Optimal Frequency of Changing Intravenous Administration Sets: Is It Safe to Prolong Use Beyond 72 Hours?

Raad, Issam; Hanna, Hend; Awad, Abeer; Alrahwan, Amin; Bivins, Carol; Khan, Azim; Richardson, Deborah; Umphrey, Jan; Whimbey, Estella; Mansour, Georganne

doi:10.1086/501879

Cited by 78 publications

(63 citation statements)

References 16 publications

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“…Data from a more recent study demonstrated that rates of phlebitis were not substantially different if administration sets were left in place 96 hours compared with 72 hours [128]. When a fluid that enhances microbial growth is infused (e.g., lipid emulsions and blood products), more frequent changes of administration sets are indicated, because these products have been identified as independent risk factors for CRBSI [152][153][154][155][156][157][158].…”

Section: Replacement Of Administration Setsmentioning

confidence: 99%

Guidelines for the prevention of intravascular catheter-related infections

O’Grady¹,

Alexander²,

Dellinger³

et al. 2002

American Journal of Infection Control

635

843

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These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The These guidelines are intended to provide evidencebased recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

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Section: Replacement Of Administration Setsmentioning

confidence: 99%

Guidelines for the prevention of intravascular catheter-related infections

O’Grady¹,

Alexander²,

Dellinger³

et al. 2002

American Journal of Infection Control

635

843

View full text Add to dashboard Cite

show abstract

“…CLABSIs are an independent risk factor for increased hospital costs and length of stay. There are four recognized routes for contamination of CVCs: (i) migration of organisms colonizing the skin at the insertion site into the catheter tract, along the catheter surface, and consequently colonization of the catheter tip (2-4); (ii) direct contamination of the catheter/catheter hub through contact with hands, contaminated fluids, or contaminated devices (5, 6); (iii) hematogenous seeding from another focus of infection (7); and (iv) rarely, contamination of intravenous infusate solutions (8). The microorganisms most commonly associated with CVC infection are Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]) and coagulase-negative staphylococci (CoNS) (9)(10)(11).…”

mentioning

confidence: 99%

Activity of Daptomycin with or without 25 Percent Ethanol Compared to Combinations of Minocycline, EDTA, and 25 Percent Ethanol against Methicillin-Resistant Staphylococcus aureus Isolates Embedded in Biofilm

Estes

Theusch

Beck

et al. 2013

Antimicrob Agents Chemother

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bCentral venous catheters commonly develop central line-associated bloodstream infections. In vitro antibiotic lock therapy (ALT) was simulated on 10 methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates imbedded in biofilm-coated silicon disks. Five days of 4-h daily exposures to daptomycin (2.5 mg/ml) in 25% ethanol or minocycline (3 mg/ml) plus 25% ethanol and 30 mg/ml EDTA resulted in significantly greater elimination of MRSA colonization than treatment with minocycline alone. Of the 5 million central venous catheters (CVCs) inserted annually, an estimated 80,000 are associated with central lineassociated bloodstream infections (CLABSIs) (1). CLABSIs are an independent risk factor for increased hospital costs and length of stay. There are four recognized routes for contamination of CVCs: (i) migration of organisms colonizing the skin at the insertion site into the catheter tract, along the catheter surface, and consequently colonization of the catheter tip (2-4); (ii) direct contamination of the catheter/catheter hub through contact with hands, contaminated fluids, or contaminated devices (5, 6); (iii) hematogenous seeding from another focus of infection (7); and (iv) rarely, contamination of intravenous infusate solutions (8). The microorganisms most commonly associated with CVC infection are Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]) and coagulase-negative staphylococci (CoNS) (9-11). Within 24 h of CVC insertion, host proteins coat the catheter, forming a conditioning film in which microorganisms may bind, forming three-dimensional extracellular structures colonizing the lumen of the CVC. Organisms embedded in this biofilm are usually refractory to treatment with systemic antibiotic therapy alone (6, 12). These organisms have reduced susceptibility to antimicrobial agents in the range of 10-to 1,000-fold compared to planktonic cells (13).Published CLASBI guidelines recommend that infected longterm CVCs be removed if associated with severe sepsis, suppurative thrombophlebitis, endocarditis, bloodstream infection that continues despite 72 h of antimicrobial therapy to which the infecting microbes are susceptible, or infections due to S. aureus and that short-term CVCs be removed from patients with CLABSIs due to S. aureus (14). Unfortunately, on occasion, clinical circumstances may preclude removing the CVC for reasons of safety or feasibility. Antibiotic lock therapy (ALT) involves instilling a highly concentrated antibiotic solution into a catheter lumen and allowing the solution to dwell for a specified time period for the purpose of sterilizing the lumen and salvaging the CVC. In conjunction with systemic antimicrobial agents, ALT is indicated for CLABSIs involving long-term catheters with no signs of exit site or tunnel infection with the goal of catheter salvage.Daptomycin, a novel lipopeptide antibiotic, has potent bactericidal activity in vitro against most clinically important Grampositive pathogens, including MRSA, CoNS, vancomycin-resistant enterococci...

