Central venous catheter infections: Concepts and controversies

Reed, Christopher Robert; Sessler, Curtis N.; Glauser, Frederick L.; Phelan, B. A.

doi:10.1007/bf01726542

Cited by 82 publications

(31 citation statements)

References 72 publications

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“…Several factors are known to influence risk of infection associated with the use of ordinary CVCs; number of lumens, insertion site, repeated catheterization, duration of catheterization, type of dressing, experience of personnel inserting the device and that of special intravenous therapy personnel. 13,[15][16][17] However, the complication rate, in our study, of the remaining long-term dCVCs during the high-dose treatment was comparable with that of other reports concerning conventional CVCs. 18,19 To our knowledge, there is only one previous study describing the use of long-term dCVCs in adults during harvesting and subsequent high-dose treatment with PBSC rescue.…”

supporting

confidence: 84%

Vascular access devices used during harvest of peripheral blood stem cells: high complication rate in patients with a long-term dialysis central venous catheter

Johansson

A²,

As³

et al. 1999

Bone Marrow Transplant

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Summary:PBSC harvesting requires good quality venous access. The efficacy and complication rate of the venous access devices used during stem cell harvest in 101 consecutive patients were examined. Four different categories of venous access were used: (1) long-term dialysis central venous catheter (dCVC), (2) short-term dCVC, (3) peripheral venous cannulae (PVC), and (4) PVC and conventional central venous catheter. The number of harvest occasions per patient or harvest days per occasion were similar between the various categories of access. Complications during harvest occurred in 13 out of 48 (27%) occasions using a long-term dCVC compared to six out of 97 (6%) in the other three categories pooled together (P Ͻ 0.01). Forty-two of the 101 patients received a long-term dCVC to facilitate the harvest. The long-term dCVC was planned to stay in place and also be used as a conventional i.v. line during the following high-dose treatment. Twenty-one (50%) of the longterm dCVCs were removed due to complication. Thirteen (31%) of the long-term dCVCs were usable throughout the entire treatment period. In conclusion, we recommend that PBSC harvesting is performed through peripheral venous catheters when practically possible, otherwise via short-term dCVC. Keywords: PBSC collection; harvest; central venous access; central venous catheter; complication; thrombosis An increasing number of patients with various malignant disorders are undergoing high-dose therapy followed by autologous stem cells rescue as a part of their treatment. 1 PBSC collected by leukapheresis has become the main cell source in recent years. The procedure requires a high blood flow through intravenous (i.v.) lines between patient and apheresis machine. In some patients it is possible to use intravascular devices inserted in the peripheral arm veins, or to insert a femoral dialysis catheter. In other patients with a functional central venous catheter (CVC) already in place, this catheter can be used as the return line for blood from the leukaphereses machine to the patient. However, many patients need a double lumen central venous dialysis catheter (dCVC) to ensure harvesting. There are two different categories of dCVC, the stiff dCVC for short-term use 2 and the softer silastic dCVC for long-term use. 3The long-term type of dCVC can also be used for routine venous access, starting with delivery of chemotherapy for the mobilisation of stem cells through the period of highdose chemotherapy until bone marrow recovery. Most experience of long-term dCVCs has been collected in the haemodialysis setting. The majority of reported complications leading to removal of the long-term dCVCs are catheter-related infections (9-28%) 4-7 and failure due to poor flow rates or thromboses (5-30%). 4,[6][7][8][9][10] The published experience on use of long-term dCVC for stem cell harvesting is limited. 3,11,12 In March 1993 we decided to use long-term dCVC for stem cell harvesting and high-dose therapy in patients unable to have peripheral venous cannulae (PVC) due to poor ...

