Prevention of indwelling central venous catheter sepsis

Abstract

In an attempt to decrease the incidence of central venous catheter sepsis in children with cancer, we conducted a study to evaluate the benefit of adding broad‐spectrum antibiotics to the catheter “flush solution.” In a prospective, placebo‐controlled, double‐blinded, randomized trial, 69 children with different types of malignancies were studied. The central venous catheters in these children were flushed with either the standard solution (normal saline + 100 U/ml of heparin) or the study solution (25 μg/ml of both amikacin and vancomycin added to the standard solution). At the conclusion of the study, 64 children with a total of 67 indwelling central venous lines were assessable. The total catheter days on study were 20,700 days, with a median of 323 catheter days per patient. We documented 10 events of catheter‐related infections (0.49 events/1,000 catheter days at risk). Five of these events were catheter‐related sepsis (0.24 sepses/1,000 catheter days): two were fungal and three were bacterial. Due to the low incidence of catheter‐related sepsis in this study, no statement regarding the prophylactic use of antibiotics could be made. The extremely low rate of catheter‐related sepsis reported herein may be retrospectively attributed to continuous staff education regarding aseptic techniques in handling these catheters. Staff education is essential, and probably the most effective factor in preventing catheter‐related sepsis. © 1996 Wiley‐Liss, Inc.

Use of Vancomycin-Containing Lock or Flush Solutions for Prevention of Bloodstream Infection Associated with Central Venous Access Devices: A Meta-Analysis of Prospective, Randomized Trials

“…Seven trials fulfilled inclusion criteria [85][86][87][88][89][90][91]. The characteristics of the included trials are shown in table 1.…”

“…Five studies used vancomycin combined with heparin alone, 1 study used a vancomycin-amikacin-heparin solution [91], and 1 study had 2 treatment groups: recipients of vancomycin-heparin alone and recipients of a vancomycin-ciprofloxacin-heparin solution [90]. The vancomycin-ciprofloxacin-heparin solution arm was not included in the analysis.…”

“…Of the studies that used this criteria, 4 evaluated a vancomycin-heparin lock solution [85,86,88,90], and the remainder evaluated a vancomycin-heparin flush solution. In 2 studies, after a specified time period, the lock solution was aspirated and discarded [85,86]; in the remaining 5 studies [87][88][89][90][91], the solution was flushed into the bloodstream.…”

“…Of the 7 studies, 3 described IVD care procedures [85,86,89], and 5 reported details of the randomization procedure, which was adequate in each case [85,86,88,90,91]. Every study was a double-blinded trial.…”

Peroperative teicoplanin for prevention of gram-positive infections in neutropenic patients with indwelling central venous catheters: a randomized, controlled study

“…McCarthy et al instilled teicoplanin into catheters and found a prolonged catheter life [7]. In a similarly designed placebo-controlled study, however, Daghistani et al were unable to show a protective effect of this strategy [2].…”