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“…The risk of catheter-related infection correlates with the patient's age, weight, underlying diseases, immune system status and type of fluid injection (15,16). Several preventive techniques have been shown, which can reduce the incidence of infections including: adequate knowledge, insertion and keeping of catheter only in necessary situations, hygiene, use of appropriate solutions (alcoholicchlorhexidine) for skin disinfection, care protocol implementation, CVC insertion under ultrasound guidance, preference of subclavian line instead of other sites, change of dressings (no more than seven days), and avoiding antibiotic prophylaxis (1,(17)(18)(19)(20). The most important principle of prevention is personnel training for catheter care and observing the principles of sterilization (15,21).…”

Section: Discussionmentioning

confidence: 99%

Incidence of Central Venous Catheter-Related Infection and Risk Factors in Critically Ill Post-Operative Cancer Patients: A Randomized Prospective Cohort Study

Beigmohammadi

2015

Arch Crit Care Med

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Background: Cancer patients are susceptive to infection. Catheter-related bloodstream infections are the first cause of nosocomial bloodstream infections in intensive care units. Objectives: The aim of this study was to evaluate the association between the type of central intravenous catheter and bloodstream infection in post-operative cancer surgery patients at surgery intensive care units (ICU). Methods: In a randomized, non-blind study, 66 cancer surgery patients were studied. The primary aim was rate of central venous catheter-related infection by type of catheter. The patients were enrolled in three groups: simple catheter (n = 23) (without antimicrobial), impregnated catheter in the internal part (n = 28), and AGB + catheter (n = 15) (impregnated catheter in external and internal part); all catheters were triple lumen, polyurethane (arrow, chlorhexidine and silver sulfadiazine, USA). Insertion of catheters was done in full sterile conditions based on the center for disease control (CDC) guidelines for the prevention of intravascular catheterrelated infection. Catheter related infection was confirmed by positive blood culture of blood samples of central catheter. The chi square or Fisher's exact test was used to compare base values and difference in rate of colonization and bloodstream catheter-related infection. A P value of less than 0.05 was considered statistically significant. Results: Sixty-six patients participated in this study in three groups. There was no significant difference regarding the baseline demographic and clinical characteristics of patients between groups (P > 0.05). Distributions of surgery types were statistically the same in the three groups (P = 0.323). Impregnated catheters had no significant effect on colonization (P = 0.565) or bloodstream infection prevention (P = 0.490). Conclusions: Compared to standard catheters, impregnated catheters had no effect on colonization or bloodstream infection prevention.

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Optimal Frequency of Changing Intravenous Administration Sets: Is It Safe to Prolong Use Beyond 72 Hours?

Abstract: In patients at low risk for infection from infusion- or catheter-related infection who are not receiving total parenteral nutrition, blood transfusions, or interleukin-2, delaying the replacement of IV tubing up to 7 days may be safe, as well as cost-effective

Cited by 78 publications

References 16 publications

Guidelines for the prevention of intravascular catheter-related infections

Guidelines for the prevention of intravascular catheter-related infections

Activity of Daptomycin with or without 25 Percent Ethanol Compared to Combinations of Minocycline, EDTA, and 25 Percent Ethanol against Methicillin-Resistant Staphylococcus aureus Isolates Embedded in Biofilm

Incidence of Central Venous Catheter-Related Infection and Risk Factors in Critically Ill Post-Operative Cancer Patients: A Randomized Prospective Cohort Study

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