Tunneling short-term central venous catheters to prevent catheter-related infection

Randolph, Adrienne G.; Cook, Deborah J.; Gonzales, Calle A.; Brun‐Buisson, Christian

doi:10.1097/00003246-199808000-00038

Cited by 118 publications

(45 citation statements)

References 25 publications

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“…al (17) . Many randomized clinical trials and reviews have clearly demonstrated that the use of tunneled catheters and those with cuffs reduce the risks of catheter-related sepsis by 44% -77% as compared to the use of non-tunneled catheters and those without cuff, by reducing the risks of bacterial migration from the skin to the circulation and diminishing the formation of biofilm (6,8,13,23) . There was no statistically significant difference in regard to the use of Mupirocin versus honey for bacteremias caused by S. aureus.…”

Section: Discussionmentioning

confidence: 99%

“…The use of CVCs should be quite limited due to the frequent occurrence of bloodstream infection; as shown in several studies, the rate is approximately 40% (1)(2)(3)(4)(5)(6)(7) . Infection is the second leading cause of mortality among patients with end stage renal disease (ESRD) and represents, approximately, 14% of deaths among these individuals, preceded only by cardiovascular events (8) .…”

Section: Introductionmentioning

confidence: 99%

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Uso profilático de Mupirocina em cateter venoso central de hemodiálise: revisão sistemática e metanálise

et al. 2012

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Objective: To evaluate the impact of the use of topical Mupirocin on the insertion of central venous catheter for hemodialysis. Methods: This was a systematic review with meta-analysis. Results: After a careful and extensive search, we included three clinical trials that compared the use of Mupirocin versus other intervention in central venous catheter for hemodialysis. Conclusion: The study found that the use of topical Mupirocin is effective in reducing episodes of infection among hemodialysis patients, increasing duration time for catheter, and significantly reducing S aureus infections, which are the most prevalent in this population. RESUMENObjetivo: Evaluar el impacto del uso de Mupirocina tópica en inserción de cateter venoso central para hemodiálisis. Métodos: Revisión Sistemática con Metaanálisis. Resultados: Después de una criteriosa y extensa búsqueda, se incluyeron tres ensayos clínicos que compararon el uso de Mupirocina versus otra intervención en cateter venoso central para hemodiálise. Conclusión: El estudio demostró que el uso de Mupirocina tópica es eficaz para la reducción de los episodios de infecciones entre los pacientes en hemodiálisis, aumentando el tiempo de utilización del cateter, además de reducir significativamente las infecciones por S aureus, las más prevalentes en esa población.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Uso profilático de Mupirocina em cateter venoso central de hemodiálise: revisão sistemática e metanálise

et al. 2012

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“…Evidence from studies on tunneling effi cacy have suggested that this technique reduces CVC infections in patients with short-term devices, where most colonized pathogens arise from the catheter insertion site. A meta-analysis of randomized controlled trials demonstrated that tunneling decreased catheter colonization by 39% and bloodstream infection by 44% compared to non-tunneling [36]. Th ese results were partly due to one trial with CVCs inserted via the internal jugular vein, and no signifi cant risk reduction was observed when only the data from fi ve subclavian catheter trials were pooled.…”

Section: Tunnelingmentioning

confidence: 99%

Prevention of Central Venous Catheter-related Infection in the Intensive Care Unit

