Guidelines for the prevention of central venous catheter-related blood stream infections with prostanoid therapy for pulmonary arterial hypertension

Abstract

SUMMARY Intravenous prostanoids are the backbone of therapy for advanced pulmonary arterial hypertension (PAH) and have improved long-term outcome and quality of life. Currently, two prostanoids are approved by the US Food and Drug administration for parenteral administration: epoprostenol (Flolan) and treprostinil (Remodulin). Chronic intravenous therapy presents considerable challenges for patients and caregivers who must learn sterile preparation of the medication, operation of the pump, and care of the central venous catheter. Patients are routinely counseled and advised regarding the risks of CR-BSIs and catheter care before central line insertion. Central line infections as well as bacteremia are well documented risks of chronic intravenous therapy and may significantly contribute to morbidity and mortality. Recent reports have suggested a possible increase in CR-BSI; therefore, the Scientific Leadership Council of the Pulmonary Hypertension Association decided to provide guidelines for good clinical practice regarding catheter care. Although data exits regarding patients with central venous catheters and the risk of blood stream infections in patients with cancer or other disorders, there is little data regarding the special needs of patients with pulmonary arterial hypertension requiring central venous access. These guidelines are extrapolated from the diverse body of literature regarding central venous catheter care.

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…Guidelines for the prevention of central venous catheter bloodstream infections have been proposed [227]. Abrupt interruption of the epoprostenol infusion should be avoided, because in some patients this may lead to a PH rebound with symptomatic deterioration and even death.…”

Guidelines for the diagnosis and treatment of pulmonary hypertension

“…Guidelines for the prevention of central venous catheter bloodstream infections have recently been proposed [124]. Abrupt interruption of the epoprostenol infusion should be avoided as, in some patients, this may lead to a rebound PH with symptomatic deterioration and even death.…”

Optimising the management of pulmonary arterial hypertension patients: emergency treatments

“…Patients had neither fever nor local signs of infection, but some had unexplained clinical deterioration, emphasising the importance of surveillance blood cultures. In this context, good clinical practice guidelines have been issued on the prevention and treatment of catheter infections [37].…”