Catheters In Intensive Care Unit Research Articles

Evaluation of infections associated with central venous catheters in ICU

Objective: Central venous catheter-related infections lead to an increase in widespread antibiotic use, prolonged hospital stays, increased costs, as well as morbidity and mortality. In this study, we aimed to evaluate the infections associated with central venous catheters used in our intensive care unit (ICU) and identify the possible contributing factors. Methods: The hospital records of patients aged 18 and above who were admitted to ICU and had central venous catheters (femoral, jugular, and subclavian catheters) were retrospectively evaluated. Patients’ demographic data and also reason for admission, APACHE II score, duration of ICU stay, and 28-day mortality were recorded. Additionally, data on the time of catheter insertion, catheter site, catheter type, administration of blood and total parenteral nutrition (TPN) through the catheter, presence of catheter-related infection, identified pathogens, time of infection development after catheter insertion, and concurrent blood culture results were recorded. Results: A total of 169 patients were included in the study, of whom 99 (58.6%) were male and 70 (41.4%) were female. The catheters were located in the femoral region in 56 (33.1%) cases, jugular region in 99 (58.6%) cases, and subclavian region in 14 (8.3%) cases. There was no significant difference in the development of catheter infection based on the site of application (p=0.929). The rates of infection were significantly higher in catheters used for TPN and blood transfusion (p=0.002 and p=0.005, respectively). The average duration of intensive care stay was significantly higher in patients who developed catheter infections. Conclusion: Catheter-related bacteremia is an important risk factor for morbidity and mortality, especially in critically ill patients. In our study, no significant differences were found in the rates of catheter-related infection based on the application sites. We observed that the use of TPN, blood transfusion, and longer catheter duration posed risks for infection.

Construction of a nursing care instrument for patients with central venous catheters

Objective: to build a nursing care instrument for patients with short-term central venous catheters in an Intensive Care Unit. Methods: a multi-method study in three stages: structuring of the instrument; pre-testing of the instrument; agreement analyses among nurses and final composition of the instrument. Results: the instrument, in its first version, presented three domains related to the moment of insertion (five items), maintenance (15 items) and catheter removal (ten items). Most of the 30 items were assessed as relevant (23/77%) and presented a satisfactory Content Validity Index (28/93%). Ten items were reformulated, 32 new items were included, and three items were deleted. Conclusion: the instrument was constructed, which presented response validity for the care of nurses to patients with central venous catheters in Intensive Care Units, consisting of three domains and 59 items evaluated by nurses and considered appropriate for the moments of insertion, maintenance and removal of the catheter.

A study on catheter associated urinary tract infections (CAUTI) and antibiotic sensitivity pattern of uropathogens causing CAUTI from a tertiary care hospital

Catheter-associated urinary tract infections (CAUTI), remains the commonest hospital-acquired infection (HAI). This emphasizes the need to implement and monitor effective infection control programs to reduce the risk of CAUTI. Aim of the present study was to determine the etiology with antibiotic susceptibility and also to calculate CAUTI rate. The Patients admitted in intensive care unit (ICU), Rajarajeshwari Medical College and Hospital who were on urinary catheter insertion for >48 hours from 1 August, 2019 to 30 September, 2019 were included in the study. Under aseptic conditions urine samples were collected from clinically suspected cases of CAUTI, the samples were processed in the department of Microbiology, as per standard protocols. Uropathogens were isolated, identified and subjected to antibiotic sensitivity test. CAUTI rate was calculated and results were noted. Among 460 patients on catheter in ICU, 28(6%) patients developed clinical signs or symptoms of UTI. Of 28 urine samples cultured, 4(14%) yielded growth of single organis [Escherichia coli (3), Klebsiella (1)] and 24(86%) showed no evidence of growth. 2300 catheter days were obtained of 460 patients on indwelling catheter in ICU. Thus CAUTI rate was 1.74 per 1000 catheter days over a 2 month period.CAUTI remained a great burden to patient safety and a challenge to the infection control team. Implementation of proper care bundles and continuous education to health care workers plays a key role in reducing the CAUTI rates, thereby decreasing the morbidity and hospital stay to the patients.

