Is it safe to remove central lines in patients with platelets less than 20,000/uL

Background: Patients with tunnelled CVL may develop blood stream infections which at times are difficult to control without line removal. Concomitant severe thrombocytopenia with platelet transfusion refractoriness is often considered a hard contraindication to any procedure involving a major blood vessel. There is very little literature on the actual clinical risks of tunnelled central line removal in febrile pancytopenic patients. Procedure: We analysed complications and outcomes in all or patients, a total of 52, who underwent CVL removal with platelets <20,000/uL. Results: No bleeding episodes or unplanned transfusions could be associated with CVL removal. No other complications were also reported. All patients had time to hemostasis within 5 minutes of catheter removal. A total 31 patients were febrile at the time of CVL removal, of which 17 became afebrile within 2 days. We found no difference in response when comparing those whose antibiotic therapy was change/escalation versus those who did not. Removal of CVL under local anaesthesia remained complication-free even at platelets counts less than 20.000/uL. With only RDP support 17 lines were pulled out without any complications when platelets were below 5.000. Conclusion: Our findings suggest that central lines can be safely removed with platelet counts less than 20.000/ul and that this may result in enhanced blood stream infection control. This might be particularly relevant to neutropenic patients in this day and age of MDR germs emergence and paucity of new effective antibiotics.

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Eliminating Central Line-associated Blood Stream Infection (CLABSI) on Patients Admitted with Central Lines Through Systematic Assessment and Line Maintenance

American Journal of Infection Control ◽

10.1016/j.ajic.2017.04.159 ◽

2017 ◽

Vol 45 (6) ◽

pp. S100-S101

Author(s):

Abegail Pangan ◽

Eileen A. Finerty

Keyword(s):

Blood Stream Infection ◽

Blood Stream ◽

Central Line ◽

Central Lines ◽

Systematic Assessment

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Central Line Associated Blood Stream Infections in Pediatric Hematology/Oncology Patients With Different Types of Central Lines

Pediatric Blood & Cancer ◽

10.1002/pbc.26053 ◽

2016 ◽

Vol 63 (9) ◽

pp. 1603-1607 ◽

Cited By ~ 21

Author(s):

Jeffrey D. Hord ◽

John Lawlor ◽

Eric Werner ◽

Amy L. Billett ◽

David G. Bundy ◽

...

Keyword(s):

Blood Stream ◽

Central Line ◽

Oncology Patients ◽

Blood Stream Infections ◽

Central Lines ◽

Pediatric Hematology ◽

Different Types

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Lessons learned from a hospital‐wide review of blood stream infections for paediatric central line‐associated blood stream infection prevention

Journal of Paediatrics and Child Health ◽

10.1111/jpc.14276 ◽

2018 ◽

Vol 55 (6) ◽

pp. 690-694

Author(s):

Anita J Campbell ◽

Christopher C Blyth ◽

Christopher J Hewison ◽

Yu‐Ping Chen ◽

Leanne Gough ◽

...

Keyword(s):

Infection Prevention ◽

Blood Stream Infection ◽

Blood Stream ◽

Central Line ◽

Lessons Learned ◽

Blood Stream Infections

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Effect of Early Removal of Central Catheterization in Febrile Neutropenic Patients with Acute Leukemia

Blood ◽

10.1182/blood.v126.23.4895.4895 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4895-4895

Author(s):

Su Hyun Hwang ◽

Yong Won Choi ◽

Seong Hyun Jeong ◽

Joon Seong Park

Keyword(s):

Febrile Neutropenia ◽

Acute Leukemia ◽

Conflicts Of Interest ◽

Blood Stream Infection ◽

Univariate Analysis ◽

Blood Stream ◽

Central Line ◽

Central Catheter ◽

Early Removal ◽

Neutropenic Patients

Abstract Background: A guideline of central line-related blood stream infection (CRBSI) is only for immune-competent patients with end-stage renal disease on hemodialysis. We need widely acceptable guideline whether remove or maintain a central catheter in febrile neutropenic patients. Method: Medical records from 293 cases (95 patients) of febrile neutropenia with Central Catheterization were obtained retrospectively, and clinical characteristics, particularly duration of fever, were analyzed according to the early removal of central catheterization under anti-cancer chemotherapy for acute leukemia. Results: Forty-eight cases (16.4%) have already baseline fever and 25 cases (8.5%) showed baseline pneumonic infiltration prior to chemotherapy. The insertion sites of catheterization were subclavian (85.3%), internal jugular (12.6%), and others (2.0%). Early removal of central catheter was done at 93 cases (31.7%) and the cause of early removal was fever (63.4%), malfunction (11.8%), and others (24.7%). The duration of fever was significantly shortened by early removal of central catheterization (5.4 vs 7.5 days, p=0.003, Figure 1A). In addition, the duration of fever was related with age, diagnosis, type of chemotherapy, presence of baseline fever or pneumonic consolidation in univariate analysis. The site of central access or body mass index as well as existence of CRBSI did not affect duration of fever. In multivariate analysis, early removal of central catheter was independently associated with short duration of fever (OR=0.619, 95% CI=0.46-0.83, p=0.001, Table 1). The effect of early removal of central catheter was highlighted when micro-organisms were documented (Figure 1B). Summary: In patients with febrile neutropenia, early removal of central catheter can shorten the duration of fever particularly when BSI was documented. Disclosures No relevant conflicts of interest to declare.

