scholarly journals Central Venous Catheter Types and Association with Bloodstream Infection in the Pediatric Intensive Care Unit: Experience of two Years

2021 ◽  
Author(s):  
Sevgi Topal ◽  
Özlem Sarac Sandal ◽  
Gökhan Ceylan ◽  
Gülhan Atakul ◽  
Mustafa Çolak ◽  
...  
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Pediatric Intensive Care ◽  
Binary Logistic Regression ◽  
Venous Catheter ◽  
Binary Logistic Regression Analysis ◽  
Central Venous ◽  
Indwelling Catheters ◽  
The Relationship ◽  
Central Catheters

Objective: Central venous catheters (CVC) provides great convenience in pediatric intensive care units (PICUs). In this study, we aimed to prospectively examine patients who underwent CVC in the PICU in terms of catheter types and infections Methods: We conducted our monocentric, prospective, and cohort study by including patients between January 2019 and December 2020, involving all central catheters temporarily inserted, except port-line catheters, PICCs, indwelling catheters (cuffed and uncuffed tunnel catheters), and arterial catheters. The main issue we focus on is the rate of catheter-associated bloodstream infection (CLABSI). We analyzed the relationship between infection and risk factors using binary logistic regression analysis. Results: We included 26 CLABSIs with 196 CVCs. The incidence rate was 6.2/1000 catheter days. We found that the incidence of CLABSI increased in femoral catheters (OR: 0.04 p: 0.035, 95% CI: 0.49-3.49). Moreover, the incidence was increased in catheters with 3 lumens (OR: 0.06, p: 0.031, 95% CI: 0.34-1.69). The prolongation of the catheter also increases the risk of infection (OR: 0.06, p: 0.028, 95% CI: 0.56-2.36). Also, we found that the frequency of CLABSI increased in patients with underlying immunodeficiency (OR: 0.19, p: 0.007, 95% CI: 0.85-1.39) and in patients who were given total parenteral nutrition (OR: 0.02, p: 0.041, 95% CI: 0.063-2.38). Conclusion: The number of studies that directly compare catheter types in pediatric patients and their relationship with CLABSI is limited. Moreover, the comparison of unrelated studies is difficult because of heterogeneity in study populations. Multicenter pediatric prospective studies focused on identifying catheter-associated infections are needed.

scholarly journals Estratégia Multidimensional na Redução de Infeção Associada a Cateter Venoso Central em Pediatria

2016 ◽  
Vol 29 (6) ◽  
pp. 373
Author(s):  
Jorge Rodrigues ◽  
Andrea Dias ◽  
Guiomar Oliveira ◽  
José Farela Neves
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous ◽  
Group 2

<p><strong>Introduction:</strong> To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate.<br /><strong>Material and Methods:</strong> A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 <em>versus</em> group 2).<br /><strong>Results:</strong> Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter.<br /><strong>Discussion:</strong> After multidimensional strategy implementation there was no reported central-line associated bloodstream infection<br /><strong>Conclusions:</strong> Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.</p>

Evaluating Central Venous Catheter Care in a Pediatric Intensive Care Unit

2009 ◽  
Vol 18 (6) ◽  
pp. 514-520 ◽  
Author(s):  
Carol Hatler ◽  
Linda Buckwald ◽  
Zoraida Salas-Allison ◽  
Cathleen Murphy-Taylor
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Infection Control ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Central Catheters

