Abstract
Objective To evaluate if body surface temperature close to the central venous catheter insertion area is different when patients develop catheter-related bloodstream infections.Methods Observational cross-sectional study. Using a non-contact infrared thermometer, 3 consecutive measurements of body surface temperature were collected from 39 patients with central venous catheter on the following sites: nearby the catheter insertion area or totally implantable catheter reservoir, the equivalent contralateral region (without catheter), and forehead of the same subject.Results A total of 323 observations were collected. Respectively, both in male and female patients, disregarding the occurrence of infection, the mean temperature on the catheter area minus that on the contralateral region (mean ± standard deviation: -0.3±0.6°C versus -0.2±0.5ºC; p=0.36), and the mean temperature on the catheter area minus that on the forehead (mean ± standard deviation: -0.2±0.5°C versus -0.1±0.5ºC; p=0.3) resulted in negative values. Moreover, in infected patients, higher values were obtained on the catheter area (95%CI: 36.6-37.5ºC versus 36.3-36.5ºC; p<0.01) and by temperature subtractions: catheter area minus contralateral region (95%CI: -0.17 - +0.33ºC versus -0.33 - -0.20ºC; p=0.02) and catheter area minus forehead (95%CI: -0.02 - +0.55ºC versus -0.22 - -0.10ºC; p<0.01).Conclusion Using a non-contact infrared thermometer, patients with catheter-related bloodstream infections had higher temperature values both around catheter insertion area and in the subtraction of the temperatures on the contralateral and forehead regions from those on the catheter area.
Highlights
Central venous catheters (CVC) are devices that allow delivery of medication and nutritional therapies as well provide hemodynamic measures that cannot be safely accomplished otherwise.[1]
Near 5 million CVC are inserted per year, in the United States, with a documented rate of related infections ranging between 3 to 26% per year.[4,5,6,7] Considering only intensive care units, 80 thousand of catheter-related bloodstream infections (CRBSI) occurred in a year.[8]. The costs related to each case of CRBSI could reach US$56,000,(9) with an average increase in hospital stay of 6.5 days for critically ill patients.[10]. In addition, CRBSI have been associated with up to 25% mortality,(8,10) catheter replacement and interruption of intravenous therapy.[11,12]
Researchers had described a low sensibility to detection of local inflammation around CVC insertion area based on clinical findings.[13]. They reported that vascular device colonization could happen even in the absence of infectious symptoms or signs.[14,15] On the other hand, the body surface temperature, evaluated with a noncontact infrared thermometer (NCIT), could be altered nearby infectious processes.[16]
Summary
Central venous catheters (CVC) are devices that allow delivery of medication and nutritional therapies as well provide hemodynamic measures that cannot be safely accomplished otherwise.[1] These vascular accesses can be classified as short and long-term use. Short-term CVC are usually non-tunneled polyurethane catheters with single or multiple lumens and should be inserted only in hospitalized patients to use for days or weeks.[2] Examples of long-term CVC (>3 months) are the cuffed tunneled catheters (i.e., HICKMAN® or BROVIAC®) and the totally implantable port. Researchers had described a low sensibility to detection of local inflammation around CVC insertion area based on clinical findings (pain, erythema, swelling and purulence).(13) They reported that vascular device colonization could happen even in the absence of infectious symptoms or signs.[14,15] On the other hand, the body surface temperature, evaluated with a noncontact infrared thermometer (NCIT), could be altered nearby infectious processes.[16]
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