Catheter Hub Research Articles

A new technique for difficult removal of a peripherally inserted central venous catheter (PICC) in a neonate

In general, the removal of peripherally inserted central venous catheters (PICC) in neonates by gentle traction is easy. In our case, the removal of a 28G PICC in a term neonate was impossible by manual traction even with force. Previously described non-invasive interventions using a stylet were not successful because it was not possible to pass the stylet along the catheter hub of the narrow 28G PICC. In the end, the catheter could be removed non-operatively by cutting the catheter just distal to the hub and inserting a stylet of a new PICC (same brand and size) into the patients' retained catheter. Subsequently, the force of manual traction on the catheter could be increased without increased risk of catheter stretching and breakage. After catheter removal, the surface of the remaining PICC was intact.Conclusion: By thinking outside the box, surgical intervention was prevented in this neonate. What is Known: • On general, peripherally inserted central venous catheters (PICC) can be removed easily by gentle traction. • There are no clear recommendations about what to do if standard interventions fail to remove a PICC. What is New: • Our technique is a non-invasive option for difficult PICC removal and can prevent surgery. • The retained PICC is cut distal to the hub, and after stylet reinsertion, sustained manual traction is performed.

Use of alcohol containing caps for preventing bloodstream infections: A randomized controlled trial.

A majority of bloodstream infections seen in intensive care units stem from intravascular catheters used on patients. Catheter hubs are the entrance for pathogenic microorganisms into the inner surfaces of the catheters. The pathogenic microorganisms colonization in the mentioned areas can cause central line-associated bloodstream infection (CLABSI). This study was conducted as a randomized controlled trial to investigate the effect of alcohol-containing caps on the prevention of CLABSI. Total of 95 patients participated in the study. Isopropyl alcohol-containing caps were used for protecting the needle-free connectors closing the hubs of the central venous catheters in the intervention group. However, the control group patient received standard catheter caps. There was a statistically significant difference between groups in terms of infection distribution (X2 = 13.058; p < 0.001). The risk of infection in the control group was 13.7 times higher than the risk of infection in the intervention group. Our results suggest that alcohol-containing caps are effective or in preventing CLABSI. These findings suggest that alcohol-containing caps on ports are effective in preventing CLABSI.

Impact of Continuous Education and Training in Reduction of Central Line-associated Bloodstream Infection in Neurointensive Care Unit.

ABSTRACTBackgroundPatients in the neurointensive care unit have high utilization of devices, thereby increased chance of getting device-associated infection (DAI). Central line-associated bloodstream infection (CLABSI) remains one of the most important DAI. Education remains an important part of the hospital infection control and improves the infection-control practices.Materials and methodsTo evaluate the effectiveness of a quality initiative in reducing incidence of CLABSI, a prospective study (January 2017–December 2018) was done estimating CLABSI incidence before and after the intervention. Continuous teaching and training for hand hygiene practice and central-line catheter hub care were used as the tool for this study.ResultsThe quality improvement (QI) initiative achieved a 48% reduction in the CLABSI rate from the baseline rate of 8.7 to 4.5 per 1000 catheter days. The overall mortality showed a reduction from 1.5 to 0.05% during the post-intervention period. There was a significant improvement in compliance with the hand hygiene practice and catheter hub care in the post-intervention period.Discussion and conclusionThis study demonstrates adherence to hand hygiene and catheter hub care with continuous teaching, training, and supervision was highly effective in reducing the CLABSI rate.Clinical significanceCentral line-associated bloodstream infection is one of the most important DAI causing significant morbidity and mortality in critically ill patient. Our findings support that continuous educational intervention of hand hygiene with and training on the catheter hub care are two most important preventive measures in the reduction of CLABSI incidence.How to cite this articleMohapatra S, Kapil A, Suri A, Pandia MP, Bhatia R, Borkar S, et al. Impact of Continuous Education and Training in Reduction of Central Line-associated Bloodstream Infection in Neurointensive Care Unit. Indian J Crit Care Med 2020;24(6):414–417.