Background Catheter-related bloodstream infection remains an important health problem for hospitalized children. Although placement of a central venous catheter is a life-saving intervention for critically ill children, these same central catheters are a potential source of infection. Objectives Few studies that directly address care of central venous catheters for children in intensive care units have been reported. This evaluation was designed to describe the extent of evidence-based practices for care of insertion sites of central venous catheters in the pediatric intensive care unit of an urban tertiary care center. Another goal was to determine the influence of 2 different regimens for dressing changes on rates of catheter-related bloodstream infections and costs. Methods A convenience sample and an exploratory design were used to collect data in 2 phases, including 30 days to establish baseline information and 30 days each during which patients received dressing care for a central venous catheter with a transparent dressing alone and with a transparent dressing plus a chlorhexidine-impregnated dressing. Nurses also participated in a survey of knowledge about infection control practices related to central catheters. Results Few differences were found between the transparent dressing alone and a chlorhexidine-impregnated dressing plus the transparent dressing. A serendipitous finding was the number of times that central catheters were accessed daily. Conclusions The results of this project suggest that infection control efforts may be most appropriately focused on processes rather than on products.

scholarly journals Attributable Cost and Length of Stay for Patients With Central Venous Catheter—Associated Bloodstream Infection in Mexico City Intensive Care Units A Prospective, Matched Analysis

2007 ◽  
Vol 28 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Francisco Higuera ◽  
Manuel Sigfrido Rangel-Frausto ◽  
Victor Daniel Rosenthal ◽  
Jose Martinez Soto ◽  
Jorge Castañon ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Mexico City ◽  
Venous Catheter ◽  
Central Venous ◽  
Icu Stay ◽  
The Mean ◽  
Length Of Icu Stay

Background.No information is available about the financial impact of central venous catheter (CVC)-associated bloodstream infection (BSI) in Mexico.Objective.To calculate the costs associated with BSI in intensive care units (ICUs) in Mexico City.Design.An 18-month (June 2002 through November 2003), prospective, nested case-control study of patients with and patients without BSI.Setting.Adult ICUs in 3 hospitals in Mexico City.Patients and Methods.A total of 55 patients with BSI (case patients) and 55 patients without BSI (control patients) were compared with respect to hospital, type of ICU, year of hospital admission, length of ICU stay, sex, age, and mean severity of illness score. Information about the length of ICU stay was obtained prospectively during daily rounds. The daily cost of ICU stay was provided by the finance department of each hospital. The cost of antibiotics prescribed for BSI was provided by the hospitals' pharmacy departments.Results.For case patients, the mean extra length of stay was 6.1 days, the mean extra cost of antibiotics was $598, the mean extra hospital cost was $11,591, and the attributable extra mortality was 20%.Conclusions.In this study, the duration of ICU stay for patients with central venous catheter-associated BSI was significantly longer than that for control patients, resulting in increased healthcare costs and a higher attributable mortality. These conclusions support the need to implement preventive measures for hospitalized patients with central venous catheters in Mexico.

Prevention of Central Venous Catheter-Associated Bloodstream Infections in Pediatric Intensive Care Units A Performance Improvement Collaborative

2009 ◽  
Vol 30 (7) ◽  
pp. 645-651 ◽  
Author(s):  
Howard E. Jeffries ◽  
Wilbert Mason ◽  
Melanie Brewer ◽  
Katie L. Oakes ◽  
Esther I. Mufioz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Evidence Based ◽  
Central Venous ◽  
Improvement Project ◽  
Team Members ◽  
Prevention Interventions

Objective.The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.Methods.An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved.Results.The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections.Conclusions.We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.

scholarly journals Current Status and Risk Factors of Complications Associated with Central Venous Catheterization in Pediatric Intensive Care Unit

2021 ◽  
Author(s):  
JingMei Li ◽  
JiaFei Zhang ◽  
Bo Feng ◽  
ChunHui Wang ◽  
MeiLing Wang
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Intravenous Infusion ◽  
Insertion Site ◽  
Pediatric Intensive Care ◽  
Venous Catheter ◽  
Central Venous ◽  
Puncture Site

