Prospective Study of Catheter Replacement and Other Risk Factors for Infection of Hyperalimentation Catheters

Abstract

To determine risk factors for infection of hyperalimentation catheters, we prospectively studied 169 catheter systems (88 patients) by using a semiquantitative culture technique. Infection occurred in 24 (14%) catheters (16 patients), was inversely proportional to the number of previous catheters inserted by the operator (P less than .02), and was proportional to the interval between admission and catheter insertion (P less than .0005). Catheter replacement over a guidewire was no more likely to be associated with infection than was a de novo percutaneous insertion at another site (P = .6). Using a proportional hazards model, we estimated the risk of infection per day to be 1.3 times greater for a catheter if the patient had been hospitalized 50 days instead of seven days, and 3.8 times greater if the patient had a Swan-Ganz catheter at the time of insertion.

Guidelines for the prevention of intravascular catheter-related infections

“…Well-organized programs that enable health-care providers to provide, monitor, and evaluate care and to become educated are critical to the success of this effort. Reports spanning the past two decades have consistently demonstrated that risk for infection declines following standardization of aseptic care [39][40][41][42][43], and that insertion and maintenance of intravascular catheters by inexperienced staff might increase the risk for catheter colonization and CRBSI [43,44]. Specialized "IV teams" have shown unequivocal effectiveness in reducing the incidence of catheter-related infections and associated complications and costs [45][46][47].…”

Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit

“…21 After studying the local workflow, soliciting clinician input, and mapping the process of CVC care, 22 the team established priority areas for measurement. These areas included provider education, 23 trainee supervision, 24 insertion site, [25][26][27] hand hygiene, 28 skin antisepsis, 29 and use of maximal sterile barriers. 30 …”

“…24 Since house staff insert most CVCs in our MICU, the checklist included whether the proceduralist was properly supervised. Based on guidelines established by the American Board of Internal Medicine, 33 we considered trainees ''supervised'' if they had previously performed five CVC insertions or if another provider with experience of at least five CVC insertions supervised them during the procedure.…”

Role of Arterial catheters as a source of Hospital related Bacteremia

“…Catheter management, including both insertion and maintenance, also may influence risk for infection. Several studies have shown that catheters placed by less experienced personnel are at increased risk for infection [65].Another study analyzed the efficacy of using a skilled team for placement of peripheral intravenous catheters [66].In this study, an intravenous therapy team significantly reduced both local and bacteremic complications associated with the placement of peripheral intravenous catheters, in part related to the timely placement of the catheters. Two studies suggest that insertion of central venous catheters with less than maximal sterile barriers increases the risk of catheter-related infection [46].…”