A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill

Timsit, Jean François; Rupp, Mark E.; Bouza, Emilio; Chopra, Vineet; Kärpänen, Tarja J.; Laupland, Kevin B.; Lisboa, Thiago; Mermel, Leonard A.; Mimoz, Olivier; Parienti, Jean Jacques; Poulakou, Garyphalia; Souweine, Bertrand; Zingg, Walter

doi:10.1007/s00134-018-5212-y

Cited by 100 publications

(122 citation statements)

References 132 publications

(162 reference statements)

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“…The management of CRBSI, however, is more nuanced with a lot of factors influencing decision‐making. These include identifying the pathogen, the clinical condition of the patient including hemodynamic stability and the immediate availability of an alternative intravenous access . The ongoing need for having a central venous access and familiarity with the use of ALT are also important pointers in the decision for CVC removal.…”

Section: Discussionmentioning

confidence: 99%

“…One of the important mechanisms in the pathogenesis of CRBSI and CC is biofilm formation, a process wherein the microorganisms adhere to the inner surface of CVC and exhibit much higher minimum inhibitory concentrations (MICs) for antibiotics when compared to non‐biofilm related infections . To address this issue, the strategy of antibiotic lock therapy (ALT) was devised to achieve 100–1000‐fold higher MICs in lumen compared to what can be achieved upon systemic administration .…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic lock therapy for salvage of tunneled central venous catheters with catheter colonization and catheter‐related bloodstream infection

Zanwar

Jain

Gokarn

et al. 2018

Transplant Infectious Dis

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Central venous catheters (CVCs) represent a significant source of infection in patients undergoing hematopoietic stem cell transplantation and can add to the cost of care, morbidity, and mortality. Organisms forming biofilms on the inner surface of catheters require a much higher local antibiotic concentration to clear the pathogen growth. Antibiotic lock therapy (ALT) represents one such strategy to achieve such high intraluminal concentrations of antibiotics and can facilitate catheter salvage. Patients with catheter colonization (CC) or hemodynamically stable catheter‐related bloodstream infection (CRBSI) received ALT per institutional policy. We analyzed the incidence of CC and CRBSI and salvage rate of tunneled CVCs (Hickman) with ALT in patients undergoing hematopoietic stem cell transplant in this retrospective study. Catheter colonization was noted in 9.8% and CRBSI in 10.7% patients. Gram‐negative bacilli (GNB) accounted for 45% and 83% of isolates in CC and CRBSI, respectively. In patients with CRBSI, the rate of catheter salvage with the use of ALT in addition to systemic antibiotics was 86% compared to 55% in patients with systemic antibiotics use only (P = 0.06). There was no CRBSI related mortality, and no increase in resistant strains was noted at subsequent CRBSI. In conclusion, ALT represents an important strategy for catheter salvage, especially for gram‐negative infections, in a carefully selected patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibiotic lock therapy for salvage of tunneled central venous catheters with catheter colonization and catheter‐related bloodstream infection

Zanwar

Jain

Gokarn

et al. 2018

Transplant Infectious Dis

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“…IJV, internal jugular vein puncture angle; OA, overlapping angle (represents part of internal jugular vein's angular width covered by carotid artery artery); SPA, internal jugular vein safe puncture angle (equal to IJV and OA difference). compared with anatomic landmarks, was associated with a greater procedural success, a lower number of attempts, shorter time to catheterize the vessel and a marked reduction of mechanical complications [11]. A Cochrane Database search including 22 randomized controlled trials confirmed that the rate of total complications overall and inadvertent artery puncture decreased by more than 70% when compared with US-guided insertion of IJV catheters with an anatomical landmark technique in both adults and children [8].…”

Section: Parametermentioning

confidence: 93%

Optimal head rotation angle for safe right internal jugular vein catheterization using out-of-plane approach: an ultrasonography study

2019

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Aim: The most common complication following internal jugular vein catheterization is the puncture of the common carotidartery. We aimed to find an optimal head rotation angle for safe vein catheter insertion while minimizing the risk of arterypuncture.Materials and methods: Eighty-two patients admitted to the intensive care unit were included in the prospective study. Ultrasound examination of the neck vessels on the right side was performed in the neutral position and at a head rotation of 15°, 30°, 45° and 60° to the left. Internal jugular vein and common carotid artery puncture angle, overlapping angle of vein by artery and vein safe puncture angle were evaluated.Results: The internal jugular vein puncture angle increased with head rotation from the neutral position to 30° and 45° and was largest at 60° (p<0.001 for all). The overlapping angle increased significantly at 45° and 60° rotation compared with the neutral position (p<0.001 for all). The vein safe puncture angle was highest at 30° and significantly different from the neutral position and 60° (p=0.003 and p=0.013, respectively).Conclusions: When performing right internal jugular vein catheterization without ultrasound guidance by using an out-of-plane technique, the head should be rotated at 30°, because the overlapping angle increases with further head rotation and can increase the risk of artery puncture.

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“…In the case of severe sepsis or shock, the catheter should be promptly removed. 15,27 However, most of the suspected catheter infections are not life-threatening and diagnostic techniques allowing an accurate diagnosis while keeping the catheter in place are an attractive option 28 (see "Management of Catheter-Related Infections" section).…”

Section: Diagnosis Of Cr-bsi With Catheter In Placementioning

confidence: 99%

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

Buetti

Timsit

2019

Semin Respir Crit Care Med

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Central venous catheter-related bloodstream infections (CR-BSI) are a frequent event in the intensive care unit (ICU) setting. In contrast to other nosocomial infections, most risk factors for CR-BSI are linked to the device and can be prevented efficiently. Rates of CR-BSI higher than 1 per 1,000 catheter days are no longer acceptable. A continuous quality improvement program is effective to reduce them. Key elements of prevention of CR-BSI are hand hygiene, avoidance of insertion of unnecessary catheters, full sterile barrier precautions at insertion, preferential use of subclavian venous insertion site, cutaneous antisepsis with 2% chlorhexidine alcoholic preparation, use of chlorhexidine-impregnated dressings, immediate replacement of moistened or detached catheter dressings, and removal of catheters as soon as possible. Audit and feedback of the process of care, infection rates, and periodic re-education of health care providers are other instrumental tools in the prevention of CR-BSI. Catheter removal is the main therapeutic intervention, especially recommended in the case of sepsis or shock. While awaiting culture results, an empiric antimicrobial treatment of CR-BSI should target gram-positive microorganism (i.e., Staphylococcus aureus) and gram-negative coverage should be based on clinical variables, patients' risk factors, and previous colonization status. While a short course of antimicrobials (7 days) is sufficient for noncomplicated CR-BSI, a longer course of 14 days should be preferred for uncomplicated S. aureus and Candida CR-BSI. In case of persisting fever or positive blood culture after 3 days despite adequate antimicrobial therapy and catheter removal, catheter-related complications (e.g., endocarditis, thrombophlebitis, septic metastasis) should be ruled out.

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A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill

Cited by 100 publications

References 132 publications

Antibiotic lock therapy for salvage of tunneled central venous catheters with catheter colonization and catheter‐related bloodstream infection

Antibiotic lock therapy for salvage of tunneled central venous catheters with catheter colonization and catheter‐related bloodstream infection

Optimal head rotation angle for safe right internal jugular vein catheterization using out-of-plane approach: an ultrasonography study

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

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