Pulmonary artery catheter epidemiology of risk in pre–heart-transplant recipients

Abstract

Objective:Central-line–associated bloodstream infections (CLABSIs) are a known complication of central venous access. Pulmonary artery catheters (PAC) are frequently used in pre–heart-transplant patients, but the rate of CLABSI in this population is unknown. We sought to estimate the rate of CLABSI and identify factors associated with development of infection in patients actively listed for heart transplantation with a PAC.Design:Retrospective cohort study.Setting:This study was conducted in 3 intensive care units at an academic tertiary-care center in Minnesota.Patients:61 pre–heart-transplant patients in an intensive care unit with a PAC in place from January 2013 to December 2016, totaling 219 PACs.Methods:At-risk patients, pertinent risk factors, and demographic data were obtained using Mayo Clinic’s Unified Data Platform. CLABSIs were identified through internal infection prevention and control data. Characteristics of PAC use and infection rate were collected and analyzed using Kaplan-Meier estimates and time-dependent Cox models.Results:Among pre–heart-transplant patients with a PAC, there were 14 CLABSIs, for an infection rate of 5.46 of 1,000 PAC days (95% confidence interval [CI], 2.98–9.15). The most common causative organism was coagulase-negative Staphylococcus (79%). In unadjusted analyses, CLABSI was associated with shorter time to transplant (hazard ratio [HR], 2.49; P = .027), but not mortality (HR, 1.79; P = .355).Conclusions:The rate of CLABSI with PAC is high. Prolonged PAC use in the pre–heart-transplant population should be revisited.

“Effect of pulmonary artery catheterization in patients with non-ischemic cardiogenic shock: a nationwide analysis”

“…Adequate training is necessary to ensure proper manipulation of the PAC device and to reduce complications associated with its use. Careful management of the PAC, both during insertion and maintenance, is important due to the risk of infectious complications (36).…”

Introducing a nursing maintenance bundle for patients with pulmonary arterial catheters

“…Staphylococcus spp likely comprise an even higher proportion of CLABSI in PACs. 5,6 We hypothesized that our intervention led to a greater reduction in these CLABSIs by improving the sterility of line dressings and by keeping them occlusive longer, thus limiting skin flora contamination.…”

Hospital Epidemiology and Infection Control in the Transplant Center

“…Patients awaiting heart transplant frequently have pulmonary artery catheters, which allow for continuous monitoring of left ventricular filling pressures and confer a high urgency status for transplantation. At one institution, the CLABSI rate for patients with pulmonary artery catheters was five times higher than the CLABSI rate for intensive care unit (ICU) patients [10].…”