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.

scholarly journals Linezolid lock prophylaxis of central venous catheter infection

2008 ◽  
Vol 57 (4) ◽  
pp. 534-535 ◽  
Author(s):  
Jérôme Patrick Fennell ◽  
Martin O'Donohoe ◽  
Martin Cormican ◽  
Maureen Lynch
Keyword(s):  
Central Venous Catheter ◽  
Hospital Admissions ◽  
Blood Stream Infection ◽  
Central Venous Access ◽  
Venous Catheter ◽  
Venous Access ◽  
Blood Stream ◽  
Central Venous ◽  
Central Venous Catheter Infection ◽  
The Impact

Central venous catheter (CVC)-related infections are a major problem for patients requiring long-term venous access and may result in frequent hospital admissions and difficulties in maintaining central venous access. CVC-related blood stream infections are associated with increased duration of inpatient stay and cost approximately \#8364;13 585 per patient [Blot, S. I., Depuydt, P., Annemans, L., Benoit, D., Hoste, E., De Waele, J. J., Decruyenaere, J., Vogelaers, D., Colardyn, F. & Vandewoude, K. H. (2005). Clin Infect Dis 41, 1591–1598]. Antimicrobial lock therapy may prevent CVC-related blood stream infection, preserve central venous access and reduce hospital admissions. In this paper, the impact of linezolid lock prophylaxis in a patient with short bowel syndrome is described.

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.

Hub colonization of central line catheters in children with cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18530-18530 ◽  
Author(s):  
R. Norville ◽  
B. Horvath ◽  
D. Lee ◽  
A. Hyde ◽  
M. Gregurich ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Blood Stream Infection ◽  
Significant Risk ◽  
Venous Catheter ◽  
Blood Stream ◽  
Coagulase Negative Staphylococcus ◽  
Urban Hospital ◽  
Central Venous ◽  
Children With Cancer ◽  
Convenience Sample

18530 Background: Central venous catheter (CVC) hub sites provide bacterial access to the blood stream through migration along the external and internal surfaces of the catheter. Hub colonization rates vary from 29–38% in the adult literature. While pediatric studies were not found, one study reported the incidence of blood stream infections in neonates to be 30 times higher in catheters with hub colonization compared to catheter hubs that were not colonized. The purpose of this descriptive study was to obtain baseline cultures of CVC hubs to determine the incidence of colonization. Methods: Fifty-one catheter hub cultures were obtained from a convenience sample of 27 children with cancer. The mean age of the patients was 8.2 years (range 0.5–16.2 years); 77% were diagnosed with leukemia and 23% with solid tumors. Cultures were obtained by swabbing the threaded area of the catheter hub after removing the injection cap. A semi-quantitative culture for bacteria and fungus was obtained using standard laboratory procedures by a microbiologist. This study was conducted in a large urban hospital in the Southwest. Results: Fifty-seven percent of the hubs were culture positive. Of those positive cultures, 69%, 24%, 10% and 7% were colonized with 2, 3, 4 and 5 organisms, respectively. The most common organism cultured was coagulase negative staphylococcus. The only significant risk factor for this population was previous central venous catheter infections (p = 0.025). Sixty-nine percent of the lines were tunneled catheters. Central venous catheters were in place on an average of 75.3 days but this was not a factor in the colonization rate. Conclusions: The majority (57%) of the 51 central venous catheter hubs cultured were colonized with at least one organism. This study is the first to evaluate the rate of central venous catheter hub colonization in children with cancer. These findings support the need for more stringent guidelines for central venous catheter care. Further research evaluating the relationship between hub colonization and subsequent blood stream infection is needed. No significant financial relationships to disclose.

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