compared using Fisher's exact or chi-square tests. Gamma counts were determined in the Fibrimage group. Catheter tip weights were recorded. Results from the Fibrimage and weight groups were compared using Student's t-test. The enoxaparin group had fewer catheters colonized (17 of 77) vs. no enoxaparin (42 of 99; p < .01). Pericatheter sheaths contained less fibrin compared with controls. Fibrimage group gamma counts were significantly decreased for the enoxaparin subgroup (x = 2244 counts per minute) vs. controls (x = 3767 counts per minute; p < .0002). The weight of catheter tips treated with enoxaparin (x = 39 mg) vs. controls (x = 90 mg) was also significantly decreased (p < .0001). CONCLUSIONS Enoxaparin decreases the amount of fibrin surrounding central venous catheters. The incidence of catheter colonization decreases when the amount of fibrin within the pericatheter sheath decreases.
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Affiliation(s)
- Jennifer E Keller
- University of Arkansas Medical Sciences, Department of Surgery, and Arkansas Children's Hospital, Little Rock, AR 72202, USA
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