Clinical significance of Catheter-Associated Urinary Tract Infection (CAUTI) in Intensive Care Units: Three Year Experience at a Single Centre

Introduction: Catheter Acquired Urinary Tract Infection (CAUTI) is one of the most common Health Care Acquired Infections (HCAI); most of these infections are attributable to use of an indwelling urethral catheter. The aim of this study was to investigate patients with catheter-associated urinary tract infection over three years at a single hospital’s Intensive Care Unit (ICU) and to identify meaningful risk factors and causative organisms. 
 Methods: A retrograde analysis was performed on patients with indwelling catheters in ICU of Armed Forces Medical College, Pune, India. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included.
 Result: Among 350 samples collected in medical and surgical ICU, 38 patients (10.85%) had CAUTI. Using multivariate logistic regression analysis, the study showed that those with diabetes were 4.51 (p＜0.001) times likely to have occurrences of CAUTI than those without and also showed an increased incidence of CAUTI > 1.19 fold (p＜0.01) among patient with longer duration of an indwelling catheter.
 Conclusions: CAUTI is a preventable HCAI and thus the risk factors and causative organisms contributing to its development in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.

Evaluation of the Efficacy of Ultrasound in Detecting Correct Placement of Central Venous Catheter and Determining the Elimination of the Need for Chest Radiography

Abstract Background and Aims Ultrasound guidance of central venous catheter (CVC) insertion improves the safety and efficacy of its placement, but still it may not ensure correct placement of catheter tip. In our study, we aimed to identify the correct placement of CVC tip and to detect mechanical complications, by visualizing it in real time with the help of sonography and comparing this to the chest X-ray findings. Patients and Methods This was a cross-sectional observational study conducted on 80 patients with American Society of Anesthesiologists grades 1 and 2, in the age group of 18 to 65 years, who required central venous catheterization in intensive care unit. The CVC tip placement was identified with ultrasound and then the finding was compared with postinsertion chest X-ray. Results In only 9 out of the 80 patients (11.3%) malposition was detected on ultrasound and was corrected immediately, whereas in remaining 71 patients (88.8%) no intervention was required. It was observed that all the patients had correct position of CVC tip on postprocedural chest X-ray. Accidental arterial cannulation occurred in two (2.5%) patients in whom right internal jugular vein was cannulated and in two (2.5%) patients who had arrhythmia. Conclusion Ultrasonography (USG) examination can be used as a diagnostic tool method for confirmation of CVC tip and identification of cannulation-related complications. Thus, we can say that USG might obviate the need for post-CVC insertion chest X-ray.

Dressings and Securement Devices of Peripheral Arterial Catheters in Intensive Care Units and Operating Theaters: A Systematic Review.

Hemodynamic monitoring, implemented by the placement of peripheral arterial catheters (PACs), is a characterizing aspect of the intensive care units. Peripheral arterial catheters can continually detect blood pressure and quickly conduct blood sampling. The use of PACs is generally considered safe, without serious complications. Currently, only 25% of the implanted catheters are actually subject to complications, including accidental removal, dislocation, occlusion, and infection. All of these complications arise from inadequate catheter stabilization at the level of the skin. This study aimed to summarize and describe the effectiveness and characteristics of dressings and securement devices for catheter stabilization. A systematic review of literature from the following databases was conducted: MEDLINE, CINAHL, Cochrane, EMBASE, and OvidSP. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to guide article selection and reporting. Herein 626 articles were referred, with 5 directly related to the topic under discussion. We found 3 studies that describe PAC failure and 4 about dislodgement. We described 6 types of dressings or securement devices and classified them into 3 categories for classifying PAC dressings or securement devices. These were detected and grouped as adhesive tissues, sutureless devices, and transparent polyurethane dressings. Current research indicates that transparent polyurethane dressings offer the most effective catheter stabilization, but adhesive tissues may constitute a valid alternative. However, there are limited high-quality studies about effective dressings and securement devices for PACs.

