Central Venous Catheter Infection Research Articles

P1350A COMPARISON OF CENTRAL VENOUS CATHETER INFECTIONS FOR HEMODIALYSIS AND HEMATOLOGY PATIENTS

Abstract Background and Aims In addition to nephrologists who use central venous catheters (CVCs) as venous access for hemodialysis, it is also a routine practice for hematologists to benefit from them for their medical applications. There may be immediate or delayed complications of CVC placement and infections are accepted as delayed complications. We aimed to compare CVC-related infections in hematology and hemodialysis patients groups both of whose CVCs were placed by interventional nephrologists. Group specific infectious agents as well as infection risk factors were analyzed in order to develop guides and practices to decrease infection rates for the future. Method The number of patients who were placed a CVC in bone marrow transplantation (BMT) unit was 69 (37 males, 32 females) in the year of 2019. These patients were 47,5 ± 14,3 years old. Their CVC infection numbers and rates as well as infection agents were analyzed. This group was compared with hemodialysis patients that have non-cuffed hemodialysis catheters and who were age and sex matched with the BMT group. Infection rates for 1000 catheter days were calculated separately for both groups. Catheter infections were defined as hemoculture positivity of samples obtained from catheter lumens and/or identification of any microorganism in the catheter tip. Cases were followed up from insertion day of the catheters until when infection was identified or until the day of catheter removal. Results Catheters remained in a central vein for a median of 25 days in hemodialysis group [range: 10-51 days] while these duration was 16 days [range:8-29 days] for BMT group. The number of cases in whom a catheter related infection was identified was 17 for BMT (24%) and nine (13%) for hemodialysis group. Infection rate was 23 for 1000 catheter days in BMT group while it was 11 for 1000 catheter days in hemodialysis patients. BMT patients have a wider range of infection agents; 78% of them being gram positives and 19% of them being gram negatives. It was noteworthy that all of the catheter related infections in hemdialysis patients were related to gram positive bacteria. Rate of infections due to extended spectrum beta lactamase (ESBL) secreting E.coli or Klebsiella was 24% and infection risk of ESBL secreting agents was directly proportional to the time spent with the catheter. Infection findings in the catheter exit site (e.g. erythema, crusts or effusions) was found as statistically significant risk factors for bloodstream infections in BMT patients while these factors were not statistically significant for hemodialysis patients. Conclusion Gram positive infections make up the majority of CVC-related infections both for hematology and hemodialysis patients. Infection risks due to resistant species is proportional to the time spent with catheters. Catheter exit site findings should be cautionary for probable bloodstream infections especially for immunosuppressed patients.

The Insertion Site Should Be Considered for the Empirical Therapy of Short-Term Central Venous and Arterial Catheter-Related Infections.

Little is known on causative pathogens of intravascular catheters infection according to the catheter insertion site. The present study aimed to describe the epidemiology of causative microorganisms of catheter-related infection and colonization according to the insertion site. Multicenter observational study using data from four large randomized controlled trials investigating different prevention strategies in which extensive prospective high-quality data collection at catheter insertion and catheter removal was performed. Twenty-five ICUs in France. Patients were recruited from 2006 to 2014 as soon as they required a catheterization with a short-term central venous catheter or peripheral arterial catheter with an expected duration of use of more than 48 hours. We described the distribution of microorganisms in central venous catheter and arterial catheter-related bloodstream infections and colonization according to the insertion type (femoral vs nonfemoral) included in the four studies. None. A total of 7,235 patients and 15,259 catheters were included. Among central venous catheter, the distribution of microorganisms associated with catheter-related bloodstream infection and colonization was significantly different between femoral and nonfemoral sites. Among central venous catheter catheter-related bloodstream infection, nonfermenting Gram-negative bacilli were more frequently detected at the femoral site (31% vs 4% for nonfemoral site; p < 0.01). After adjustment for confounding factors, the femoral site was still associated with an increased risk for catheter-related bloodstream infection due to nonfermenting Gram-negative bacilli (odds ratio, 6.33; 95% CI, 1.59-25.28; p < 0.01). Among colonized arterial catheters, the distribution of microorganisms was significantly different between femoral and radial site (p < 0.01). Colonized arterial catheters due to nonfermenting Gram-negative bacilli were more frequently observed at the femoral site (20% vs nonfemoral site 12%; p = 0.01). The proportion of intravascular catheter infections due to nonfermenting Gram-negative bacilli was high for the femoral insertion site. Empirical antipseudomonal therapy should be considered if a femoral catheter-related bloodstream infection is suspected.

