No association between ultrasound-guided insertion of central venous catheters and bloodstream infection: a prospective observational study

Cartier, Vanessa; Haenny, Andreas; İnan, Ciḡdem; Walder, Bernhard; Zingg, Walter

doi:10.1016/j.jhin.2014.03.009

Cited by 15 publications

(6 citation statements)

References 52 publications

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“…This may have influenced the risk of mechanical and infectious complications found in this study, although the reduction in catheter infection risk associated with the use of ultrasonography that was found in one randomized study 22 was not confirmed in a subsequent large observational study. 31 Daily chlorhexidine bathing 32,33 and chlorhexidine-impregnated dressings 34 were not used. Whether these measures influence the difference in infectious risk between insertion sites is unknown.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Complications of Central Venous Catheterization by Insertion Site

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Intravascular Complications of Central Venous Catheterization by Insertion Site

et al. 2015

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“…The rationale for this recommendation is that ultrasonography has been shown to reduce the number of cannulation attempts and mechanical complications [22]. Although one observational study has demonstrated no reduction in CLABSI risk with ultrasound-guided CVC insertion [23], two pooled studies spanning a range of patient populations and medical devices have demonstrated benefit for prevention of CLABSI [24, 25]. Our findings concur with these pooled studies, and support the routine use of ultrasound guidance for CVC localisation as a means of reducing risk of CLABSI by approximately 50%.…”

Section: Discussionmentioning

confidence: 99%

Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities

et al. 2017

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Central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) result in poor clinical outcomes and increased costs. Although frequently regarded as preventable, infection risk may be influenced by non-modifiable factors. The objectives of this study were to evaluate organisational factors associated with CLABSI in Victorian ICUs to determine the nature and relative contribution of modifiable and non-modifiable risk factors. Data captured by the Australian and New Zealand Intensive Care Society regarding ICU-admitted patients and resources were linked to CLABSI surveillance data collated by the Victorian Healthcare Associated Infection Surveillance System between 1 January 2010 and 31 December 2013. Accepted CLABSI surveillance methods were applied and hospital/patient characteristics were classified as 'modifiable' and 'non-modifiable', enabling longitudinal Poisson regression modelling of CLABSI risk. In total, 26 ICUs were studied. Annual CLABSI rates were 1·72, 1·37, 1·00 and 0·93/1000 CVC days for 2010-2013. Of non-modifiable factors, the number of non-invasively ventilated patients standardised to total ICU bed days was found to be independently associated with infection (RR 1·07; 95% CI 1·01-1·13; P = 0·030). Modelling of modifiable risk factors demonstrated the existence of a policy for mandatory ultrasound guidance for central venous catheter (CVC) localisation (RR 0·51; 95% CI 0·37-0·70; P < 0·001) and increased number of sessional specialist full-time equivalents (RR 0·52; 95% CI 0·29-0·93; P = 0·027) to be independently associated with protection against infection. Modifiable factors associated with reduced CLABSI risk include ultrasound guidance for CVC localisation and increased availability of sessional medical specialists.

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“…77 However, the impact of ultrasound on the rate of catheter infections is uncertain: a prospective study showed no effect of ultrasound guidance on CVC-associated BSIs or mortality. 78 In hospitals where ultrasound equipment is available and the physician has a sufficient training level, combining the anatomic landmarks ultrasound catheter insertion procedures should therefore be considered.…”

Section: Ultrasound-guided Placementmentioning

confidence: 99%

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

Buetti

Timsit

2019

Semin Respir Crit Care Med

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Central venous catheter-related bloodstream infections (CR-BSI) are a frequent event in the intensive care unit (ICU) setting. In contrast to other nosocomial infections, most risk factors for CR-BSI are linked to the device and can be prevented efficiently. Rates of CR-BSI higher than 1 per 1,000 catheter days are no longer acceptable. A continuous quality improvement program is effective to reduce them. Key elements of prevention of CR-BSI are hand hygiene, avoidance of insertion of unnecessary catheters, full sterile barrier precautions at insertion, preferential use of subclavian venous insertion site, cutaneous antisepsis with 2% chlorhexidine alcoholic preparation, use of chlorhexidine-impregnated dressings, immediate replacement of moistened or detached catheter dressings, and removal of catheters as soon as possible. Audit and feedback of the process of care, infection rates, and periodic re-education of health care providers are other instrumental tools in the prevention of CR-BSI. Catheter removal is the main therapeutic intervention, especially recommended in the case of sepsis or shock. While awaiting culture results, an empiric antimicrobial treatment of CR-BSI should target gram-positive microorganism (i.e., Staphylococcus aureus) and gram-negative coverage should be based on clinical variables, patients' risk factors, and previous colonization status. While a short course of antimicrobials (7 days) is sufficient for noncomplicated CR-BSI, a longer course of 14 days should be preferred for uncomplicated S. aureus and Candida CR-BSI. In case of persisting fever or positive blood culture after 3 days despite adequate antimicrobial therapy and catheter removal, catheter-related complications (e.g., endocarditis, thrombophlebitis, septic metastasis) should be ruled out.

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No association between ultrasound-guided insertion of central venous catheters and bloodstream infection: a prospective observational study

Cited by 15 publications

References 52 publications

Intravascular Complications of Central Venous Catheterization by Insertion Site

Intravascular Complications of Central Venous Catheterization by Insertion Site

Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

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