A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit.

Needle-free connectors were initially designed and promoted to avoid blood exposure for healthcare workers. Some recent data suggest that the latest generation of connectors (with positive displacement) may be of interest for reducing central venous line infections. We have been using needle-free connectors for several years in our intensive care unit and here we present a protocol for installing these connectors on central venous catheters. After insertion of the catheter and control of the permeability of the lines, the connectors must be purged with 0.9% NaCl before being connected. The connectors replace all disposable caps used on infusion stopcocks and manifolds. All the connectors are changed every 7 days as recommended by the manufacturer (except when there is macroscopic contamination, which requires an immediate change of the connector). Before each injection, the connector must be disinfected for at least 3 seconds with 70% isopropyl alcohol. The connectors must not be disconnected (unless changed), as the injection is done through the device. Setting up the connectors slightly increases the total time required to place the catheter and there is no formal evidence that these connectors reduce the incidence of infectious or thrombotic complications. However, these devices simplify the management of central venous lines and prevent the catheter circuit from "opening" once it has been sterilely installed.

A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit

A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit

The correlation between nursing workload and bloodstream infection from central venous catheter in ICU

Introduction: Bloodstream infection associated with the presence of central venous catheters is the second most common hospital infection in the Intensive Care Unit (ICU). The nursing stuff is an essential part of the human resources of the ICU which contributes substantially to provide holistic and effective care to critically ill patients. The level of the nursing workload and its possible influence on the clinical course and outcome of critically ill ICU patients has been systematically studied in recent years. Mainly, was studied the connection with the care quality indicators such as mortality and infections Aim: The purpose of this study was to estimate the nursing workload in the ICU and to investigate the impact of bloodstream infection from Central Venous Catheter (CLABSI). Methods: The study sample consisted of 39 patients who were hospitalized in a multidisciplinary ICU in a 3 month period. For the detection of bloodstream infections we used the surveillance definition of CDC/NHSN for in vitro confirmed bloodstream infection (CLABSI). Measurement of nursing workload was via the NAS scale and the calculation was performed for each patient once existed or entering the ICU from baseline and constantly on a daily basis. A comparison of the quantitative variables was done with the statistical criterion Pearson’s x 2 , to compare the bisectors qualitative variables selected quantitative variables was used the t-test analysis and MannWhitney test. Results: Of the total sample, 74,4% (n = 29) were male, with a mean age 59 ± 21 years. The duration of ICU stay was 24 ± 23 days and mortality was 41%. The duration of hospitalization was 28 ± 24 days and the corresponding mortality of 46.2%. All correlations presented no statistically significant difference than the first day’s NAS in which appears the biggest difference between the values (p=0,046) but the NAS of the patients who did not develop bacteremia be more increased over those experienced. Conclusions: The nursing workload in our study did not prove as a risk factor for the occurrence of bloodstream infection in the ICU.

Impact of MaxZero™ needle-free connector on the incidence of central venous catheter-related infections in surgical intensive care unit