Developing an Infection Prevention Position for a Multi-Center Hospital-based Dialysis System

<h3>Background</h3> There exists in most dialysis centers opportunities for improvement, including infection control practices, work practice safety, medication safety, regulatory compliance, training, and cost reduction. Although IP's are experts in HAI prevention, implementation science and problem-solving, it is typical for dialysis centers to have only limited access to an infection preventionist (IP). This hospital-based dialysis system created a .8 FTE IP dialysis staff position to support existing quality improvement efforts and address compliance and infection control issues. <h3>Methods</h3> 2 IPs are responsible for this health system's infection prevention program, including 4 outpatient hemodialysis centers, 1 inpatient hemodialysis center and a home peritoneal dialysis program. Prior to September 2018, the dialysis centers' monthly audits, compliance and quality improvement issues were the responsibility of the centers' supervisors and manager. Based on an increase in NHSN positive blood culture events and observed infection control and compliance issues, the health system identified the need for additional IP support for dialysis. A .8 FTE IP position was created within dialysis with job responsibilities in the area of both infection control and compliance. <h3>Results</h3> Positive blood culture events dropped 42%, from 12 in 2018 to 7 (as of December 2019). Compliance with the contact time during dialysis catheter hub disinfection improved from 8% to a sustained 100%. Likewise, compliance with skin antisepsis contact time improved from 40% to a sustained 100%. The IP was a major contributor to over 25 successful quality improvement projects which focused on safety, infection prevention, regulatory compliance and cost reduction. <h3>Conclusions</h3> The addition of an IP to the dialysis staff can contribute to best practices, safety, infection prevention, regulatory compliance, and reduced costs. Collaboration with the health system's IP's, dialysis staff and leadership is essential for success.

Leakage of isopropanol from port protectors used in neonatal care-Results from an in vitro study.

BackgroundTo decrease contamination of needleless catheter hubs, caps or port protectors impregnated with isopropanol (IPA) have been developed and shown to be superior to other disinfection methods. The safety of the caps has been questioned, as they can be associated with alcohol leakage across the hub membrane.ObjectivesWe evaluated the use of IPA caps and the scrub-the-hub method from the safety standpoint of possible alcohol leakage across the hub membrane.MethodsCircuits imitating an intravenous line were constructed. Circuits with an IPA cap were flushed with sodium chloride after the hub had been exposed to the cap for 1 hour, 24 hours, and 7 days. At the end of each period the fluid was collected and amounts of IPA in it were measured, using gas chromatography. Scrub circuits without IPA caps were also tested and ethanol from these was measured using the same method.ResultsIn this in vitro study, IPA was detected in all samples from cap circuits, and ethanol was detected from all scrub circuits. Leakage increased over time in IPA circuits. After 24 hours and 7 days of exposure, the first injection resulted in higher amounts of IPA; thereafter, the levels decreased. The amounts of ethanol measured from the scrub circuits were low.ConclusionsIPA caps can cause leakage of alcohol across the hub membrane. Leakage increased over time, and a 30 sec drying time was not sufficient to solve the problem. Scrub-the-hub seems safe to use with regard to alcohol leakage.

Positive-pressure needleless connectors did not increase rates of catheter hub colonization respecting the use of neutral-pressure needleless connectors in a prospective randomized trial

IntroductionThe aim of this study was to compare the colonization rates of central venous catheter (CVC) and arterial catheter (ArtC) hubs fitted with two types of needleless connectors (NCs). MethodsWe designed a prospective randomized study to compare rates of catheter hub colonization of CVC and ArtC hubs fitted with two types of needleless connectors: neutral-pressure NCs (NP-NCs) and positive-pressure NCs (PP-NCs) in critically ill patients. All NCs were replaced every 7 days of use. ResultsWe obtained 326 cultures from 146 catheters (81 CVC and 65 ArtC) in 70 patients. The total cumulative days of risk were 1250 catheter-days. Global swab cultures were positive in NP-NCs in 29/198 (14.6%) versus 17/128 (13.3%) in PP-NCs during catheter use. We did not observe any cases of CRBSI. ConclusionsIn our experience, the use of PP-NCs did not result in significantly more frequent hub colonization with respect to NP-NCs.

The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients.

Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. The 5-year preintervention period (2008-2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013-2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.

