scholarly journals Re-Evaluating the Protective Effect of Hemodialysis Catheter Locking Solutions in Hemodialysis Patients

2019 ◽  
Vol 8 (3) ◽  
pp. 412 ◽  
Author(s):  
Chang-Hua Chen ◽  
Yu-Min Chen ◽  
Yu Yang ◽  
Yu-Jun Chang ◽  
Li-Jhen Lin ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Treated Group ◽  
Central Venous Catheters ◽  
Exit Site ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Impact ◽  
Catheter Function

Catheter-related bloodstream infections (CRBSIs) and exit-site infections (ESIs) are common complications associated with the use of central venous catheters for hemodialysis. The aim of this study was to analyze the impact of routine locking solutions on the incidence of CRBSI and ESI, in preserving catheter function, and on the rate of all-cause mortality in patients undergoing hemodialysis. We selected publications (from inception until July 2018) with studies comparing locking solutions for hemodialysis catheters used in patients undergoing hemodialysis. A total of 21 eligible studies were included, with a total of 4832 patients and 318,769 days of catheter use. The incidence of CRBSI and ESI was significantly lower in the treated group (citrate-based regimen) than in the controls (heparin-based regimen). No significant difference in preserving catheter function and all-cause mortality was found between the two groups. Our findings demonstrated that routine locking solutions for hemodialysis catheters effectively reduce the incidence of CRBSIs and ESIs, but our findings failed to show a benefit for preserving catheter function and mortality rates. Therefore, further studies are urgently needed to conclusively evaluate the impact of routine locking solutions on preserving catheter function and improving the rates of all-cause mortality.

scholarly journals The Impact of Early Dressing Removal on the Tunneled Central Venous Catheters

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 93s-93s
Author(s):  
G. Ammar
Keyword(s):  
Infection Rate ◽  
Central Venous Catheters ◽  
Control Group ◽  
Site Infection ◽  
Exit Site ◽  
Central Venous ◽  
Exit Site Infection ◽  
Significant Difference ◽  
The Impact ◽  
Interventional Group

Background: There were many studies compared between different types of dressing such as chlorhexidine gluconate gel (CHG), (CHG) disc, gauze dressing and transparent dressing regarding its intact to the skin, infection rate and patients satisfaction. However, there was few studies regarding the impact of removing the dressing on the occurrence of exit site infection of tunneled central venous catheters. Aim: The objective of the current study was to evaluate the impact of early central venous catheter (CVC) dressing removal of the well-healed exit site infections. Methods: It was a quasi-experiment pilot study conducted over 15 months duration in a specialized oncology center. All adult patients who had newly inserted tunneled central venous catheters (CVC) in place were recruited. Patients were distributed to control and experimental group based on first come first served. Patients in the control group (n=8) received the standard protocol of applying (CVC) dressing, while patients in the interventional group (n=8) received the protocol of no dressing. Results: There was no significant difference in the infection rate between the two groups ( P = 1), so that, a total of two cases had developed catheter-related bloodstream infection (CLABSI), one in the control group and the other in the interventional group. Moreover, one patient in the interventional group had developed exit site infection. However, patients with no dressing protocol (interventional group) perceived an improvement in their quality of life and they were satisfied with this protocol. Conclusion: Applying no dressing protocol to a well-healed exit site CVCs showed encouraging results in terms of exit site and bloodstream infections. That is to say; it did not predispose patients to increased risk of infections. Furthermore, patients with no dressing protocol feel more comfortable in their lifestyle.

scholarly journals 89. A Collaborative & Novel Antimicrobial Stewardship Initiative– Mandatory Approval of Peripherally Inserted Central Venous Catheters

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S60-S61
Author(s):  
Sonal Patel ◽  
Jose A Vazquez ◽  
Aaron Chase ◽  
Eti Ebong
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Antibiotic Administration ◽  
Central Venous ◽  
Picc Line ◽  
Tract Infections ◽  
The Impact

Abstract Background Central line-associated bloodstream infections result in thousands of deaths and billions of dollars annually. At the Augusta University Medical Center (AUMC), it was identified that ~50% of peripherally inserted central venous catheters (PICCs) that were placed for intravenous (IV) antibiotic administration were unnecessary. A novel initiative was implemented, which required antimicrobial stewardship/infectious diseases approval for PICC insertions if the indication was for IV antibiotic administration only. The objective of this study was to determine the impact of this initiative. Methods A retrospective observational study was conducted at the AUMC. All adult patients with a PICC line insertion order for IV antibiotic administration, between December 2017 and May 2019 were included. The vascular access team would forward requests for PICC insertions to the antimicrobial stewardship pharmacist. The pharmacist would approve/disapprove the PICC or recommend an infectious diseases consult. The variables collected were: infection types, infectious diseases consultation, reason for PICC denial and 30-day PICC-related complications. Results A total of 215 requests for PICC insertion (for IV antibiotics) were placed. Of these, 54% of the requests were denied, while 46% were approved. The reasons for PICC denial included: midline catheter preferred (47%), switched to oral antibiotics (33%), further work-up required (10%), or no antibiotics needed (7%). The types of infections treated were: bone and joint infections (28%), urinary tract infections (13%), intra-abdominal infections (12%), endocarditis/endovascular infections (11%), skin soft tissue infections (9%), pneumonia (7%), catheter-related bloodstream infections (6%), central nervous system infections (6%), bacteremia (4%) and others (4%).The infectious diseases consult team was involved in the care of 79% of the patients. Of those that received a PICC line, only 5% experienced any PICC-related complications. The overall cost savings for PICCs that were denied was ~ $294,000. Conclusion Mandatory antimicrobial stewardship/infectious diseases approval for PICC insertion can decrease healthcare cost and reduce the number of unnecessary PICC lines placed. Disclosures All Authors: No reported disclosures

