Mechanical Complications from Insertion of Subclavian Venous Feeding Catheters: Comparison of de Novo Percutaneous Venipuncture to Change of Catheter Over Guidewire

Newsome, Heber H.; Armstrong, Carl W.; Mayhall, Glen; Sugerman, Harvey J.; Miller, Kathy B.; Rich, Anne M.; Dalton, Harry P.

doi:10.1177/0148607184008005560

Cited by 31 publications

(14 citation statements)

References 18 publications

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“…Most studies examined by HICPAC concluded that, in cases where the catheter being removed is known to be infected, guidewire exchange is contraindicated. 302,[304][305][306][307] A systematic review concluded that, compared with new site replacement, guidewire exchange was associated with a trend toward a higher rate of subsequent catheter colonisation, regardless of whether patients had a suspected infection at the time of replacement. Guidewire exchange was also associated with trends toward a higher rate of catheter exit-site infection and CR-BSI.…”

Section: Methodsmentioning

confidence: 99%

epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England

Pratt¹,

Pellowe²,

Wilson³

et al. 2007

Journal of Hospital Infection

602

478

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National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001. These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters. The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence). A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines. These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations. Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiri...

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Section: Methodsmentioning

confidence: 99%

epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England

Pratt¹,

Pellowe²,

Wilson³

et al. 2007

Journal of Hospital Infection

602

478

View full text Add to dashboard Cite

show abstract

“…Theoretically, a new CVC insertion at a new site exposes the patient to some risk of arterial or lung puncture while, logically, GWX will eliminate the risk associated with such a puncture [16-19]. However, GWX may expose patients to a greater risk of line contamination through inadequate protection of the insertion field with anti-bacterial solutions.…”

Section: Introductionmentioning

confidence: 99%

The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters

et al. 2013

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IntroductionThe management of suspected central venous catheter (CVC)-related sepsis by guide wire exchange (GWX) is not recommended. However, GWX for new antimicrobial surface treated (AST) triple lumen CVCs has never been studied. We aimed to compare the microbiological outcome of triple lumen AST CVCs inserted by GWX (GWX-CVCs) with newly inserted triple lumen AST CVCs (NI-CVCs).MethodsWe studied a cohort of 145 consecutive patients with GWX-CVCs and contemporaneous site-matched control cohort of 163 patients with NI-CVCs in a tertiary intensive care unit (ICU).ResultsGWX-CVC and NI-CVC patients were similar for mean age (58.7 vs. 62.2 years), gender (88 (60.7%) vs. 98 (60.5%) male) and illness severity on admission (mean Acute Physiology and Chronic Health Evaluation (APACHE) III: 71.3 vs. 72.2). However, GWX patients had longer median ICU lengths of stay (12.2 vs. 4.4 days; P < 0.001) and median hospital lengths of stay (30.7 vs. 18.0 days; P < 0.001). There was no significant difference with regard to the number of CVC tips with bacterial or fungal pathogen colonization among GWX-CVCs vs. NI-CVCs (5 (2.5%) vs. 6 (7.4%); P = 0.90). Catheter-associated blood stream infection (CA-BSI) occurred in 2 (1.4%) GWX patients compared with 3 (1.8%) NI-CVC patients (P = 0.75). There was no significant difference in hospital mortality (35 (24.1%) vs. 48 (29.4%); P = 0.29).ConclusionsGWX-CVCs and NI-CVCs had similar rates of tip colonization at removal, CA-BSI and mortality. If the CVC removed by GWX is colonized, a new CVC must then be inserted at another site. In selected ICU patients at higher central vein puncture risk receiving AST CVCs GWX may be an acceptable initial approach to line insertion.

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“…A widely practiced technique intended to reduce the incidence of mechanical complications associated with central venous catheterization is the use of Seldinger guide wire exchanges in lieu of routine catheter replacement at a new site. 16,[23][24][25]39,45,49,56,69,70,[110][111][112] This allows a new catheter to be substituted with substantially less risk of insertion-related complications. However, the new catheter is inserted over a guide-wire that might have been contaminated during the removal of the previous catheter.…”

Section: Prevention Of Catheter-associated Infectionmentioning

confidence: 99%

Detection and Prevention of Central Venous Catheter‐Related Infections

Kruse

Shah

1993

Nut in Clin Prac

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Infectious complications of central venous catheterization are an important clinical problem. Although systemic infection complicates only a small fraction of cases, the prevalence of catheter-related sepsis remains high because of the widespread use of these catheters in acutely ill hospitalized patients. The major route of infection is probably by migration of microorganisms from the skin along the outer surface of the catheter and through the subcutaneous catheter tract to the bloodstream. Semi-quantitative catheter tip cultures have become a standard clinical tool for the evaluation for catheter-related infection. Despite the use of this technique and a variety of other proposed methods for evaluating catheter colonization and infection, discriminating catheter-related sepsis from sepsis originating at another site is often difficult. Prevention of these infections is important. There have been many investigations of the factors that contribute to catheter infections. These studies have shown that meticulous attention to sterile technique during catheter insertion and during routine maintenance is critical.

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Mechanical Complications from Insertion of Subclavian Venous Feeding Catheters: Comparison of de Novo Percutaneous Venipuncture to Change of Catheter Over Guidewire

Cited by 31 publications

References 18 publications

epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England

epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England

The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters

Detection and Prevention of Central Venous Catheter‐Related Infections

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