BackgroundCentral venous catheter-related infections (CRIs) are a complication of central venous catheters in intensive care unit (ICU). Some needle-free connectors have been designed to decrease CRI, but there is a lack of data concerning their impact on infection. ObjectivesThe objective was to explore the impact of MaxZero™ connectors (BD; Franklin Lakes, US) on CRI in ICU. MethodsObservational, pre–post design study (2011–2013 and 2014–2016) conducted in the surgical ICU of a tertiary care hospital (18 beds). Patients with a central venous catheter and a length of stay ≥48 h were included. The connectors replaced all disposable caps used on infusion stopcocks and ramps. The primary parameter was to compare the incidence of CRI between the “before” period and the “after” period. ResultsA total of 1633 patients were included (789 “before” and 844 “after”). There was no difference between groups concerning the global duration of catheterisation (12.5 ± 11.5 days vs. 12.1 ± 10.9 days). There were 61 CRIs before and 28 CRIs after the introduction of connectors; the incidence of CRI in the “before” group was 20.33 CRI/year (6.18 CRI per 1000 catheter-days) vs. 9.33 CRI/year (2.73 CRI per 1000 catheter-days) in the “after” group (incidence rate ratio = 0.44; 95% confidence interval = 0.28–0.68, p < 0.001). However, after a global analysis of the 6-year period, when adjusting for seasonal effect and pre-existing linear trend, the effect was no longer significant (adjusted incidence rate ratio = 0.57; 95% confidence interval = 0.24–1.35, p = 0.20). ConclusionsOur results do not allow us to conclude to a potential beneficial effect of MaxZero™ on CRI but are compatible with its prolonged and safe use in ICU. Only future prospective works will be able to confirm the value of these connectors for CRI prevention.

Our experiences in central venous catheterization in intensive care unit: Retrospective Evaluation

Our experiences in central venous catheterization in intensive care unit: Retrospective Evaluation

Quality control management on indwelling catheter in ICU

Objective To investigate the application effect of quality control management in the prevention of indwelling catheter associated urinary tract infection in intensive care unit (ICU) patients. Methods Cases of patients stayed in the department of ICU undergoing indwelling catheter over 10 d were selected by using time stage sampling method. Totally 136 cases of patients were selected from January 1, 2012 to December 31, 2012, as the control group. A total of 145 cases of patients were selected from January 1, 2013 to December 31, 2013, as the performance group. Cases in performance group were taken standardized training and quantify the performance appraisal on the basis of measures in the control group. The urine routine was tested and bacterial was cultured at indwelling catheter 3 d, 7 d and 10 d, respectively. The indwelling catheter associated urinary tract infections of the two groups were compared. Results After the implementation of the performance appraisal management, the incidences of indwelling catheter associated urinary tract infection at 3 d, 7 d and 10 d were 4.8% (7/145), 19.3% (28/145) and 32.4% (47/145), respectively. Within each quarter, the incidence of indwelling catheter associated urinary tract infection was rising with indwelling catheter time prolonged. And the incidences of the first and second quarter were higher than three and four quarter. The incidences of indwelling catheter associated urinary tract infections at 3 d, 7 d and 10 d in the performance group were lower than the control group, the differences were statistically significant (χ2=4.494, 30.660 and 49.307, P < 0.05). Conclusions Standardized training of nursing staff in ICU and implementation of performance appraisal management could effectively improve the enthusiasm and sense of responsibility of the nurses, and effectively reduce the incidence of indwelling catheter associated urinary tract infection. Key words: Quality control management; Indwelling catheter; Urinary tract infection; Intensive care unit

Effect of target monitoring and intervention combination strategies on prevention of catheter-related blood stream infections in ICU patients

Objective To explore the effect of target monitoring and intervention combination strategies on prevention of catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) patients. Methods Target monitoring and intervention combination strategies were implemented in patients with central venous catheters in ICU since January 2015. 372 patients with central venous catheters in 2014 were selected as the control group, and 426 patients who received target monitoring and intervention combination strategy were taken as the intervention group. The incidence rates of CRBSI in two groups were compared. Results There were 5 cases of infection in the intervention group, and the incidence rate of infection was 1.17%; there were 13 cases of infection in the control group, and the incidence rate of infection was 3.49% (χ2=13.38, P<0.05). The incidence rate of CRBSI in the intervention group was 1.41‰, while it was 4.17‰ in the control group (χ2=8.94, P<0.05). Conclusions Target monitoring and intervention combination strategies can significantly reduce the incidence of CRBSI in patients with central venous catheters in ICU. Key words: Intensive care unit; Catheter-related blood stream infections; Target monitoring; Intervention combination

The effects of four different drugs administered through catheters on slime production in coagulase negative Staphylococci