Central venous catheter infection in Canadian home parenteral nutrition patients: a 5-year multicenter retrospective study.

A lower central venous catheter (CVC) infection rate suggests an improvement in practice and education. CVC infection remains a complication that often requires significant health care resources. Use of tunneled CVC and patient education on catheter care reduces CVC infection rates. CVC infection is one of the most frequent, life-threatening complications in home parenteral nutrition (HPN) patients. Our objective was to conduct a 5-year retrospective chart review regarding CVC infections in 3 adult HPN programs. Data were collected from the Canadian HPN Registry and patient charts that include demography, infection diagnosis, blood cultures, and treatments. Results are reported as median (range) ± standard error of mean or population frequency. Eighty-one charts were reviewed. Mean age was 51.98 ± 1.71 years. Short bowel syndrome (54.3%) was the primary diagnosis, with 36 months (range, 1324 months) median length of HPN therapy. Forty-seven subjects (58%) had infections over a 5-year period. Of these, there were 144 sepsis events. There was positive correlation (r=0.423; P<0.001) between number of infections and HPN duration. The median length of time the CVC was in place was 281 (range, 14-4380) days. There were 66.7% tunneled CVCs; 25.9% peripherally inserted central catheters (PICCs), and 7.4% implanted venous port. In this sample, there was no association between line infection and catheter type. Most patients presented with fever (58.3%) and chills (38.2%). Blood cultures were done (89.6%), and coagulase negative Staphylococcus was the resulting pathogen present in 25.7%. Patients with bloodstream infection were treated for 17.9 ± 1.2 days with combination antibiotics (22.2%). Overall, the CVC infection rate was 0.97 per 1000 catheter days. We found the standard approach to infection prevention is comparable to reports in literature. However, a subset of patients with multiple CVC infections require education with an emphasis on preventive techniques in order to reduce the incidence of infection.

CE Article: Central Venous Catheter Infection in Canadian Home Parenteral Nutrition Patients: A 5-Year Multicenter Retrospective Study

Highlights A lower CVC infection rate suggests an improvement in practice and education. CVC infection remains a complication that often requires significant health care resources. Use of tunneled CVC and patient education on catheter care reduces CVC infection rates.

SAT-215 INCIDENCE AND RISK FACTORS OF NON TUNNELED HEMODIALYSIS CATHETER INFECTIONS: A FOLLOW UP STUDY IN TWO HEMODIALYSIS CENTERS IN CAMEROON