Positive-pressure needleless connectors did not increase rates of catheter hub colonization respecting the use of neutral-pressure needleless connectors in a prospective randomized trial

IntroductionThe aim of this study was to compare the colonization rates of central venous catheter (CVC) and arterial catheter (ArtC) hubs fitted with two types of needleless connectors (NCs). MethodsWe designed a prospective randomized study to compare rates of catheter hub colonization of CVC and ArtC hubs fitted with two types of needleless connectors: neutral-pressure NCs (NP-NCs) and positive-pressure NCs (PP-NCs) in critically ill patients. All NCs were replaced every 7 days of use. ResultsWe obtained 326 cultures from 146 catheters (81 CVC and 65 ArtC) in 70 patients. The total cumulative days of risk were 1250 catheter-days. Global swab cultures were positive in NP-NCs in 29/198 (14.6%) versus 17/128 (13.3%) in PP-NCs during catheter use. We did not observe any cases of CRBSI. ConclusionsIn our experience, the use of PP-NCs did not result in significantly more frequent hub colonization with respect to NP-NCs.

A Novel “Inocap” Method for Homogeneous Catheter Hubs Bacterial Inoculation Using a Combination of Male Luer Caps and O-rings.

Catheter-related bloodstream infections (CRBSIs) pose significant health risks and financial consequences for healthcare systems worldwide. In order to develop novel antiseptic technologies as alternative prophylactics for CRBSIs, a consistent and reproducible bacterial inoculation method is required for testing the technologies’ antiseptic effects. This study developed and investigated a new “Inocap” model for standardized bacteria inoculation on to surfaces of catheter hubs that is exposed and highly susceptible to contamination in healthcare settings. The results showed a significantly smaller variance in the number of bacteria inoculated onto the catheter hubs by the new Inocap method than the traditional dip method (p ≈ 0.02) while producing no significant difference in the mean value (p > 0.25), indicating that this new Inocap method could work as a more precise inoculation model for future disinfection studies. Address Correspondence to author: 2301/2 New Petchburi Rd. Bangkapi, Huaikwang, Bangkok Thailand 10310 email: tanant.w@cathecare.com Keywords: Bacteria inoculation model, disinfection, catheter related bloodstream infections, intraluminal infection, catheter hubs, contamination Address Correspondence to author: 2301/2 New Petchburi Rd. Bangkapi, Huaikwang, Bangkok Thailand 10310 email: tanant.w@cathecare.com Received: June 30, 201 Revision received: July 3, 2018 Accepted after revision: July 10, 2018 BKK Med J 2018;14(2): 28-33. DOI: 10.31524/bkkmedj.2018.09.006

583. Improving Catheter Scrub Technique and Compliance in a Level IV Neonatal ICU

BackgroundCentral line-associated bloodstream infections (CLABSIs) are challenging to prevent in the neonatal population due to the long-term necessity of central access for nutrition and medication. Neonates are a population at high risk for CLABSIs, and infections in this group are associated with prolonged hospitalization, greater healthcare costs, and increased mortality. Current bundles for CLABSI prevention include a friction scrub of the catheter hub prior to each use. Real-time audits of correct technique can be challenging. In July of 2018, our team developed a new strategy for auditing scrub technique in an attempt to reduce CLABSI rates.MethodsThis project took place in a NICU with 118 level 4 beds from July 2018 to February 2019. Our NICU is located in a large metropolitan area and serves as a referral center for complex neonates throughout the region. The intervention period encompassed 25,085 patient-days and 6,206 line days. Real-time friction scrub audits were performed for both dedicated line team staff as well as bedside nurses. In order to determine whether a healthcare worker’s (HCW) scrub technique was successful, a colorless luminescent product was applied to a practice catheter hub that adhered to the hub, but was not visible to the HCW. The HCW would then demonstrate a friction scrub on the practice catheter, and the hub was placed under a black light to show where any residual product may be present. This process was repeated until the staff member was able to remove the product from the hub. Once the staff was successful, monthly real-time audits were continued to reinforce the correct technique.ResultsBetween July 2018 and February 2019, compliance with scrub technique and ability to clear product from catheter hubs increased by 50%. The CLABSI rate in the first 9 months after intervention was 0.806 per 1000 line days as compared with 2.170 per 1000 line days in the previous fiscal year.ConclusionThe number of CLABSI’s during the intervention period was 63% less when compared with the previous fiscal year. This process, in conjunction with our other CLABSI prevention practices, has significantly decreased both our CLABSI rate and overall numbers. This project emphasizes the importance of focusing on the basics of infection prevention practices and continual auditing to prevent practice creep.Disclosures All authors: No reported disclosures.