Abstract Background: The objective of this study was to evaluate incidence and influencing factors of complications related to central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Xi'an Children's Hospital.Methods: We analyzed the complications of all children that had CVCs and were hospitalized between June 2020 to February 2021. A total of 334 CVCs were inserted in 310 children.Results: We noted 102 (30.54%) CVCs-related complications. Complications related to CVCs insertion were infection of catheter (13.17%) and malposition of catheter (8.38%), occlusion of CVCs (2.99%), accidental removal (0.6%), puncture site exudate (4.79%), central venous thrombosis (0.6%). Infection mainly due to Staphylococcus epidermidis. 88 cases (24.55%) of CVCs were extubated due to complications. Analysis of the frequency of maintenance-related complications except for center vein thrombosis showed no differences between the jugular, femoral and subclavian vein access (P > 0.05). It was found that the duration of the catheterization use was critical for the occurrence of CVCs-related infections, puncture site exudate, occlusion (P < 0.05). Suture-off, bleeding of insertion site, and the maximum channels of intravenous infusion in patients were dominant risk factors of catheter-related complications. Conclusion: The risk factors of complications during catheter indwelling are suture-off, bleeding of insertion site and the maximum channels of intravenous infusion in patients. Therefore, strict aseptic operation in various operations, control of the infusion channel, effective fixation of the central venous catheter, reduce the malposition and pull of the catheter, and reduce the infiltration of blood at the puncture point, are particularly important to prevent the complications related to the central venous catheter.

scholarly journals ADESÃO ÀS MEDIDAS PARA PREVENÇÃO DA INFECÇÃO DA CORRENTE SANGUÍNEA RELACIONADA AO CATETER VENOSO CENTRAL

2017 ◽  
Vol 8 (2) ◽  
Author(s):  
Alanna Gomes Da Silva ◽  
Adriana Cristina De Oliveira
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Venous Catheter ◽  
Descriptive Statistics ◽  
Intervention Period ◽  
Central Venous ◽  
Post Intervention ◽  
Period Analysis ◽  
Quasi Experimental ◽  
Terapia Intensiva

Objetivo: verificar a adesão da equipe multiprofissional para as medidas de prevenção da infecção da corrente sanguínea relacionada ao cateter venoso central. Metodologia: estudo quase-experimental, realizado na unidade de terapia intensiva de um hospital de urgência e emergência. A população foi composta pelas equipes médicas e de enfermagem. A coleta de dados ocorreu em três fases distintas: Período pré-intervenção, Período de intervenção e Período pós-intervenção. As análises foram por meio de estatística descritiva e pelos testes ?² de Pearson e exato de Fisher. Resultados: verificou-se uma baixa adesão global pelos enfermeiros e técnicos, especialmente à higiene das mãos (22,7%) e desinfecção do hub (10,4%) e uma adesão de 100% da equipe médica ao utilizar a barreira máxima de precaução. Conclusão: mesmo com um resultado satisfatório para a inserção dos cateteres nos períodos pré e pós-intervenção, essas medidas não representam completa adesão pela equipe de enfermagem.Descritores: Infecções Relacionadas a Cateter, Unidades de Terapia Intensiva, Cateteres Venosos Centrais.ADHERENCE TO MEASURES TO PREVENT BLOODSTREAM INFECTION RELATED TO THE CENTRAL VENOUS CATHETERObjective: To verify the multiprofessional staff adherence to measures to prevent bloodstream infection related to the central venous catheter. Methodology: A quasi-experimental study, carried out at an intensive care unit from emergency and urgency hospital. The population was composed by medical and nursing staff. Data collection took place in three distinct phases: Pre-intervention period, intervention period and post-intervention period. Analysis were made through descriptive statistics and Pearson’s ?² and Fisher’s exact tests. Results: There was a low overall adherence by nurses and technicians, especially to hand hygiene (22.7%) and hub disinfection (10.4%), and a 100% adherence from medical staff when using the maximum barrier of precaution. Conclusion: Even with a satisfactory result for catheters insertion in the pre-and post-intervention periods, these measures are not enough when the catheter maintenance measures are not fully adhered by the nursing team.Descriptors: Catheter-Related Infections, Intensive Care Units, Central Venous Catheters.ADHESIÓN PARA LA PREVENCIÓN DE INFECCIÓN DEL TORRENTE SANGUÍNEO RELACIONADAS CON EL CATÉTER VENOSO CENTRALObjetivo: Determinar la adhesión de miembros del equipo multiprofesional para la prevención de infección del torrente sanguíneo relacionadas con el catéter venoso central. Metodología: Estudio cuasi-experimental realizado en una unidad de cuidados intensivos de un hospital de emergencia y urgencia. La población estaba compuesta por el personal médico y de enfermería. La recolección de datos ocurrió en tres fases: periodo previo a la intervención; Período de intervención y después de la intervención. Los análisis fueron hechos por la estadística descriptiva y las pruebas de ?² de Pearson y la prueba exacta de Fisher. Resultados: Se observó una baja de miembros en general por las enfermeras y los técnicos, especialmente higiene de las manos (22,7%) y la desinfección del hub (10,4%) y una membresía de 100% del personal médico usando la barrera máximo precaución. Conclusión: Incluso con un resultado satisfactorio para la inserción de catéteres en el pre y post-intervención, estas medidas no son suficientes cuando las medidas para el mantenimiento de los catéteres no se cumplen por completo por el personal de enfermería.Descriptores: Infecciones Relacionadas con Catéteres, Unidades de Cuidados Intensivos, Catéteres Venosos Centrales.