Non-tunneled central venous catheter (NTCVC) are useful for urgent initiation of acute and chronic dialysis. However they are associated with a high risk of infection limiting the duration of their use to less than 3 weeks for jugular and one week for femoral catheters. Nevertheless, in many sub-Saharan African countries, NTCVC are used for longer periods even for chronic dialysis due to limited access to tunneled catheters and vascular surgery for arteriovenous fistulas. We sought to identify risk factors for NTCVC infections in patients on hemodialysis We prospectively followed up for 6 weeks, all consenting incident and prevalent patients using NTCVC for hemodialysis through a NTCVC in the two public hemodialysis units in Yaounde. We excluded prevalent catheters with a history of infection. The study variables of interest were: the profile of physician inserting central venous catheter(CVC), respect of asepsis during CVC manipulation by health personnel, frequency of catheter repositioning during dialysis, patient hygiene of catheter exit site, and occurrence of non-catheter-related bacterial infection. The outcome of interest was the occurrence of CVC infection defined as a body temperature >37.5˚C or <36.˚C in the presence of a purulent discharge at the catheter exit site with or without a positive catheter/blood culture. The study was approved by the ethics board of the hospitals. We followed up a total of 131 NTCVC in 131(65.6% male) participants. Most catheters(n=129; 98.5%) were placed by nephrology fellows, and the remainder by nephrologists. Reasons for catheter insertion were: urgent start of chronic dialysis for ESKD (n=67; 51.1%), AKI (n=41; 31.3%), and failed AV fistula (n=23; 17.6%). In all, there were (n=97;74%) incident and (n=34;26%) prevalent catheters. The sites of catheter insertion were: right internal jugular, (n=77;58.8% ), right femoral, (n=52;39.7% ), and left femoral,(n= 21.5%). The median [IQR] follow-up duration of the NTCVC was 36.0 [11.0-42.0] days and was significantly longer for prevalent catheters (42.0 [16-42] versus 29[11-42]; p=0.02). The median [IQR] follow-up duration of was 12.5 [8.0-40.0] days for femoral, and 42 [21.0-42.0] for jugular catheters. The overall incidence of catheter infection was 6.9 cases per 1000 catheter days. The incidence was significantly higher for femoral compared to jugular catheters (11.5 versus 4.8 per 1000 catheter days; p=0.02), and non-significantly higher for incident compared to prevalent catheters (7.4 versus 5.4 cases per 1000 catheter days; p=0.48). Poor patient hygiene of exit site (RR=21.4, [5.7 – 80.3] p= 0.00) and occurrence of non-catheter related bacterial infection (RR=4.9, [1.1 – 20.9] p=0.03) were independent risk factors of non-tunneled catheter infection. Our results suggest a need for improved patient education on care of the catheter exit site area, and limiting the use of the femoral site. The catheter infection risk associated with the presence of non-catheter bacterial infections requires further studies. There is an urgent need to reduce the duration of use of these catheters through patient education and cost containment of tunneled catheters and fistula surgery.

A Randomized, Double-Blind, Placebo-Controlled Trial (TAURCAT Study) of Citrate Lock Solution for Prevention of Endoluminal Central Venous Catheter Infection in Neutropenic Hematological Patients.

Infection of long-term central venous catheters (CVCs) remains a challenge in the clinical management of cancer patients. We aimed to determine whether a lock solution with taurolidine-citrate-heparin would be more effective than placebo for preventing nontunneled CVC infection in high-risk neutropenic hematologic patients. We performed a prospective, multicenter, randomized (1:1), double-blind, parallel, superiority, placebo-controlled trial involving 150 hematological patients with neutropenia carrying nontunneled CVCs who were assigned to receive CVC lock solution with taurolidine-citrate-heparin or heparin alone. The primary endpoint was bacterial colonization of the CVC hubs. Secondary endpoints were the incidence of catheter-related bloodstream infection (CRBSI), CVC removal, adverse events related to the lock solution, and the 30-day case fatality rate. CVC lock solution with taurolidine-citrate-heparin was associated with less colonization of the CVC hubs than that with placebo, with no statistically significant differences: 4.1%, versus 10.1% (relative risk [RR] = 0.41, 95% confidence interval [CI] = 0.11 to 1.52), with a cumulative incidence of 4.17 (95% CI = 0.87 to 11.70) and 10.14 (95% CI = 4.18 to 19.79), respectively. There were no significant differences regarding the secondary endpoints. Only three episodes of CRBSI occurred during the study period. No adverse events related to the administration of the lock solution occurred. In this trial involving high-risk patients carrying nontunneled CVCs, the use of taurolidine-citrate-heparin did not show a benefit over the use of placebo. Nevertheless, the safety of this prevention strategy and the trend toward less hub colonization in the taurolidine-citrate-heparin group raise the interest in assessing its efficacy in centers with higher rates of CRBSI. (This study has been registered in ISRCTN under identifier ISRCTN47102251.).