Objectives: Higher rate of slime production has been found in pathogen bacteria strains. Accordingly, the factors that contribute to higher slime production rate increase the infection risk, while the factors that reduce the slime production rate will reduce the infection risk. The effect of some drugs that are administered through catheters in intensive care units on slime production with coagulase negative Staphylococci was investigated. Materials and methods: In this study, the effect of four different preparations containing Glyceryl trinitrate (Perlinganit®), Dexmedetomidine (Precedex®), Esmolol (Brevibloc®), and Propofol (Propofol®) on slime production of 24 Staphylococcus epidermidis strains isolated from blood cultures of patients, and reference strain were investigated. Slime production was determined using ‘the quantitative microdilution plaque test’ described by Christensen. Results: Under controlled medium, eight strains formed slimes, and in the media containing esmolol, glyceryl trinitrate, dexmedetomidine, and propofol slimes were positive for five, 21, 15, and 18 strains, respectively. The rate of slime pro duction in glyceryl trinitrate, dexmedetomidine, and propofol containing media were higher than that of the controls. Conclusions: In the light of the results of this study, it is concluded that the drugs and/or additives increase the rate of slime production. The effects of the preparations administered through catheters on slime production should be investigated, and these effects should be kept in mind during their use. J Microbiol Infect Dis 2012; 2(4): 150-154

The effects of four different drugs administered through catheters on slime production in coagulase negative Staphylococci

Objective: Higher rate of slime production has been found in pathogen bacteria strains. Accordingly, the factors that contribute to higher slime production rate increase the infection risk, while the factors that reduce the slime production rate will reduce the infection risk. The effect of some drugs that are administered through catheters in intensive care units on slime production with coagulase negative Staphylococci was investigated. Methods: In this study, the effect of four different preparations containing Glyceryl trinitrate (Perlinganit&reg;), Dexmedetomidine (Precedex&reg;), Esmolol (Brevibloc&reg;), and Propofol (Propofol&reg;) on slime production of 24 Staphylococcus epidermidis strains isolated from blood cultures of patients, and reference strain were investigated. Slime production was determined using &lsquo;the quantitative microdilution plaque test\' described by Christensen. Results: Under controlled medium, eight strains formed slimes, and in the media containing esmolol, glyceryl trinitrate, dexmedetomidine, and propofol slimes were positive for five, 21, 15, and 18 strains, respectively. The rate of slime production in glyceryl trinitrate, dexmedetomidine, and propofol containing media were higher than that of the controls. Conclusions: In the light of the results of this study, it is concluded that the drugs and/or additives increase the rate of slime production. The effects of the preparations administered through catheters on slime production should be investigated, and these effects should be kept in mind during their use.

Management of central venous catheters in intensive care units: Comparative study of guidelines versus practice.

