Central Venous Catheter Salvage in Ambulatory Central Line–Associated Bloodstream Infections

BACKGROUND Guidelines for treatment of central line–associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients <22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

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CE Article: A Quality Improvement Approach in Standardizing Pediatric Central Venous Catheter Dressings and Its Impact on the Reduction of Central Line-Associated Bloodstream Infections and Costs

Journal of the Association for Vascular Access ◽

10.2309/j.java.2019.002.002 ◽

2019 ◽

Vol 24 (2) ◽

pp. 11-19

Author(s):

Christopher Kramer ◽

Darcy Doellman ◽

Casey Blaser ◽

Robin Huneke Rosenberg ◽

Stéphanie F. Bernatchez

Keyword(s):

Quality Improvement ◽

Central Venous Catheter ◽

Pediatric Patients ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Line ◽

Central Venous ◽

Clabsi Rate

Highlights A CVC dressing inventory is beneficial to pediatric patients. Dressing standardization reduced unplanned dressing changes and costs. In our study, the new dressing inventory helped reduce the CLABSI rate.

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Risky Business: Peripheral and Central Venous Catheters Both Pose Risks

Patient Safety ◽

10.33940/vascular/2019.9.4 ◽

2019 ◽

pp. 28-39

Author(s):

Lynette Hathaway ◽

Mary Magee

Keyword(s):

Risk Factors ◽

Patient Safety ◽

Bloodstream Infections ◽

Venous Catheter ◽

Venous Access ◽

Central Line ◽

Central Venous Catheters ◽

Central Venous ◽

Healthcare Facilities ◽

Relationship Of

Venous access is an essential method of providing life-saving therapy. As part of intensive efforts to decrease the incidence of central line–associated bloodstream infections (CLABSIs), healthcare facilities may be increasing the use of short (noncentral) peripheral venous catheters (PVCs). To investigate this, the Patient Safety Authority (PSA) sought to explore the relationship of actual to predicted complications per central venous catheters (CVCs) and PVCs over a nine-year period. In addition, as PVCs are not without risk and CVCs pose risks aside from infection, we sought to identify the type and relationship of PVC to CVC complications and to quantify the timing and types of PVC and CVC complications and their associated risk factors. A query of the PSA’s statewide event reporting database, the Pennsylvania Patient Safety Reporting System (PA-PSRS), for venous catheter complication events and a query of the National Healthcare Safety Network (NHSN) database for both primary bloodstream infections (BSIs) and CLABSIs occurring at inpatient facilities from January 1, 2009, through December 31, 2017, yielded 115,937 events. A methodical sampling of PA-PSRS yielded 2,413 PVC and CVC events. These were analyzed for the timing of complications reported, the type of complication reported, and any identified risk factors. Overall reports of PVC complications increased, and the correlation between actual and predicted PVC events over the nine years studied is strong and statistically significant. The slight decrease in the number of reported CVC complications was not statistically significant. The authors used regression analysis to determine the best-fitting line through the predicted and actual observed events during the period of observation. These data are not intended to present a predictive model of future events. No correlation was found between the numbers of PVC and CVC complications. The greatest number of PVC complications, particularly infiltration, occurred during catheter maintenance. Excluding NHSN-reported CLABSIs, the greatest number of CVC complications, particularly pneumothorax, occurred during catheter insertion. Education and training are key to preventing intravascular device–associated complications. Healthcare facilities are encouraged to evaluate policy, procedures, and actual practices to eliminate complications and improve outcomes. In addition, quality improvement efforts aimed at decreasing CLABSIs should include measuring CVC complications and all PVC complications as a balancing metric.

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Central venous catheter bundle implementation in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections

10.26226/morressier.56d5ba30d462b80296c95453 ◽

2016 ◽

Author(s):

Mona Salama

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Line ◽

Central Venous

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Faculty Opinions recommendation of Central venous catheter repair is associated with an increased risk of bacteremia and central line-associated bloodstream infection in pediatric patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14264133.15777271 ◽

2012 ◽

Author(s):

Theo Zaoutis

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Pediatric Patients ◽

Venous Catheter ◽

Central Line ◽

Central Venous ◽

Increased Risk

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Risk factors for unplanned removal of central venous catheters in hospitalized children with hematological and oncological disorders

10.22541/au.160645869.93914774/v1 ◽

2020 ◽

Author(s):

Moe Miyagishima ◽

Hamada Motoharu ◽

Yuji Hirayama ◽

Hideki Muramatsu ◽

Takahisa Tainaka ◽

...

Keyword(s):

Risk Factors ◽

Cumulative Incidence ◽

Pediatric Patients ◽

Cohort Analysis ◽

Multivariable Analysis ◽

Central Line ◽

Central Venous Catheters ◽

Central Venous ◽

Subdistribution Hazard ◽

Significant Difference

Background: Central venous catheters (CVCs) have been essential devices for the treatment of children with hematological and oncological disorders. Only few studies investigated the complications and selections of different types of CVCs in these pediatric patients. This study aimed to compare risk factors for unplanned removal of two commonly used CVCs, i.e., peripherally inserted central catheters (PICCs) and tunneled CVCs, and propose better device selection for the patient. Procedure: This retrospective, single center cohort analysis was conducted on pediatric patients with hematological and oncological disorders inserted with either a PICC or a tunneled CVC. Results: Between January 1, 2013, and December 31, 2015, 89 patients inserted with tunneled CVCs (total 21,395 catheter-days) and 84 with PICCs (total 9,177 catheter-days) were followed up until the catheter removal. The median duration of catheterization was 88 days in PICCs and 186 days in tunneled CVCs (p = 1.24×10-9). PICCs at the 3-month cumulative incidence of catheter occlusion (5.2% vs. 0%, p = 4.08×10-3) and total unplanned removal (29.0% vs 7.0%, p = 0.0316) were significantly higher, whereas no significant difference was observed in the cumulative incidence of central line-associated bloodstream infection (11.8% vs. 2.3%, p = 0.664). Multivariable analysis identified younger age (<2 years) (subdistribution hazard ratio [SHR], 2.29; 95% confidence interval [CI], 1.27–4.14) and PICCs (SHR, 2.73; 95% CI, 1.48–5.02) were independent risk factors for unplanned removal. Conclusion: Our results suggest that tunnel CVCs would be a preferred device for children with hematological and oncological disorders requiring long-term, intensive treatment.

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Reducing central catheter-associated infections in pediatric surgery clinic: Implementation of a care bundle

Progress in Health Sciences ◽

10.5604/01.3001.0014.9281 ◽

2021 ◽

Vol 11 (1) ◽

pp. 57-65

Author(s):

Eda Dolgun ◽

Okgün Alcan Aliye ◽

Ayşe Islamoğlu ◽

Birsen Eroğlu ◽

Meltem Polat ◽

...

Keyword(s):

Pediatric Surgery ◽

Healthcare Professionals ◽

Bloodstream Infections ◽

Venous Catheter ◽

Recovery Process ◽

Central Line ◽

Care Bundle ◽

Central Venous ◽

Implementation Period ◽

Bundle Compliance

Purpose: Central line care bundle comprises a few evidence-based interventions for improving patients' outcomes and recovery process. This semi-experimental study aimed to determine the effect of pediatric central line care bundle implementation on central line-associated bloodstream infections (CLABSI) rates. Materials and methods: A central line care bundle was implemented for pediatric surgery patients (n=70). Baseline observations were made to determine the central line care bundle compliance of healthcare professionals for 435 catheter days. Subsequently, physicians and nurses were educated about the central line care bundle. After the implementation period, 722 catheter days were observed to determine post-implementation compliance. Baseline CLABSI rates were compared with post-implementation CLABSI rates. Results: It was found that the entire central line care bundle compliance was 32.4% pre-implementation and 86.3% post-implementation. After education, the physicians' and nurses' central line care bundle compliance showed statistically significant improvement (p= 0.0001). There were five CLABSI events in the pre-implementation period and three CLABSI events in the post-implementation period. It was determined that the number of CLABSI decreased in the post-implementation period compared to the pre-implementation period, but this difference was not statistically significant (p= 0.207). Conclusions: Central line care bundle implementation decreased the CLABSI rates. It is recommended the Implementation of a central line care bundle on the care of pediatric surgery patients with the central venous catheter.