Nurses’ peripheral intravenous catheter-related practices: a descriptive study

Background: Peripheral intravenous catheter (PIVC) insertion and maintenance are the procedures most commonly performed by nurses in clinical settings. However, current catheter failure rates are high, thus compromising the patient’s therapeutic plan and well-being. Objective: To understand nurses’ practices during PIVC insertion and maintenance. Methodology: A transversal and descriptive study was conducted in a cardiology ward in central Portugal. Nurses’ (n = 26) practices during PIVC management were observed and recorded by a research nurse during the morning shift, using a checklist based on transnational standard of care (SoC) recommendations. Results: During PIVC insertion (n = 38) the main digressive areas included glove usage (55.2%), use of the aseptic non-touch technique (44.7%), hand hygiene (18.4%-84.2%), and patient education (28.9%). Regarding PIVC maintenance (n = 66), catheter hub disinfection (78.8%), catheter flushing (53.3%- 78.8%), and patient education (24.2%) were the main deviating areas found. Significant PIVC failure rates were found (25.8%). Conclusion: Overall, a substantial number of PIVC-related practices does not comply with current SoC recommendations, which may pose a risk to patient safety and care quality

Drawing blood cultures through intravascular catheters: Controversy and update.

Studies published between 1999 and 2011 demonstrated increased blood culture contamination with catheter-drawn cultures compared with percutaneously-drawn cultures. Studies published between 2012 and 2015 reported that use of antiseptic barrier caps on central venous catheter hubs significantly reduces the incidence of catheter-drawn blood culture contamination. Local guidelines regarding sites for blood culture collection should reflect institution-level blood culture contamination rates for percutaneously-drawn and catheter-drawn cultures using currently available technologies that reduce contamination at both sites.

Innovations in Quality Improvement of Intravascular Catheter-Related Bloodstream Infections

Significant reductions in catheter-related bloodstream infections (CRBSI) have occurred in the United States. Reductions in CRBSIs are attributed to the widespread implementation of the practice-based measures and innovations in the diagnosis, treatment, and prevention of CRBSI. Diagnosis of CRBSI historically required removal of the central venous catheter (CVC) for catheter tip culture. Removing the CVC for CRBSI diagnosis predisposes many patients to potential life-threatening complications. Advances in diagnostic techniques such as culturing catheter hubs, catheter entry site cultures, applying differential time to positivity, molecular diagnostics, biomarkers, and innovative approaches like biosensors on the CVC lumen may provide an alternative to CVC removal. Removal of the CVC is common for the treatment of CRBSI; however, antimicrobial lock therapy is increasingly used as a CVC salvage method. Implementation of newer technology such as antimicrobial coated catheters, chlorhexidine-impregnated dressings, and antiseptic port protectors are crucial for the prevention of CRBSIs. Increasing evidence also support newer sutureless CVC securement devices prevent CRBSIs. CRBSI remains a significant clinical problem despite advances made in the diagnosis, management, and prevention. Molecular techniques are increasingly being used for pathogen identification in CRBSI, but the optimal diagnostic test remains debatable. Increasing experience is being gained with antimicrobial lock therapy for CRBSI treatment with catheter salvage. Use and adherence to practice-based measures and technological innovations has significantly reduced CRBSIs. Continued efforts are required to develop a cost-effective and targeted approach for CRBSI prevention.

Antiseptic measures during the insertion and manipulation of vascular catheters.

Several measures related to asepsis for preventing catheter-related bloodstream infection have been proposed. The aseptic measures recommended by scientific societies include hand hygiene of the person who is inserting or manipulating the catheter; maximum sterile barrier precautions during catheter insertion; disinfection of catheter hubs; the use of needle-less connectors and injection ports; the avoidance of antibiotic ointments (except in hemodialysis catheters); change the dressing if it is soiled, loose or damp; and aseptic technique during dressing changes. Other measures only recommended by the most recently published guides (possibly due to the publication of recent studies reporting their beneficial effects) are the use of antimicrobial-impregnated dressings, changing transparent dressings every 7 days, and bathing of the patient with chlorhexidine. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

Prevention of hemodialysis catheter infections: Ointments, dressings, locks, and catheter hub devices

Tunneled central venous catheters used for the provision of hemodialysis are associated with excess morbidity and mortality. Catheter related exit site and blood stream infections are major risks of their use. Although catheter-avoidance is the best strategy to reduce infections and mortality in the hemodialysis population, the use of catheters remains unacceptably high. In this review, the existing clinical practice guidelines for the prevention of hemodialysis catheter associated infections are outlined, and a comprehensive evidenced-based summary of interventions is provided. This includes details about the use of topical antimicrobial ointments and dressings, intranasal ointment application, prophylactic use of antibiotic and non-antibiotic catheter lock solutions, and catheter hub devices for the prevention of catheter blood stream infections.