Sir, An observational study was conducted on 100 nurses with minimum 6 months of experience in various intensive care units (trauma, swine flu, medical, and renal) of the hospital to assess their knowledge and clinical practice. A two-part questionnaire [Table 1] was filled by the nurses after every central venous catheter (CVC) insertion for a period of 2 months. Each correct response was scored 1; incorrect 0. Total number of catheter insertions was 148. Mean score for the study was 53%. Table 1 Questionnaire Results from Part A: Standardized equipment set, barrier precaution, filling of the checklist, and an assistant was available in 96%, 95%, 86%, and 98% of the insertions. Two-third were done on monitored beds with head low; only 1% on unmonitored beds. Povidone iodine, 70% alcohol, 2% chlorhexidine-based preparations were preferred in decreasing order for disinfection of skin (60%, 21%, and 19%, respectively). Eighty percent preferred sutures for catheter fixation and transparent bio-occlusive dressing. Results from Part B: Subclavian, internal jugular and femoral vein were preferred by 66.6%, 25%, and 9%. One-fifth were not aware of use of ultrasound. 98% managed unintended arterial puncture by removal of needle/catheter and application of pressure. 90% opined that chest X-ray confirmed placement of CVC. 96% preferred heparin based solution; 4% used normal saline. Two inspections of CVC/day were made by 50%; one/day were made by 40%. One-fifth wiped access ports with antiseptic before drug administration. Removal of infected CVC was considered by 60%; 25% believed in giving an antibiotic and observing. Three-fourth marked 4 h as maximum infusion time for blood products; 24 h for change of intravascular catheters/sets. Tubings for blood products and lipid emulsions were changed by 80% 12 hourly. Three-fourth believed in no fixed duration for changing CVC; one-fourth believed in the weekly change. Half believed in administration of antibiotics for central lines inserted in emergency. Only 25% considered a replacement of the catheter within 48 h. The remaining 25% considered replacement only on signs of infection. Routine prophylactic antibiotics was advocated by 36%. Results show that awareness on the use of chlorhexidine, ultrasound, correct management of arterial punctures and protocol for CVC inserted in emergency departments needs to be increased. Regular training programs with the nursing staff on bundles of care related to insertion and maintenance of CVC are needed.[1,2,3] American Society of Anesthesiologists guidelines[4] are focused on elective insertions of CVC's performed by anesthesiologists, but the Centers for Disease Control and Prevention guidelines[5] also address emergency placements, peripherally inserted central catheters, pulmonary artery catheter and tunneled central lines. Safety or efficacy of chlorhexidine in neonates and infants aged <2 months remains an unresolved issue. Fluid administration sets need to be changed at 96 h intervals and tubings for blood products and lipid emulsions every 24 h. Routine replacement of CVCs on the basis of fever alone and prophylactic administration of systemic antimicrobial agents is discouraged. Mandatory replacement is to be done within 48 h for all catheters inserted in an emergency without aseptic precautions.

Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients

To evaluate silver-impregnated (Oligon) central venous catheters and chlorhexidine-gluconate-impregnated sponges for reducing catheter-related colonization and infection, nonbacteremic or bacteremic. Multicenter, prospective, randomized, controlled study. Five general intensive care units in Greece. Intensive care unit patients requiring a multilumen central venous catheter between June 2006 and May 2008. Patients were randomly assigned to receive a standard catheter (standard group), a standard catheter plus chlorhexidine-gluconate-impregnated sponge (chlorhexidine-gluconate-impregnated sponge group), or an Oligon catheter (Oligon group). Catheter colonization was defined as a positive quantitative tip culture (≥10 colony-forming units/mL), catheter-related infection was defined by the previous criterion plus clinical evidence of sepsis, and bacteremia catheter-related infection as catheter-related infection plus a positive peripheral blood culture with the same micro-organism as in the catheter tip. Data were obtained from 465 patients, 156 in the standard-group, 150 in the chlorhexidine-gluconate-impregnated sponge group, and 159 in the Oligon-group. Colonization occurred in 24 (15.4%) standard catheters, 21 (14%) in the chlorhexidine-gluconate-impregnated sponge group, and 25 (15.7%) in the Oligon catheters (p = .35) (20.9, 19.9, 21.8/1000 catheter-days, respectively). Catheter-related infections were recorded in nine (5.8%) standard catheters, six (4%) in the chlorhexidine-gluconate-impregnated sponge group, and seven (4.4%) in the Oligon catheters (p = .58) (7.8/1,000, 5.7/1,000, 6.1/1,000 catheter-days, respectively). No difference was observed between the chlorhexidine- gluconate-impregnated sponge group and the standard group regarding catheter colonization (hazard ratio 1.21; 95% confidence interval 0.56-2.61; p = .64) and catheter-related infections (hazard ratio 0.65; 95% confidence interval 0.23-1.85; p = .42). The Oligon catheter did not reduce colonization or catheter-related infections when compared with the standard catheter (colonization: hazard ratio 1.0; 95% confidence interval 0.46-2.21; p = .98; catheter-related infection: hazard ratio 0.72; 95% confidence interval 0.27-1.95; p = .52). Seven patients (1.5%, 2.09/1,000 catheter-days) presented bacteremic catheter-related infections. Central venous catheters inserted either in the internal jugular or the femoral vein had greater risk to be colonized than catheters inserted in the subclavian vein (internal jugular vs. subclavian: hazard ratio 3.29; 95% confidence interval 1.26-8.61; p = .01; femoral vs. subclavian: hazard ratio 3.36; 95% confidence interval 1.17-9.65; p = .02). Acinetobacter baumannii was the predominant pathogen (37.1% episodes of colonization, 36.4% catheter-related infections, 57.1% bacteremic catheter-related infections). For short-term (median duration 7 days) central venous catheters in intensive care units with high prevalence of multiresistant Gram-negative bacteria, chlorhexidine-impregnated sponges and Oligon catheters as single preventive measures did not reduce catheter colonization or catheter-related infections. As a result of the limited amount of events, no conclusion could be reached regarding bacteremic catheter-related infections. The femoral site was the most frequently colonized insertion site in all types of catheters.

