Specific Prevention Against Infection of Local Catheters in Postoperative Pain Management

Abstract

Background: The guideline for postoperative pain management therapy recommends several obligate measures and permissive provisions keeping catheters hygienic. An organized Pain Nurse is generally regarded as convenient. But some recommendations are still discussed. The guideline is based on only few large studies and the number of catheter-related infections differs from technique and risk profile. However, all recommendations for improvement have to be compared with the guideline. This prospective study was initiated to investigate the influence of catheter fixing, the frequency of changing dressings and the use of bacterium-filters on the rate of inflammation and infection. Methods: 2545 consecutive patients, who were under treatment of the Pain Nurse, were included in the study. 1624 patients received epidural catheters, 921 patients received continuous peripheral nerve blocks. The catheters were immediately placed and fixed by stitching before performing the operation. A bacterium-filter was always interposed and after some time a second filter was added in tandem circuit. After 4 days the transparent tape was changed. The assessment of the infection severity was oriented towards the criteria of the guideline. The results of the study were statistically compared to the data of the S3-guideline. Results: 34 (14.4%) of all catheters in the sample were colonized. Catheters placed in the groin were statistically significant more often colonized than epidural catheters (28.1% vs. 6.6%, p<0.01). 5 Catheters (0.2% vs. 4.2%, p<0.01) had signs of local inflammation. Only one fairly serious infection (placement in the groin) (0.04% vs. 2.4% p<0.01) and no severe infection were observed. Conclusion: Catheter-fixing by stitching and changing catheter-dressing on the first postoperative day to avoid dampness are important measures to prevent catheter related infections. Using consequently bacterium-filters with tandem circuit is supposed to reduce the rate of catheter-related inflammations and infections.