Administration of taurolidine-citrate lock solution for prevention of central venous catheter infection in adult neutropenic haematological patients: a randomised, double-blinded, placebo-controlled trial (TAURCAT)

BackgroundCatheter-related bloodstream infection (CRBSI) is one of the most frequent complications in patients with cancer who have central venous catheters (CVCs) implanted and is associated with substantial morbidity and mortality. Taurolidine is a non-antibiotic agent with broad-spectrum antimicrobial activity, which has been used as a lock solution to prevent CRBSI in some settings. However, little is known about its usefulness in high-risk adult neutropenic patients with cancer. This prospective randomised clinical trial aims to test the hypothesis that taurolidine-citrate lock solution is more effective than placebo for preventing catheter infection in neutropenic haematological patients.MethodsThis study is a prospective, multicentre, randomised, double-blinded, parallel, superiority, placebo-controlled trial. Patients with haematological cancer who are expected to develop prolonged neutropenia (> 7 days) and who have a non-tunnelled CVC implanted will be randomised to receive prophylactic taurolidine-citrate-heparin solution using a lock technique (study group) or heparin alone (placebo group). The primary endpoint will be bacterial colonisation of the CVC hubs. The secondary endpoints will be the incidence of CRBSI, CVC removal, adverse events, and 30-day case-fatality rate.DiscussionThe lock technique is a preventive strategy that inhibits bacterial colonisation in the catheter hubs, which is the initial step of endoluminal catheter colonisation and the development of infection. Taurolidine is a nontoxic agent that does not develop antibiotic resistance because it acts as an antiseptic rather than an antibiotic. Taurolidine has shown controversial results in the few trials conducted in cancer patients. These studies have important limitations due to the lack of data on adult and/or high-risk neutropenic patients, the type of catheters studied (tunnelled or ports), and the lack of information regarding the intervention (e.g. dwelling of the solution, time, and periodicity of the lock technique). If our hypothesis is proven, the study could provide important solid evidence on the potential usefulness of this preventive procedure in a population at high risk of CRBSI, in whom this complication may significantly impair patient outcome.Trial registrationISRCTN, ISRCTN47102251. Registered on 9 September 2015.

Abstract No. 545 Factors affecting residual catheter hub radioactivity during intrahepatic delivery of 90Y TheraSphere

Abstract No. 545 Factors affecting residual catheter hub radioactivity during intrahepatic delivery of 90Y TheraSphere

Recommended Clinical Trial End Points for Dialysis Catheters.

Central venous catheters are used frequently in patients on hemodialysis as a bridge to a permanent vascular access. They are prone to frequent complications, including catheter-related bloodstream infection, catheter dysfunction, and central vein obstruction. There is a compelling need to develop new drugs or devices to prevent central venous catheter complications. We convened a multidisciplinary panel of experts to propose standardized definitions of catheter end points to guide the design of future clinical trials seeking approval from the Food and Drug Administration. Our workgroup suggests diagnosing catheter-related bloodstream infection in catheter-dependent patients on hemodialysis with a clinical suspicion of infection (fever, rigors, altered mental status, or unexplained hypotension), blood cultures growing the same organism from the catheter hub and a peripheral vein (or the dialysis bloodline), and absence of evidence for an alternative source of infection. Catheter dysfunction is defined as the inability of a central venous catheter to (1) complete a single dialysis session without triggering recurrent pressure alarms or (2) reproducibly deliver a mean dialysis blood flow of >300 ml/min (with arterial and venous pressures being within the hemodialysis unit parameters) on two consecutive dialysis sessions or provide a Kt/V≥1.2 in 4 hours or less. Catheter dysfunction is defined only if it persists, despite attempts to reposition the patient, reverse the arterial and venous lines, or forcefully flush the catheter. Central vein obstruction is suspected in patients with >70% stenosis of a central vein by contrast venography or the equivalent, ipsilateral upper extremity edema, and an existing or prior history of a central venous catheter. There is some uncertainty about the specific criteria for these diagnoses, and the workgroup has also proposed future high-priority studies to resolve these questions.