Frasca

Dahyot‐Fizelier

Mimoz

2010

Intensive Care Medicine

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This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. Frasca et al. Critical Care 2010, 14:212 http://ccforum.com/content/14/2/212 © Springer-Verlag Berlin Heidelberg 2010. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. R E V I E Wfeedback is provided to all actors [7,8]. Catheter insertion in emergency conditions increases the risk of non-compliance to the insertion protocol and, consequently, to infectious complications; these catheters must be replaced as soon as the patient's condition is stabilized [9]. Staff educational/quality improvement programEducating and training of health-care providers who insert and maintain CVCs is essential for preventing catheter-related infection, improving patient outcomes, and reducing healthcare costs [10]. Th e experience of the operator is an important issue as the risk of infectious complications is inversely proportional to the operator skills. An educational intervention in catheter insertion signifi cantly improved patient outcomes and simulationbased training programs are valuable in residency education [11]. Programs for training nurses in longterm catheter care ("IV teams") were associated with a reduction in catheter-related infections in the USA [12]. Nevertheless, without such teams the use of care protocols and nursing staff education allowed comparable results to be obtained [13]. Nursing staff reductions below a critical level may contribute to increase catheterrelated infection by making adequate catheter care diffi cult. One study reported a four times greater risk of catheter infection when the patient-to-nurse ratio was doubled [14]. Moreover, replacement of regular nurses by fl oat nurses further increases the risk of device-related infections [15]. Th ese studies clearly indicate that trained nurses, in suffi cient numbers, must be available for optimal patient care in the ICU. Type of catheterCatheter material is an important determinant in the prevention of catheter-related infection. Th e material should be biocompatible, hemocompatible, biostable, chemically neutral, not altered by administered drugs, and deformable according to surrounding strengths. Furthermore, the catheter ...

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“…Catheter-related infections were defined according to standard guidelines (9,28,29). Catheter-associated bacteremia was defined as either (1) a single positive blood culture together with a positive culture of the catheter tip or exit site with an identical organism or (2) two or more positive blood cultures (or a single positive blood culture for S. aureus) with no evidence of infection source other than the device.…”

Section: Definitionsmentioning

confidence: 99%

Randomized, Controlled Trial of Topical Exit-Site Application of Honey (Medihoney) versus Mupirocin for the Prevention of Catheter-Associated Infections in Hemodialysis Patients

Johnson

Eps

Mudge

et al. 2005

Journal of the American Society of Nephrology

140

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The clinical usefulness of hemodialysis catheters is limited by increased infectious morbidity and mortality. Topical antiseptic agents, such as mupirocin, are effective at reducing this risk but have been reported to select for antibiotic-resistant strains. The aim of the present study was to determine the efficacy and the safety of exit-site application of a standardized antibacterial honey versus mupirocin in preventing catheter-associated infections. A randomized, controlled trial was performed comparing the effect of thrice-weekly exit-site application of Medihoney versus mupirocin on infection rates in patients who were receiving hemodialysis via tunneled, cuffed central venous catheters. A total of 101 patients were enrolled. The incidences of catheter-associated bacteremias in honey-treated (n ‫؍‬ 51) and mupirocin-treated (n ‫؍‬ 50) patients were comparable (0.97 versus 0.85 episodes per 1000 catheter-days, respectively; NS). On Cox proportional hazards model analysis, the use of honey was not significantly associated with bacteremia-free survival (unadjusted hazard ratio, 0.94; 95% confidence interval, 0.27 to 3.24; P ‫؍‬ 0.92). No exit-site infections occurred. During the study period, 2% of staphylococcal isolates within the hospital were mupirocin resistant. Thrice-weekly application of standardized antibacterial honey to hemodialysis catheter exit sites was safe, cheap, and effective and resulted in a comparable rate of catheter-associated infection to that obtained with mupirocin (although the study was not adequately powered to assess therapeutic equivalence). The effectiveness of honey against antibiotic-resistant microorganisms and its low likelihood of selecting for further resistant strains suggest that this agent may represent a satisfactory alternative means of chemoprophylaxis in patients with central venous catheters.

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Tunneling short-term central venous catheters to prevent catheter-related infection

Abstract: Tunneling decreases central venous catheter-related infections. However, current evidence does not support routine tunneling until its efficacy is evaluated at different placement sites and relative to other interventions.

Cited by 118 publications

References 25 publications

Uso profilático de Mupirocina em cateter venoso central de hemodiálise: revisão sistemática e metanálise

Uso profilático de Mupirocina em cateter venoso central de hemodiálise: revisão sistemática e metanálise

Prevention of Central Venous Catheter-related Infection in the Intensive Care Unit

Randomized, Controlled Trial of Topical Exit-Site Application of Honey (Medihoney) versus Mupirocin for the Prevention of Catheter-Associated Infections in Hemodialysis Patients

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