Catheter-related sepsis in patients on intravenous nutrition: A prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis

Abstract

One hundred and ninety-five central venous catheters used for intravenous nutrition in 113 patients were studied prospectively. Catheter-related sepsis (CRS), defined by recovery of the same organism from the catheter tip and peripheral blood cultures, occurred with only 3.3 per cent of catheters or 2.3 per 1000 days of therapy. In contrast, CRS was suspected with 30 per cent of catheters and catheter contamination occurred in 37 per cent. Contamination was defined by a positive catheter tip culture without recovery of the same organism from the blood. CRS was present in 4 of 12 cases (33 per cent) with greater than 1000 colony forming units on the catheter tip but in only 2 of 54 (4 per cent) with fewer organisms. Thirty-eight cases suspected of having CRS were randomized to have catheter removal and later replacement, or replacement over a guidewire. There were no significant differences in the catheter contamination rate but there were significantly fewer problems of insertion in the guidewire group. However, transfer of Klebsiella sp., during the guidewire procedure, resulted in subsequent sepsis in one case. It is concluded that replacement of catheters over a guidewire is a safe and convenient way of establishing whether sepsis is catheter-related. Because organisms may be transferred, the procedure is not an appropriate treatment for catheter-related sepsis.

Pathogenesis of infections related to intravascular catheterization

“…3, one additional mechanism of catheter colonization requires consideration: hematogenous seeding of the catheter tip by bacteremia from a distant site of infection. Catheter colonization is thought to be facilitated by the presence of a fibrin sheath that develops on the intravascular surface of the catheter shortly after insertion (79,95,105,120,147,148,182,190 (67). Both SNAP and NTISS predict mortality risk very well, and both improve prediction models based on birth weight alone.…”

Characteristics of Bacterial Species in Positive Blood Cultures among Hospitalized Patients in Three Wards in the Department of Internal Medicine: Retrospective Chart Review 1999-2008

“…These increases were observed in the gastroenterology, hepatology and respiratory wards, and were due to: 1) an increase in patients who had serious underlying diseases including malignant tumors; 2) an increase in use of intravenous catheters; 3) an increase in elderly patients; and 4) an increase in prescription of drugs that reduce immunocompetence including anticancer agents, corticosteroids, and immunosuppressive agents (9)(10)(11).…”

Nursing considerations to complement the Surviving Sepsis Campaign guidelines

“…Failure to remove the catheter was demonstrated to be an independent predictor of mortality in an epidemiological study on CR-BSI (OR 0.22, 95% CI 0.10-0.86) (133). If the catheter is removed for suspected CR-BSI, guidewire exchange is acceptable in circumstances where catheter insertion is problematic as this reduces the risk for mechanical complications (134). If, however, the catheter tip culture appears to be positive, the newly inserted catheter should be replaced a second time because bacterial contamination can be expected and guidewire exchange on itself was shown to be an independent risk factor for the development of CR-BSI in an observational study (OR 4.59, 95% CI 2.28-9.3) (133).…”