Risk factors and preventive measures for catheter-related bloodstream infections

To review the risk factors of central venous catheter-related bloodstream infection and the recommendations for its prevention. PubMed, Cochrane Collaboration and Bireme were reviewed using the following inclusion criteria: studies published between 2000 and 2010, study design, hospitalized pediatric population with central venous catheters and studies about central venous catheter-related bloodstream infection. In addition, reference documents were retrieved from the Centers for Disease Control and Prevention and the Brazilian Health Surveillance Agency. Associated risk factors were: duration of central venous catheter use; length of hospitalization time; long-term indwelling central venous catheter; insertion of central venous catheter in intensive care unit; nonoperative cardiovascular disease; parenteral nutrition; and administration of blood products. The preventive measures recommended by studies in the literature are: development of records and multidisciplinary guidelines of care for central venous catheter insertion and maintenance; correct use of central venous catheter insertion technique; use of chlorhexidine-impregnated dressings; early catheter removal; and adoption of continued education programs for the healthcare team. The control of risk factors may lead to a reduction of 40% or greater in the incidence of catheter-related bloodstream infection. Insertion surveillance and special attention to central venous catheter in pediatric populations should guide the standardization of healthcare routines to achieve standards for comparisons within and between institutions.

Use of educational intervention in reduction of the rate of bloodstream infection associated with the central venous catheter in intensive care unit of adults: integrative review

Integrative review with the aim to identify which the educational programs are more effective in reduction of rate in bloodstream infection associated to central venous catheter in intensive care unit of adults.

Hospital-wide survey of the use of central venous catheters

There are few data on indications for central venous catheter (CVC) use. We conducted an observational, hospital-wide prospective cohort study to quantify the indications for catheter placement over dwell time and to investigate agreement between healthcare workers (HCWs) on CVC use. Catheter use was observed by on-site visits, HCW interviews, and screening of patient charts. A total of 378 CVCs were inserted in 292 patients, accounting for 2704 catheter-days. Of these, 93% CVCs were multilumen catheters and 70% were placed in the intensive care unit (ICU). Median dwell time (interquartile range) was 5 (2-9) days overall, and 4 (2-7) and 8 (3-15) in the ICU and non-ICU settings, respectively. The mean number of specified indications for CVC use per day was 1.7 (1.9 for ICU and 1.5 for non-ICU; P<0.001). The most frequent reason (49%) for catheter use was prolonged (>7 days) antibiotic therapy followed by parenteral nutrition (22.3%). A total of 130 catheter-days (4.8%) were unnecessary with a higher proportion in non-ICU settings (6.6%). In 94% of cases, there was agreement among HCWs on indications for CVC use. However, 35 on-site visits (8.3%) in non-ICU settings revealed that neither the nurse nor the treating physician knew why the catheter was in place. ICU catheters have a short dwell time but are utilised more often, whereas catheters in non-ICU settings show a reverse characteristic. Prevention measures targeting catheter care are more likely to be successful in non-ICU settings.