Reduction in catheter-related infections after switching from povidone-iodine to chlorhexidine for the exit-site care of tunneled central venous catheters in children on hemodialysis

2014 ◽  
Vol 18 ◽  
pp. S13-S18 ◽  
Author(s):  
Fabio Paglialonga ◽  
Silvia Consolo ◽  
Antonietta Biasuzzi ◽  
Jolanda Assomou ◽  
Elisabetta Gattarello ◽  
...  
Keyword(s):  
Povidone Iodine ◽  
Central Venous Catheters ◽  
Exit Site ◽  
Central Venous

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

scholarly journals 1166. Evaluating the Impact of the 2016 Candidemia Guidelines on the Incidence of Ocular Complications of Candidemia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S609-S609
Author(s):  
Molly Hillenbrand ◽  
Senu Apewokin
Keyword(s):  
Vision Loss ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Prescribing Patterns ◽  
Ocular Complications ◽  
Ocular Penetration ◽  
Significant Difference ◽  
Before And After ◽  
Eye Exams ◽  
The Impact

Abstract Background The incidence of Candida bloodstream infections has risen over the last several decades. Complications of candidemia include endogenous fungal endophthalmitis which can result in devastating outcomes including vision loss. In 2015, the IDSA guidelines were updated to recommend echinocandins as initial therapy for candidemia. Given the poor ocular penetration of echinocandins there has been some concern this change may portend an increased incidence of ocular complications in candidemic patients. We sought to examine whether patients who received empiric echinocandin therapy developed higher rates of ophthalmic complications of candidemia. Methods We identified patients in our healthcare system who had blood cultures positive for Candida species and a completed ophthalmology consult between January 1, 2014 and April 30, 2019. Chi-squared analysis was used to compare antifungal prescribing patterns before and after release of the updated IDSA guidelines. We assessed whether the switch to empiric echinocandin therapy as directed by the guidelines was associated with higher rates of abnormal eye exams. Results 47 patients treated before the guideline change were compared to 57 patients treated after the guideline change. There was no significant difference in age, gender, or comorbid diabetes and hypertension between the groups. Before the guideline change, 24/47 (51%) of patients received eye-penetrating antifungals. This decreased to 21/57 after the updated guideline (37%, p=0.21). The percentage of patients with positive eye exams was nearly equal before and after the updated guidelines, 10/47 (21%) before vs 13/57 (22%) after (p=1). After the guideline change, 7/21 (33%) of the patients treated with penetrating antifungals had positive eye exams vs 6/36 (16%) who received echinocandins (p=0.19). Conclusion Echinocandins are known to have poor ocular penetration yet our data demonstrate no change in the incidence of ophthalmic complications of candidemia after the 2016 guideline endorsed echinocandins as empiric therapy. The prevalence of positive eye exams throughout our study period was 22%, suggesting ongoing utility for these exams. Ongoing investigation is necessary to confirm and further study these findings. Disclosures All Authors: No reported disclosures

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 Taurolock versus saline 5% on preventing infection and dysfunction of hemodialysis catheters; a randomized, double blind controlled clinical trial

2020 ◽  
Vol 10 (3) ◽  
pp. e25-e25
Author(s):  
Ali Ghorbani ◽  
Fatemeh Hayati ◽  
Mehrdad Dargahi-MalAmir ◽  
Maryam Afkane
Keyword(s):  
Central Venous Catheters ◽  
Controlled Clinical Trial ◽  
Organic Solution ◽  
Central Venous ◽  
Double Blind ◽  
Catheter Related Infection ◽  
Prevention Of Thrombosis ◽  
Catheter Dysfunction ◽  
Significant Difference ◽  
Prevention Of Infections

Introduction: Despite the higher rate of morbidity and mortality, the use of central venous catheters has increased significantly compared to arteriovenous fistula. So far, no ideal organic solution has been identified for the prevention of thrombosis and catheter-related infection in patients undergoing hemodialysis. Objectives: This study aimed to evaluate the efficacy of Taurolock versus saline 5% on the prevention of catheter dysfunction and catheter-related infections. Patients and Methods: Seventy patients with chronic kidney disease, who requiring hemodialysis or those with permanent hemodialysis catheters referring to hemodialysis centers of Ahvaz, were selected and randomly divided into two groups, while 68 patients remained until the end of the study. In the first group, saline 5% was inserted into the lumen of catheter after each hemodialysis, and then catheter was blocked. In the second group, Taurolock solution (TauroLock™ -Hep 500®: Taurolidine; antimicrobial agent), citrate 4% and heparin (UI/mL) were used as antibiotics. Results: No significant difference between the catheter-related infection and positive blood culture in both saline and Taurolock groups was detected (2.94% versus 2.94%; P >0.05). Moreover, the catheter-related dysfunction in the saline 5% group was 5% less than the Taurolock group (2.94% versus 11.76%, P = 0.365). Conclusion: The results showed that saline 5% is at least as effective as a Taurolock solution for prevention of infections and catheter dysfunction. Saline is an effective, inexpensive, safe and readily available in various settings. Therefore, it could be considered as a proper alternative solution for reduction of dialysis-related side effects and costs. Trial Registration: Registration of trial protocol has been approved in Iranian registry of controlled trials (identifier: IRCT20190304042918N1; https://en.irct.ir/trial/38055, ethical code# IR.AJUMS.REC.1397.412).

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