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supporting

confidence: 84%

Vascular access devices used during harvest of peripheral blood stem cells: high complication rate in patients with a long-term dialysis central venous catheter

Johansson

A²,

As³

et al. 1999

Bone Marrow Transplant

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“…the shown link between switching to multi-lumen catheters and a subsequent rise in catheter infections 20 , the increase in the volume of drug solvent influencing fluid balance in critically ill patients, as well as the escalating economic burden and increasing demands on ICU staff. These phe- Table 3.…”

Section: Discussionmentioning

confidence: 99%

Incidence of intravenous drug incompatibilities in intensive care units

Machotka¹,

Man̆ák²,

Kubêna³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims. Drug incompatibilities are relatively common in inpatients and this may result in increased morbidity/mortality as well as add to costs. The aim of this 12 month study was to identify real incidences of drug incompatibilities in intravenous lines in critically ill patients in two intensive care units (ICUs). Methods. A prospective cross sectional study of 82 patients in 2 ICUs, one medical and one surgical in a 1500-bed university hospital. One monitor carried out observations during busy hours with frequent drug administration. Patients included in both ICUs were those receiving at least two different intravenous drugs. Results. 6.82% and 2.16% of drug pairs were found to be incompatible in the two ICUs respectively. Among the most frequent incompatible drugs found were insulin, ranitidine and furosemide. Conclusions:The study showed that a significant number of drug incompatibilities occur in both medical and surgical ICUs. It follows that the incidence of incompatibilities could be diminished by adhering to a few simple rules for medication administration, following by recommendations for multiple lumen catheter use. Future prospective studies should demonstrate the effect of applying these policies in practice.

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“…• Central venous access is technically difficult and poor line care is associated with bacteraemia and catheter-related sepsis [50,51].…”

mentioning

confidence: 99%

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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SummaryCervical spine injury occurs in 5-10% of cases of blunt polytrauma. A missed or delayed diagnosis of cervical spine injury may be associated with permanent neurological sequelae. However, there is no consensus about the ideal evaluation and management of the potentially injured cervical spine and, despite the publication of numerous clinical guidelines, this issue remains controversial. In addition, many studies are limited in their application to the obtunded or unconscious trauma victim. This review will provide the clinician managing unconscious trauma victims with an assessment of the actual performance of clinical examination and imaging modalities in detecting cervical spine and isolated ligamentous injury, a review of existing guidelines in light of the available evidence, relative risk estimates and a proposed management scheme. Cervical spine and associated spinal cord injury significantly affect the individual's functional capacity and quality of life, and carry significant implications for society. It was estimated in 1988 that a 27-year-old rendered tetraparetic would consume US$ 1 million for lifetime care and, with 721 tetraparetic individuals per million of the population, the total aggregate costs were an estimated US$ 5.6 billion per year [1]. In America, cervical, thoracic and lumbar vertebral fractures occur with an incidence of 50 000 per year [2], and cervical spine injury has an annual incidence of 5-10 000 cases per year [3,4]. More recent estimates suggest an incidence of 8-10 000 spinal cord injuries per year, of which 55% are cervical [5]. In the UK, there are approximately 1000 new cases of cervical cord injury each year [6]. Cervical spine injury complicates blunt polytrauma in 2-12% of cases [7][8][9]. However, several larger reviews that include 29 000 blunt trauma victims, and additional prospectively gathered data, demonstrate a generally lower incidence (2.0-5.2%) [10][11][12][13].The presence of a severe head injury increases the relative risk of a cervical spine injury, possibly by 8.5 times, and a focal neurological deficit by 58 times [14]. A Glasgow Coma Scale (GCS) score of < 8 is associated with a 50% increase in the incidence of cervical spine injury to 7.8% [15]. Similarly, Demetriades et al.[16] have shown that although the incidence of cervical spine injury in trauma victims with a GCS score of 13-15 was only 1.4%; this increased to 10.2% if GCS was < 8. 'Primary' cervical spine injury may be associated with head injury in 24-35% of cases [10,[16][17][18][19][20], and among polytrauma victims requiring cervical spine stabilization surgery, only 74% suffered an isolated injury [21]. The prognosis in patients suffering both head and cervical injury is typically poor, with approximately 25% being discharged to a dedicated nursing facility with little prospect of recovery [22]. Traumatic brain injury has a UK incidence of 100 per 100 000 population [23], typically among young, working age males, and therefore the combined consequences of brain and spine injury both ...

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Central venous catheter infections: Concepts and controversies

Cited by 82 publications

References 72 publications

Vascular access devices used during harvest of peripheral blood stem cells: high complication rate in patients with a long-term dialysis central venous catheter

Vascular access devices used during harvest of peripheral blood stem cells: high complication rate in patients with a long-term dialysis central venous catheter

Incidence of intravenous drug incompatibilities in intensive care units

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

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