Variation in Arterial and Central Venous Catheter Use in Pediatric Intensive Care Units

2020 ◽  
pp. 088506662096245
Author(s):  
Malini Mahendra ◽  
Patrick McQuillen ◽  
R. Adams Dudley ◽  
Martina A. Steurer
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Intraclass Correlation ◽  
Pediatric Intensive Care ◽  
Venous Catheter ◽  
Central Venous ◽  
Pediatric Intensive Care Units ◽  
Severity Scores ◽  
Hospital Characteristics

Objective: Describe patient and hospital characteristics associated with Arterial Catheter (AC) or Central Venous Catheter (CVC) use among pediatric intensive care units (ICUs). Design: Hierarchical mixed effects analyses were used to identify patient and hospital characteristics associated with AC or CVC placement. The ICU adjusted median odds ratios (ICU-AMOR) for the admission ICU, marginal R2, and conditional intraclass correlation coefficient were reported. Setting: 166 PICUs in the Virtual PICU Systems (VPS, LLC) Database. Patients: 682,791 patients with unscheduled admissions to the PICU. Intervention: None. Measures and Main Results: ACs were placed in (median, [interquartile range]) 8.2% [4.9%-11.3%] of admissions, and CVCs were placed in 14.9% [10.4%-19.3%] of admissions across cohort ICUs. Measured patient characteristics explained about 25% of the variability in AC and CVC placement. Higher Pediatric Index of Mortality 2 (PIM2) illness severity scores were associated with increased odds of placement (Odds Ratio (95th% Confidence Interval)) AC: 1.88 (1.87-1.89) and CVC: 1.82 (1.81-1.83) per 1 unit increase in PIM2 score. Primary diagnoses of cardiovascular, gastrointestinal, hematology/oncology, infectious, renal/genitourinary, rheumatology, and transplant were associated with increased odds of AC or CVC placement compared to a primary respiratory diagnosis. Presence of in-house attendings 24/7 was associated with increased odds of AC placement 1.32 (1.11-1.57). Admission ICU explained 4.9% and 3.5% of the variability in AC or CVC placement, respectively. The ICU-AMOR showed a patient would have a median increase in odds of 55% and 43% for AC or CVC placement, respectively, if the same patient moved from an ICU with lower odds of placement to an ICU with higher odds of placement. Conclusions: Variation in AC or CVC use exists among PICUs. The admission ICU was more strongly associated with AC than with CVC placement. Further study is needed to understand unexplained variation in AC and CVC use.

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