Complication Rates for Pediatric PICCs after Rewire

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Self-management of Acute and Chronic Conditions, Presented at the 38th National NAPNAP Conference on Pediatric Health Care, March 17, 2017, Denver, CO. This study was designed to analyze peripherally inserted central catheter (PICC) complication rates after rewire, as compared to newly placed PICCs. Long-term venous access is integral to the treatment and therapy of many pediatric patients. Complications with line function other than infection can be remedied many times by exchanging the catheter over a wire for a new catheter, also known as rewire. Rewiring a patient's PICC is often done in an attempt to preserve future venous access options. This is especially important in chronically ill patients who require central venous access for long periods of time. Are rewired PICCs at an increased risk of complications when compared to newly placed PICCs? IRB approval (H-35710) allowed retrospective study at a large children's hospital of the electronic medical record and PACS system, which were queried for all PICCs placed from January 2014 through December 2014. Data points collected for each patient included catheter dwell time, reason for rewire, indication of PICC placement, and complications including infection, line malfunction and malposition. Outcomes were statistically analyzed using Fisher's exact test. Comparisons were made between the total PICC population and those patients that had their PICC exchanged over a wire. A total of 1257 PICCs were placed during the study period with 157 patients having a rewire of their line. In new line placements, the complication, infection and malposition rate were 12.2%, 4.8%, and 4%, respectively. In rewire patients, the complication, infection, and malposition rate were 44.6%, 14.6%, and 17.2%, respectively. All of these values were statistically significant. The most common reasons for rewire were malposition (46.6%), and cracked catheter hub (17.8%). The two most common patient populations requiring rewires were oncology (33.1%) and TPN dependent short gut patients (33.1%). Average catheter dwell time in newly placed lines was 39 days and in rewire patients was 59 days. Complications were more frequent in the rewired group, despite the fact that rewires were performed to address such complications initially. There was a significantly higher rate of line malfunction and malposition, which may reflect the same etiologies prompting rewire in the first place, such as fibrin sheath causing occlusion, patient anatomy predisposing to recurrent malposition, or young patient age with a tendency toward line pull. The rewire infection rate was also higher, perhaps reflecting the higher risks in the rewired population, including immunosuppression and a decreased proportion of patients needing central access for long term antibiotic therapy. There is a statistically significant higher rate of subsequent complications in rewired catheters compared to newly placed catheters including a higher rate of infection. When deciding on whether to exchange a catheter over the wire, the increased risk of complications needs to be weighed against the potential benefit of preserving future vascular access options.

Incidence of central venous catheter hub contamination

PurposeTo investigate microorganisms causing central venous catheter contamination and how this contamination differs across different catheter metrics. Materials and methodsAfter obtaining IRB approval and informed consent, 830 cultures were prospectively obtained from 45 ICU patients with central venous catheter or peripherally inserted central catheter. Bacterial colonies were identified by mass spectrometry. ResultsBacterial contamination of central catheter hubs occurred 44% of the time in this study in the ICU setting. Coagulase-positive staphylococci cultures had higher median (±interquartile range) CFUs (12±232) versus coagulase-negative (3±10) and other bacteria (1±3; P<0.001). Bacterial contamination was associated with various metrics. Higher incidence (P<0.05) of coagulase-positive staphylococci cultures was associated with hub-only connections (a “hub” being a female connection; 10.9% vs. 7.9% male connections), connections without a manifold (1lumen device that mixes multiple infusions together; 9.7% vs. 0% with manifold); and central venous pressure monitoring connections (25.8% vs. 7.1% without). Internal jugular sites (10.0% vs. 2.7% femoral, 6.2% PICC, P=0.031) and medial lumens of triple lumen catheters (11.9% vs. 5.6% distal, 7.0% proximal, P=0.049) had increased incidence of higher bacteria loads (>15 CFUs). ConclusionsThis study found a high incidence of central access catheter hub bacterial contamination, which correlated with positive blood cultures in 2 of 3 total bacteremia cases identified in the 45 patients.