scholarly journals Practices and intravascular catheter infection during on- and off-hours in critically ill patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Niccolò Buetti ◽  
Stéphane Ruckly ◽  
Jean-Christophe Lucet ◽  
Arthur Mageau ◽  
Claire Dupuis ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Intravascular Catheter ◽  
Central Venous ◽  
Night Time ◽  
Cox Models ◽  
Catheter Infection ◽  
Peripheral Arterial ◽  
Catheter Infections ◽  
Similar Risk

Abstract Background The potential relationship between intravascular catheter infections with their insertion during weekend or night-time (i.e., off-hours or not regular business hours) remains an open issue. Our primary aim was to describe differences between patients and catheters inserted during on- versus off-hours. Our secondary aim was to investigate whether insertions during off-hours influenced the intravascular catheter infectious risks. Methods We performed a post hoc analysis using the databases from four large randomized-controlled trials. Adult patients were recruited in French ICUs as soon as they required central venous catheters or peripheral arterial (AC) catheter insertion. Off-hours started at 6 P.M. until 8:30 A.M. during the week; at weekend, we defined off-hours from 1 P.M. on Saturday to 8.30 A.M. on Monday. We performed multivariable marginal Cox models to estimate the effect of off-hours (versus on-hours) on major catheter-related infections (MCRI) and catheter-related bloodstream infections (CRBSIs). Results We included 7241 patients in 25 different ICUs, and 15,208 catheters, including 7226 and 7982 catheters inserted during off- and on-hours, respectively. Catheters inserted during off-hours were removed after 4 days (IQR 2, 9) in median, whereas catheters inserted during on-hours remained in place for 6 days (IQR 3,10; p < 0.01) in median. Femoral insertion was more frequent during off-hours. Among central venous catheters and after adjusting for well-known risk factors for intravascular catheter infection, we found a similar risk between off- and on-hours for MCRI (HR 0.91, 95% CI 0.61–1.37, p = 0.65) and CRBSI (HR 1.05, 95% CI 0.65–1.68, p = 0.85). Among central venous catheters with a dwell-time > 4 or > 6 days, we found a similar risk for MCRI and CRBSI between off- and on-hours. Similar results were observed for ACs. Conclusions Off-hours did not increase the risk of intravascular catheter infections compared to on-hours. Off-hours insertion is not a sufficient reason for early catheter removal, even if femoral route has been selected.

Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters*

2008 ◽  
Vol 36 (2) ◽  
pp. 397-402 ◽  
Author(s):  
David Boon Chai Koh ◽  
John R. Gowardman ◽  
Claire M. Rickard ◽  
Iain K. Robertson ◽  
Andrew Brown
Keyword(s):  
Prospective Study ◽  
Central Venous Catheters ◽  
Arterial Catheter ◽  
Central Venous ◽  
Catheter Infection ◽  
Peripheral Arterial

scholarly journals Impact of Critical Care Consultation Requests for Avoidable Central Venous Catheters on Medical-Surgical Units

2020 ◽  
Vol 41 (S1) ◽  
pp. s258-s258
Author(s):  
Madhuri Tirumandas ◽  
Theresa Madaline ◽  
Gregory David Weston ◽  
Ruchika Jain ◽  
Jamie Figueredo
Keyword(s):  
Critical Care ◽  
High Risk ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
High Risk Population ◽  
Central Venous

Background: Although central-line–associated bloodstream infections (CLABSI) in US hospitals have improved in the last decade, ~30,100 CLABSIs occur annually.1,2 Central venous catheters (CVC) carry a high risk of infections and should be limited to appropriate clinical indications.6,7 Montefiore Medical Center, a large, urban, academic medical center in the Bronx, serves a high-risk population with multiple comobidities.8–11 Despite this, the critical care medicine (CCM) team is often consulted to place a CVC when a peripheral intravenous line (PIV) cannot be obtained by nurses or primary providers. We evaluated the volume of CCM consultation requests for avoidable CVCs and related CLABSIs. Methods: Retrospective chart review was performed for patients with CCM consultation requests for CVC placement between July and October 2019. The indication for CVC, type of catheter inserted or recommended, and NHSN data were used to identify CLABSIs. CVCs were considered avoidable if a PIV was used for the stated indication and duration of therapy, with no anatomical contraindications to PIV in nonemergencies, according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).6Results: Of 229 total CCM consults, 4 (18%) requests were for CVC placement; 21 consultations (9%) were requested for avoidable CVCs. Of 40 CVC requests, 18 (45%) resulted in CVC placement by the CCM team, 4 (10%) were deferred for nonurgent PICC by interventional radiology, and 18 (45%) were deferred in favor of PIV or no IV. Indications for CVC insertion included emergent chemotherapy (n = 8, 44%) and dialysis (n = 3, 16%), vasopressors (n = 3, 16%), antibiotics (n = 2, 11%) and blood transfusion (n = 2, 11%). Of 18 CVCs, 9 (50%) were potentially avoidable: 2 short-term antibiotics and rest for nonemergent indications; 2 blood transfusions, 1 dialysis, 2 chemotherapy and 2 vasopressors. Between July and October 2019, 6 CLABSIs occurred in CVCs placed by the CCM team; in 3 of 6 CLABSI events (50%), the CVC was avoidable. Conclusions: More than half of consultation requests to the CCM team for CVCs are avoidable, and they disproportionately contribute to CLABSI events. Alternatives for intravenous access could potentially avoid 9% of CCM consultations and 50% of CLABSIs in CCM-inserted CVCs on medical-surgical wards.Funding: NoneDisclosures: None

