Bacteremia related with arterial catheter in critically ill patients

Esteve, Francisco; Pujol, Miquel; Pérez, Xosé L.; Ariza, Javier; Gudiol, Francesc; Cáceres, Enrique Limón; Verdaguer, Ricard; Máñez, Rafael

doi:10.1016/j.jinf.2011.05.020

Cited by 20 publications

(17 citation statements)

References 20 publications

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“…24 Such was the case in our control group, similar to published reports, 16,33,34 and much lower than reported by Esteve et al, 15 where improper handling of connectors was reported as a risk factor. The rate of blood culture contamination was similar to that reported by halm et al 35 In our trial, and in keeping with Koh et al, 36 increased manipulation of the arterial catheter by repeated blood extractions did not increase infection rates; however, this was a risk factor associated with infection by Rijnders.…”

Section: Discussionsupporting

confidence: 92%

“…11 Although this avoids the discomfort associated with fingersticks, it is not exempt from complications 12 and the daily loss of 40 to 70 mL of blood. 13,14 Increased handling of arterial catheters and access to the connections several times a day increases the risk of infection (0.31-3.36 x 1000 catheter-days), 15,16 obstruction (11%-29%), 17 chloride solution was withdrawn from the stopcock farthest from the insertion site, leaving the syringe attached. The sample was withdrawn from the stopcock nearest the insertion, and then blood in the attached syringe was reinfused.…”

Section: Intervention Groupmentioning

confidence: 99%

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Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Torredà

Llano-Serrano

Almirall-Solsona

et al. 2014

American Journal of Critical Care

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Background Use of an arterial catheter to obtain hourly blood samples for intensive insulin therapy monitoring avoids causing patients the discomfort of repeated fingersticks. Returning the clearing volume may decrease procedure-related blood loss by 50% and minimize the risk of anemia. Objectives To compare the feasibility of 2 arterial catheter clearing-volume return setups for hourly blood extractions and to evaluate the related complications and the accuracy of arterial samples in determining glycemia.Methods In an open clinical trial, 90 critical patients undergoing intensive insulin therapy who had a radial arterial catheter were randomized to an intervention group-nonwaste needleless setup or nonwaste syringe setup and compared with the standard setup (control group). Mechanical and infectious complications related to the arterial catheter were evaluated. Blood glucose measurements at point-of-care glucometer (arterial catheter or fingerstick sample) were compared with laboratory results (venous blood). Results No patient had catheter-related infection in the intervention group (an estimated 12 776 manipulations); the control group had 2 infection episodes in 5230 catheter-days (an estimated 13 075 manipulations). The incidence of bacterial colonization was not significantly higher in the needleless group than in the syringe group (22.2% vs 12.2%; relative risk, 0.55; 95% CI, 0.16-1.71), with 1778 (SD, 114) and 1918 (SD, 82) catheter manipulations, respectively. Arterial catheter complications were negligible in all patients. Glycemia was detected from arterial catheter samples as effectively as with laboratory results (venous samples) except when hematocrit was less than 25%. Conclusions Use of blood obtained via an arterial catheter is safe and effective for glucose monitoring in patients undergoing intensive insulin therapy, with no increase in complications of catheterization.

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Section: Discussionsupporting

confidence: 92%

Section: Intervention Groupmentioning

confidence: 99%

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Torredà

Llano-Serrano

Almirall-Solsona

et al. 2014

American Journal of Critical Care

View full text Add to dashboard Cite

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“…Although there may be many determinants of this risk, a major component is the widespread use of invasive devices in the ICU. Although most device-associated BSIs have been attributed to central venous catheters, arterial catheterization may be an under-recognized source [51]. It is believed that most vascular catheters become infected by the extraluminal route (i.e., at the percutaneous entrance site).…”

Section: Risk Factorsmentioning

confidence: 99%

Update on bloodstream infections in ICUs

Timsit

Laupland²

2012

Current Opinion in Critical Care

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The incidence of healthcare-associated BSIs increases and is associated with bacteria resistant to antimicrobials used in community-acquired infections. The recent years have witnessed the emergence of extensively resistant bacteria in many regions worldwide, and this is associated with major implications for failure of antimicrobial therapies. Enhanced preventive efforts and optimization of therapy are needed in order to reduce the major burden of BSIs in critically ill patients and to minimize the further emergence of resistance.

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“…We can only speculate that the reason for this result in our study is the short length of time the catheters were in place and a relatively low rate of colonization of catheter tips. Researchers 7,27,28 have reported that colonization of catheter tips may be more closely related to the insertion site of the arterial catheter and the length of time the catheter is in place than to the catheter system. In our study, further logistic regression analysis indicated that the length of time the catheter was in place was an important factor in the colonization of catheter tips, and we found no significant difference between the 2 groups in the length of time the catheter was in place.…”

Section: Vamp Groupmentioning

confidence: 99%

Closed Blood Conservation Device for Reducing Catheter-Related Infections in Children After Cardiac Surgery

Tang

Feng

Chen

et al. 2014

Critical Care Nurse

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BACKGROUND Arterial catheters are potential sources of nosocomial infection. OBJECTIVE To investigate use of a closed blood conservation device in preventing catheter-related bloodstream infections in children after cardiac surgery. METHODS Children with an indwelling arterial catheter after cardiac surgery were randomly assigned to 2 groups: a control group with a conventional 3-way stopcock in the catheter system and an interventional group with the conservation device in the catheter system. Catheter tips, catheter intraluminal fluid, and blood samples obtained from the catheter and peripherally were cultured for microbiological analysis. RESULTS Intraluminal fluid contamination was significantly lower (P = .03) in the interventional group (3 of 147 catheters) than in the control group (10 of 137 catheters). The 2 groups did not differ significantly in the rate of tip colonization (9 of 147 vs 12 of 137; P = .40) or in the number of catheter-related bloodstream infections (0 of 147 vs 2 of 137; P = .21). CONCLUSION Use of a closed blood conservation device could decrease the incidence of catheter-related contamination of intraluminal fluid. (Critical Care Nurse. 2014;34[5]:53-61)

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Bacteremia related with arterial catheter in critically ill patients

Cited by 20 publications

References 20 publications

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Update on bloodstream infections in ICUs

Closed Blood Conservation Device for Reducing Catheter-Related Infections in Children After Cardiac Surgery

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