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Prevalence of the Use of Central Venous Access Devices Within and Outside of the Intensive Care Unit: Results of a Survey Among Hospitals in the Prevention Epicenter Program of the Centers for Disease Control and Prevention

Infection Control and Hospital Epidemiology ◽

10.1086/502163 ◽

2003 ◽

Vol 24 (12) ◽

pp. 942-945 ◽

Cited By ~ 92

Author(s):

Michael Climo ◽

Dan Diekema ◽

David K. Warren ◽

Loreen A. Herwaldt ◽

Trish M. Perl ◽

...

Keyword(s):

Central Venous Access ◽

Bloodstream Infections ◽

Venous Catheter ◽

Venous Access ◽

Teaching Hospitals ◽

Central Venous ◽

Prevalence Survey ◽

Icu Patients ◽

Medical Centers ◽

Control And Prevention

AbstractObjective:To determine the prevalence of central venous catheter (CVC) use among patients both within and outside the ICU setting.Design:A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers at each Epicenter performed a hospital-wide survey, collecting data on CVC use.Setting:Inpatient wards and ICUs of six large urban teaching hospitals.Results:At the six medical centers, 2,459 patients were surveyed; 29% had CVCs. Among the hospitals, from 43% to 80% (mean, 59.3%) of ICU patients and from 7% to 39% (mean, 23.7%) of non-ICU patients had CVCs. Despite the lower rate of CVC use on non-ICU wards, the actual number of CVCs outside the ICUs exceeded that of the ICUs. Most catheters were inserted in the subclavian (55%) or jugular (22%) site, with femoral (6%) and peripheral (15%) sites less commonly used. The jugular (33.0% vs 16.6%; P < .001) and femoral (13.8% vs 2.7%; P < .001) sites were more frequently used in ICU patients, whereas peripherally inserted (19.9% vs 5.9%; P < .001) and subclavian (60.7% vs 47.3%; P < .001) catheters were more commonly used in non-ICU patients.Conclusions:Current surveillance and infection control efforts to reduce morbidity and mortality associated with bloodstream infections concentrate on the high-risk ICU patients with CVCs. Our survey demonstrated that two-thirds of identified CVCs were not in ICU patients and suggests that more efforts should be directed to patients with CVCs who are outside the ICU.

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Predictors of Central Line-Associated Bloodstream Infection and Early Catheter Removal for Pediatric Patients Undergoing Tunneled Central Venous Catheter Placement

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.767 ◽

2020 ◽

Vol 231 (4) ◽

pp. S209

Author(s):

Gabriela Frid ◽

Marina L. Reppucci ◽

Brian Arrinza Coakley

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Pediatric Patients ◽

Venous Catheter ◽

Central Line ◽

Catheter Placement ◽

Catheter Removal ◽

Central Venous ◽

Central Venous Catheter Placement

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Early Onset versus Late Onset Peripherally Inserted Central Venous Catheter Infections: An Analysis of Risk Factors and Microbiology

Infection Control and Hospital Epidemiology ◽

10.1086/671726 ◽

2013 ◽

Vol 34 (9) ◽

pp. 980-983 ◽

Cited By ~ 6

Author(s):

Paul Chittick ◽

Sobia Azhar ◽

Kalyani Movva ◽

Paula Keller ◽

Judith A. Boura ◽

...

Keyword(s):

Risk Factors ◽

Central Venous Catheter ◽

Early Onset ◽

Late Onset ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Venous ◽

Peripherally Inserted Central Catheters ◽

Catheter Infections ◽

Central Catheters

The risks and microbiology for peripherally inserted central catheters (PICCs) are less well described than those for traditional central catheters, particularly as they pertain to duration of catheterization. We compared patients with early- and late-onset PICC bloodstream infections at our institution and found significant differences in microbiologic etiologies.

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