scholarly journals Polymicrobial Bloodstream Infections among Children and Adolescents with Central Venous Catheters Evaluated in Ambulatory Care

2008 ◽  
Vol 46 (3) ◽  
pp. 387-394 ◽  
Author(s):  
K. J. Downes ◽  
J. P. Metlay ◽  
L. M. Bell ◽  
K. L. McGowan ◽  
M. R. Elliott ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Ambulatory Care ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Central Venous

Clinical Experience With Minocycline and Rifampin-Impregnated Central Venous Catheters in Bone Marrow Transplantation Recipients: Efficacy and Low Risk of Developing Staphylococcal Resistance

2003 ◽  
Vol 24 (12) ◽  
pp. 961-963 ◽  
Author(s):  
Ioannis Chatzinikolaou ◽  
Hend Hanna ◽  
Linda Graviss ◽  
Gassan Chaiban ◽  
Cheryl Perego ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Clinical Experience ◽  
Marrow Transplantation ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Low Risk ◽  
Clinical Use ◽  
Retrospective Evaluation ◽  
Central Venous

AbstractIn this retrospective evaluation of the 4-year clinical use of minocycline and rifampin-impregnated catheters in bone marrow transplantation (BMT) patients, we report low risk of development of staphylococcal resistance to the antibiotics coating the catheters and efficacy in preventing primary staphylococcal bloodstream infections.

scholarly journals Infections associated with the central venous catheters

2014 ◽  
Vol 142 (3-4) ◽  
pp. 261-266
Author(s):  
Biljana Draskovic ◽  
Izabella Fabri ◽  
Anna Uram-Benka ◽  
Goran Rakic
Keyword(s):  
Intensive Care ◽  
Critically Ill Patients ◽  
Venous Access ◽  
Health Condition ◽  
Central Venous Catheters ◽  
Maintenance Period ◽  
Central Venous ◽  
Prevention Of Infection ◽  
Catheter Infections

Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient?s health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

scholarly journals Incidence rates of bloodstream infections in children with long-term central venous catheters at Instituto Nacional do Câncer, Brazil (1995 to 2001)

2002 ◽  
Vol 6 ◽  
pp. S29
Author(s):  
Marcelo Schirmer ◽  
Eduardo Velasco ◽  
Carlos A.S. Martins ◽  
Leda M. Dias ◽  
Vânia M.S.C. Gonçalves ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Incidence Rates ◽  
Central Venous Catheters ◽  
Central Venous

Intravascular Catheter Colonization and Related Bloodstream Infection in Critically III Neonates

1990 ◽  
Vol 11 (6) ◽  
pp. 301-308 ◽  
Author(s):  
Wendy A. Cronin ◽  
Teresa P. Germanson ◽  
Leigh G. Donowitz
Keyword(s):  
Bloodstream Infection ◽  
Insertion Site ◽  
Bloodstream Infections ◽  
Coagulase Negative Staphylococcus ◽  
Intravascular Catheter ◽  
Catheter Colonization ◽  
Catheter Tip ◽  
Critically Ill Neonates ◽  
Peripheral Arterial ◽  
Intravenous Catheters

AbstractIntravascular catheter tip colonization was prospectively evaluated in critically ill neonates to determine its relationship to the type of device used, duration of catheterization, insertion site and nosocomial bloodstream infection. Sixty-one percent (376 of 621) of all intravascular catheter tips were retrieved from 91 infants. Thirteen percent (41 of 310) of peripheral intravenous, 14% (6 of 42) of umbilical, 21% (3 of 11) of central venous, 36% (4 of 11) of peripheral arterial and 100% (2 of 2) of femoral catheters were colonized. Duration of catheterization was significantly longer for colonized lines (p < .001). Eight of 26 (30.8%) peripheral intravenous catheters remaining in place for more than three days were colonized, compared with 33 of 284 (11.6%) at three days or less (p= 0.012). Coagulase-negative staphylococcus was the organism most frequently isolated from catheter tips and bloodstream infections. Catheter colonization rates in this population were higher than those found in adults. Heavily manipulated devices and those in place for longer periods of time were the most frequently colonized.

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