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308 Improving Central Line Associated Blood Stream Infection (CLABSI) Rates in Pediatric Burn Patients with Central Lines in or Near Wounds

Journal of Burn Care & Research ◽

10.1093/jbcr/iry006.230 ◽

2018 ◽

Vol 39 (suppl_1) ◽

pp. S124-S124

Author(s):

O Arredondo ◽

T Palmieri ◽

D Greenhalgh ◽

S Sen

Keyword(s):

Blood Stream Infection ◽

Blood Stream ◽

Central Line ◽

Burn Patients ◽

Central Lines

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Achieving Zero Catheter Related Blood Stream Infections: 15 Months Success in a Community Based Medical Center

Journal of the Association for Vascular Access ◽

10.2309/java.12-4-8 ◽

2007 ◽

Vol 12 (4) ◽

pp. 218-224 ◽

Cited By ~ 26

Author(s):

Sophie A. Harnage

Keyword(s):

Nursing Practice ◽

Blood Stream Infection ◽

Medical Center ◽

Blood Stream ◽

Central Line ◽

Community Based ◽

Blood Stream Infections ◽

Patient Morbidity ◽

Surgical Icu ◽

Inpatient Length Of Stay

Abstract Achieving Zero Catheter Related Blood Stream Infections: 15 Month Success In A Community Based Medical Center. Background and Purpose: Catheter related blood stream infection (CRBSI) is a major cause of patient morbidity, mortality, and cost. Lower CRBSI rates would decrease inpatient length of stay. Project: An innovative central line bundle was developed to reduce CRBSI. An innovative combination of focused nursing practice and product technologies were selected for the bundle and implemented through a defined educational program. Data was collected from thirty-two critical care beds: 16 medical/surgical ICU and 16 Trauma-Neuro ICU beds. Results: From January 2006 thru March 2007 there were Zero occurrences of CRBSI. Over this 15 month period our PICC insertions increased by 103%, and our interventional radiology referral rate decreased to less than 2%. Implications/Conclusions: A multimodality bundle, combining nursing practice interventions and technology can successfully decrease the incidence of CRBSI. While some of the bundle components have not been widely researched and instead are based on theory or accepted clinical practice, the early outcome provides a basis for additional study and refinement. It also invites research into the various components of the bundle to evaluate the effect each separate practice and product lends to its success.

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811. Utilizing IV team in Reducing the Central Line Associated Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1001 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S448-S448

Author(s):

Swetha Srialluri ◽

Ali Hassoun

Keyword(s):

Critically Ill ◽

Financial Burden ◽

Blood Stream ◽

Central Line ◽

Klebsiella Pneumonia ◽

Blood Stream Infections ◽

Central Lines ◽

Increased Risk ◽

Before And After ◽

Clabsi Rate

Abstract Background Central Line-Associated Blood Stream Infections (CLABSI) are defined as the laboratory confirmed blood stream infections after 48 hours of the line placement and excluding other sources of infection. CLABSI can lead to prolonged hospital stay, increased risk of mortality and financial burden on the health care system. In our study, we aimed at evaluating the incidence of CLABSI after involving the IV team in both critically ill and non-critically ill patients. Methods A retrospective chart review was performed from July 2011 to August 2019 at a 971 bedded community hospital. IV team has been involved in the central line care since 2013 and started changing the scheduled central line dressings. The interventions that were introduced since then include usage of Curos, wearing masks and gloves for any contact with central lines, flushing the central lines using pulsatile method, and not drawing the routine labs. Allpoints program was introduced in July 2018 which is a retraining program to the nurses emphasizing on central line dressing changes using a sterile technique, pulsatile flushing method and medication administration. CLABSI rate was calculated per 1,000 central line days yearly and quarterly and was compared before and after the involvement of IV team. Results Total number of events from July 2011 to August 2019 were 275. Average central line days were 22,350. Most common organisms that were isolated are Staphylococcus aureus (13.45%) followed by Staphylococcus Epidermidis (9.8%), Candida Albicans (8.7%), E. Coli (8.72%) and Klebsiella Pneumonia (6.9%). The average CLABSI rates quarterly and yearly were 1.00 and 1.32 respectively, per 1000 central line days. Average CLABSI rates before and after the involvement of IV team were 1.32 and 1.18 respectively. CLABSI rate has decreased significantly after the involvement of the IV team in 2013. The largest impact on the CLABSI infection rate was between July 2018 to August 2019 which can be attributed to the Allpoints program. CLABSI rate in 2018 and 2019 were 0.86 and 0.6 respectively. Conclusion Our analysis showed that involving the IV team in the central line care and implementing the preventive strategies like usage of curos, pulsatile flush technique, wearing mask and gloves for any contact with central line helped in reducing CLABSI. Disclosures All Authors: No reported disclosures

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