Bacterial colonization of non-permanent central venous catheters in hemodialysis dogs

Non-permanent central venous catheters (CVCs), are the most commonly used vascular access in veterinary patients undergoing hemodialysis. In human dialysis patients, CVC infection represents a common cause of morbidity and mortality. The aim of this retrospective observational study was to evaluate the prevalence of bacterial colonization of CVCs in dogs submitted to hemodialysis treatment at time of CVC removal.The CVCs of all dogs submitted to hemodialysis (n = 23) at the Veterinary Teaching Hospital ''Mario Modenato'' of the University of Pisa between January 2015 and December 2016 were considered. For all dogs, data regarding signalment, reason for hemodialysis treatment, duration of catheterization (≤15 or >15 days), CVC complications, and 30-day survival were considered. Statistical analysis was performed using Graph Pad Prism™. Five over 23 dogs (22%) showed positive bacterial culture of CVC (+), and 18/23 dogs (78%) negative culture of CVC (-). The most prevalent microorganism was Staphylococcus Spp (3/5; 60%). No significant difference was found in the prevalence of CVC infection according to age, gender, reason for hemodialysis, CVC complications, duration of catheterization, and outcome. No statistically significant difference (p = 0.64) in survival curves was reported at log rank analysis between dogs with CVC - and CVC +.The prevalence of bacterial CVC contamination in our dialysis dogs showed relatively low. Exclusive use of CVC for hemodialysis, good hygiene practice during CVC management, and use of chlorhexidine as an antiseptic should be strongly encouraged.

Bacteriological study of indwelling central venous catheter among patients in ICU

Aim: The aim is to study the bacteriological profile of indwelling central venous catheter (CVC) among patients in intensive care unit (ICU). Settings and Design: The study was conducted on admitted patients with indwelling CVC in medical ICU, surgical ICU, and critical care unit of Krishna hospital, Karad. The study design was a prospective observational study. Materials and Methods: Two hundreded patients admitted with an indwelling, CVC. These patients were followed daily for the development of catheter related blood stream infections (CRBSIs) 48 h after insertion of CVC, in which case two sets of blood samples were drawn along with catheter tip and skin swab for culture. Statistical Methods: Incidence of CRBSIs was measured per 1000 catheter days. Results: Among 200 suspected cases with indwelling CVC, 1028 catheter days were observed, and CRBSI rate was 61.28/1000 catheter days. The incidence of CRBSIs were detected in 63 (31.5%) patients. Conclusions: This prospective study has highlighted the incidence, aerobic bacteriological profile of CVC infections, and also the changing trends in the susceptibility pattern of the isolates to routinely used antibiotics in our tertiary care centre. Combined efforts of the microbiologist, clinicians, and hospital infection control team are needed to tackle CRBSI. A proper training program of hospital staffs, maintenance of proper hand hygiene, following up of proper guidelines of catheter insertion, and maintaining aseptic precaution, prior to CVC insertion can reduce CRBSI.

579. Machine-Learning Based Models for Prediction of Recurrence-free Catheter Retention After ALT Treatment of CLABSI in a Pediatric Population

BackgroundDeciding whether to attempt salvage of an infected central venous catheter (CVC) can be challenging. While line removal is the definitive treatment for central-line associated bloodstream infection (CLABSI), salvage may be attempted with systemic antibiotics and antibiotic lock therapy (ALT). Weighing risk and benefit of CVC salvage is limited by uncertainty in the future viability of salvaged CVCs. If a CVC is likely to require subsequent removal (e.g., due to recurrent infection) salvage may not be beneficial, whereas discarding a viable CVC is also not desirable. Here we describe a machine learning approach to predicting outcomes in CVC salvage.MethodsEpisodes of pediatric CLABSI cleared with ALT were identified by retrospective record review between January 1, 2008 and December 31, 2018 and were defined by a single positive central blood culture of a known pathogen or two matching cultures of a possible contaminant. Clearance was defined as 48-hours of negative cultures and relapse was defined as a matching positive blood culture after clearance. Predictive models [logistic regression (LR), random forest (RF), support vector machine (SVM) and an ensemble combining the three] were used to predict recurrence-free CVC retention (RFCR) at various time points using a training and test set approach.ResultsOverall, 712 instances CLABSI cleared with ALT were identified. Demographic and microbiological data are summarized in Tables 1 and 2. Few (8%) instances recurred in the first 28 days. 58% recurred at any time within the study period. Rates of RFCR were 75%, 43%, 22% and 10% at 28, 91, 182 and 365 days. Machine learning (ML) models varied in their ability to predict RFCR (Table 3). RF models performed best overall, although no model performed well at 91 days.ConclusionML models provide an opportunity to augment clinical decision making by learning patterns from data. In this case, estimating the likelihood of useful line retention in the future could help guide informed decisions on salvage vs. removal of infected CVCs. Limitations include the heterogeneity of clinical data and the use of an outcome capturing both clinical decision making (line removal) and infection recurrence. With further model development and prospective validation, practical machine learning models may prove useful to clinicians. Disclosures All authors: No reported disclosures.

Factors Associated with Infection of Central Venous Catheters Placed on Admission in the Emergency Area

TCentral venous catheters (CVC) are devices that allow access to the bloodstream at the central level for medication administration, fluid therapy, total parenteral nutrition, hemodynamic monitoring or hemodialysis.

Evidence-based Practices in the Prevention of Central Venous Catheter Infections: Knowledge of Intensive Care Nurses

Evidence-based Practices in the Prevention of Central Venous Catheter Infections: Knowledge of Intensive Care Nurses

UMA ANÁLISE DA EDUCAÇÃO EM SAÚDE NA REDUÇÃO DOS INDICADORES DE INFECÇÃO PRIMÁRIA RELACIONADA A CATETER VENOSO CENTRAL

As infecções hospitalares constituem grave problema de saúde pública. O objetivo deste estudo foi verificar de que forma a Educação Permanente em Saúde pode contribuir para a diminuição dos indicadores de infecção primária relacionada ao cateter venoso central em um hospital público e universitário da cidade de Porto Alegre, Rio Grande do Sul. Foram empregados dados referentes aos indicadores de infecção primária relacionada ao cateter venoso central e à s ações de educação com o mesmo tema, de informações dos Relatórios de Indicadores de Infecção Hospitalar, dos Relatórios de Gestão e Administração e das Querys (banco de dados) de capacitação, relativas aos anos de 2014 a 2017. Os resultados mostram que o indicador de infecção apresentou redução de 4,21 para 3,0 infecções por 1000 procedimentos-dia nos referidos anos. As ações educativas relacionadas ao tema do cateter venoso central aumentaram no período, elevando o número de participantes e participações nas atividades (quatro vezes mais) em 2017. Houve também um público alvo mais abrangente, onde a enfermagem representou 38% dos profissionais capacitados, seguida pelos médicos (31%) e técnicos em enfermagem (25%). As capacitações realizadas, juntamente com as outras ações, auxiliaram na redução dos indicadores de infecção por cateter venoso central.

Intestinal failure-associated liver disease in adult patients.

The aim of this review is to give up-to-date information on intestinal failure-associated liver disease (IFALD) and how its investigation and management has evolved. Despite advances in treatment for patients with intestinal failure, IFALD remains a significant cause of mortality. Liver biopsy remains as the gold standard for the diagnosis of IFALD, but its invasive nature has prompted assessment of noninvasive techniques. Risk factors for IFALD are both nonnutritional (e.g. sepsis) and nutritional. Strict protocols for the prevention of central venous catheter infections in patients with intestinal failure are well established, as is the optimization of the constituents of parenteral nutrition. Further research comparing the available lipid emulsions has become available. Novel approaches at maximizing intestinal absorption are discussed including glucagon-like peptide-2 analogues, as well as surgical approaches. Although there are data on the novel investigative and therapeutic strategies for managing IFALD, further study is required to identify a suitable noninvasive technique for earlier diagnosis and then monitoring of IFALD. Further data are also required on the impact of novel therapies aimed at improving absorption and reducing parenteral nutrition load on IFALD occurrence and progression.

SUN-PO260: Central Venous Catheters Infections Related to Parenteral Nutrition Provision

SUN-PO260: Central Venous Catheters Infections Related to Parenteral Nutrition Provision

P4.14: Financial burden of critically-ill patients receiving parenteral nutrition (PN) in a reference intensive care unit (ICU) in Istanbul: An additional cost from Syrian refugees

Introduction: The number of critically-ill patients has increased over the years due to progress in intensive care medicine and parenteral nutrition (PN) techniques. Long-term survival is possible and does not depend only primarily on the disease etiology (head trauma and pulmonary complications etc.) but on accompanying morbidities and complications such as central venous catheter infections. Prolonged ICU admissions are costly as well. Therefore, covering the cost of these critical patients (primary disease treatment including interventional and surgical issues, all consultations and treatment protocols) is an important issue, and having health insurance coverage for their treatment and all of the needed follow-up care (including almost 4 millions Syrian refugees, as well) is critical. Methods: A computer-based analysis was done retrospectively to search the covering health insurance programmes of our patients treated in our adult ICUs during January to December 2018. Syrian refuees were also included in the study, as state insurance coverage was supplied to all. Other then known government-issued general health insurance, private health insurance options and the payments done by the patients’ own resources were also interrogated. Results: A total of 186 patients were included in the study. Mean age was 51 years (range, 18–91). The average period of ICU stay was 45 days (range, 1–204), including longer hospitalization time due to surgical complications or existing comorbidities. The postoperative stay in intensive care unit (ICU) was also included in this period. In our data, the only health insurance coverage was seen to be supplied by the state (n=186, 100 %). There was no private insurance coverage. No patients used their own financial resources for treatment, as well (including Syrian refugees). Conclusion: It is well-known that state insurance in Turkey covers all policlinic applications and postdischarge home care (including all refugees), and patients pay only a small amount of fee as employee contribution for the medications at pharmacies. The new information in the present study is the governmental coverage of all Syrian refugees in ICUs, as well. Taking the great amount of bill that an ICU patient should encounter, the importance of state insurance is obvious for the comfort of patient and the ease of financial portion of their treatment.

SUN-057 Reducing Central Venous Catheter Burden in Haemodialysis Patients: The Impact of Changing Practice within an Australian Renal Unit

Despite varying worldwide practice, renal guidelines suggest minimisation of central venous catheter (CVC) use for dialysis access in haemodialysis (HD) patients as CVCs may lead to increases in morbidity and mortality. Few prospective studies have described the impact of renal unit initiatives aimed at reducing catheter burden and their potential effect on patient survival. We present data from a 10 year observational cohort study in an adult tertiary renal unit in Sydney, Australia. Initiatives introduced included; regular review of data regarding CVC infection rates and CVC exposure within the unit, appointment of a vascular access nurse specialist and regular multi-disciplinary team meetings between renal physicians, vascular surgeons and dialysis co-ordinators. Eligible patients over 18 years of age who required HD and did not have a functioning dialysis access, thereby requiring a CVC, were included. Patients were classified by treating physician into one of 4 groups based upon reason for CVC insertion. Patients believed to have acute kidney injury (AKI) and expected to recover to dialysis independence were classified as AKI; patients starting maintenance dialysis without a permanent access in place were classified as end stage kidney disease (ESKD); patients with failure of an existing HD access were classified as HD failure and patients transferring from peritoneal dialysis (PD) without an HD access were classified as PD failure. Prospective data were collected over 10 years on all patients and CVCs and linked to administrative health and registry data. Descriptive and survival analyses were performed and have been censored for transplantation. The study cohort included 557 patients and 1067 CVCs. The median patient age was 71.7 years [59.3-78.6]. The reasons for initial CVC insertion were; AKI (246 patients, 44% of total), ESKD (182, 33%), HD failure (84, 15%) and PD failure (45, 8%). Despite this, the majority of CVCs were required for HD failure (368, 35%), followed by AKI (338, 32%), ESKD (272, 25%) and PD failure (89, 8%). Over the data collection period the reasons for initial CVC placement changed. From 2005 to 2015 the proportion of patients requiring an initial CVC due to ESKD fell from 23% to 18%, whereas the proportion resulting from AKI rose from 27% to 59%. Total CVC days increased across the study period from 4859 days in 2005 to 5445 days in 2015, however days attributed to ESKD, HD failure and PD failure fell (1554 to 1200, 2330 to 2026, 595 to 542 respectively) (Figure 1). Use of tunnelled CVCs rose from 61% to 80%. Rates of CVC infection, classified as either a confirmed bacteraemia or the removal of a CVC due to suspicion of infection, fell from 5.76/1000 catheter days to 0.37/1000 catheter days. This prospective study describes how simple initiatives introduced in an Australian renal unit may reduce CVC burden and mitigate CVC associated infection rates.

Clinical outcome in low socioeconomic patients with severe acute pancreatitis treated either with early nasogastric tube or total parenteral nutrition: a randomized controlled trial

Background: Early nasogastric feeding has shown beneficial effect in the low socioeconomic group of patient with severe acute pancreatitis (SAP). The current randomized controlled study was performed to assess the effect of early nasogastric feeding as compared to total parenteral nutrition (TPN).Methods: Fifty patients admitted with diagnosis of SAP were randomly allocated to receive nnteral feeding (EF) (at the rate of 25 ml/hour and was gradually increased up to 100 ml/hr) or TPN within 24 hours of hospital admission. The nutritional regimen was aimed to be iso-caloric between the two groups. Patient’s demographics, hospital stay, nutrition, total cost, complication, and mortality were observed for 1 month in follow up.Results: All fifty patients were completed the study. Patient demographics were similar in both groups. 38/50 belonged to low socioeconomic status in the study group (Twenty in EF and eighteen in TPN group). The complications were significantly lower in EF group (pancreatic infection (11 vs. 4, p=0.037), central venous catheter infection (EF=0 vs. TPN=8, p=0.002), multiorgan failure (EF=5, TPN=12, p=0.037). Early recovery in EF group was significant with the mean duration of hospital stay of 6.76 days as compared to 10.4 days in the TPN group. The mean expenditure in the EF group was 1268 as compared to 13688 Indian rupees in the TPN group.Conclusions: This study shows that early EF improves early recovery, lower complications and cost effective measure in SAP especially in low socioeconomic group of patients.

Infection of Small-Bore Tunneled Central Venous Catheters

OBJECTIVE. The purpose of this study is to evaluate the association of common clinical variables with small-bore tunneled central venous catheter (CVC) infection. MATERIALS AND METHODS. Retrospective data were collected from all small-bore (6-French) tunneled CVCs placed by the interventional radiology service between 2012 and 2015. Only patients who had a documented reason for tunneled CVC removal were included in the analysis to capture all events. Transfemoral, transhepatic, and translumbar placements were excluded to reduce cohort heterogeneity. Multiple clinical variables were collected from a review of the medical record. The t test and Fisher exact test were used for two-group comparisons for continuous variables and categoric variables, respectively. Logistic regression analyses were further used to identify variables that were associated with catheter infection. RESULTS. One hundred eighty-two patients (105 women [57.7%] and 77 men [42.3%]) with a mean (± SD) age of 49.7 ± 16 years were included. Thirty-two catheters (17.6%) were removed because of infection. Noninfected lines were removed at a mean of 39 (SD, 57.3) days, whereas infected lines were removed at a mean of 95.9 (SD, 113.4) days after placement (p < 0.001). There was a statistically significant difference in the number of tunneled CVCs removed for infection when the indication for tunneled CVC placement was the administration of IV antibiotics (p = 0.04). By multivariate analysis, only time to removal (p = 0.002; odds ratio, 0.992; 95% CI, 0.986-0.998) and a history of tunneled CVC (p = 0.01; odds ratio, 0.306; 95% CI, 0.121-0.772) were associated with catheter removal for infection. CONCLUSION. Time to catheter removal and history of tunneled CVC were associated with an increased risk of tunneled CVC removal because of infection.

Assessment of Nurses knowledge concerning Prevention of Central Venous Catheter Infection in Intensive Care Units at Baghdad Teaching Hospitals

Background: Nurses knowledge concerning the Prevention of Central Venous Catheter Infection in intensive care units in hospitals is one of the main issues that nurses should know is to reduce or prevent patients' complications. Aims of study: Assess the Nurses knowledge concerning the Prevention of Central Venous Catheter Infection, to find out the relationship between the nurses knowledge with their demographic and occupational characteristics. Methodology: To achieving this objectives a questionnaire was developed according to review of literature and consist of two parts, the first part deal with demographic and occupational characteristic of intensive care unit nurses, while the second part include questions for knowledge test regarding prevention of central venous catheter infection, Sample consist of (50) nurses who work in intensive care unit in: Ghazi Alhareri Teaching Hospital, