Can We Achieve Consensus on Central Venous Catheter-Related Infections?

Abstract

Central venous catheter-related bacteraemia is a substantial and preventable source of iatrogenic morbidity and mortality. A single episode of catheter-related bacteraemia has an estimated cost of A$50,000, with an attributable mortality between 10 and 35%. Catheter colonization is diagnosed with standard culture techniques. Diagnostic criteria for catheter-related bacteraemia include the results of cultures from the catheter tip, the peripheral blood and other possible sites of infection. The presence of clinical symptoms and subsequent defervescence may assist in making the diagnosis. This review explores the existing definitions of catheter-related infections and proposes a new and more rigorous classification with criteria for definite, probable and possible catheter-related bacteraemia. The authors hope that this classification will enhance the interpretation of the literature and the planning of new investigations.Infection rates can be reduced by appropriate site selection, adequate skin preparation, sterile technique and appropriate dressings. Decreased manipulation of administration sets, with more careful technique and less frequent set replacement, may reduce hub contamination. Infection rates increase with the duration in situ of the catheter, however are not reduced by regular scheduled catheter replacement or guide-wire exchanges. A range of antimicrobial catheter materials and coatings are under investigation, some of which are effective in reducing the rate of catheterrelated bacteraemia. Chorhexidine-silver sulphadiazine and rifampicin-minocycline are the best studied combinations to date. Further developments are expected, although none are likely to be as effective as not inserting or removing the central venous catheter when it is not required.

Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

“…The CVCs inserted to the jugular vein were associated with approximately two and a half times the risk of infection compared with CVC inserted to subclavian vein in the multivariate analysis. It is also reported in other studies that colonization and infection is more likely in catheters inserted to jugular vein than in catheters inserted to subclavian vein [1,3,14]. Reasons for the higher infection rate in the jugular vein site is thought to be related to difficulty keeping the dressing in place and contamination with oropharyngeal secretions.…”

“…Many different risk factors for CRI in intensive care patients have been reported in the literature [3,4,8,9,11-13]. These include insertion site, duration of catheterization, type of dressing, type of catheter, frequent manipulations, improper aseptic techniques, number of catheter lumens, type of topical antiseptic solution used and use of the catheter for TPN.…”

“…The CVCs kept in place for ≥ 8 days were associated with approximately two times the risk of infection compared with catheters kept in place for ≤ 7 days. The practise of routinely changing catheters according to some defined time period to reduce the risk of CRI is commonly referred to as "scheduled" replacement [3,7]. There is little or no support from the literature for scheduled replacement, even though it continues to be a common clinical practice.…”

“…Estimates of their use in the United States alone suggest that over five million CVCs are inserted annually [1,2]. Although CVCs have significant benefits in many clinical situations, the increase in their use over the last 20 years has been associated with at least a doubling of resultant nosocomial infections [3,4]. A number of factors may contribute to the risk of catheter related infections (CRI) [5-9].…”

Showering with central venous catheters: Experience using the CD-1000 composite dressing

“…I n the United States, there are more than 5 million central venous catheters (CVCs) inserted annually. 1,2 Although the majority of these catheters are inserted for acute care needs and removed within hours to days, others remain in place for months to years. Regardless of their use, CVCs are responsible for an estimated 250,000-400,000 bloodstream infections per year, with an associated mortality of 10%-35%.…”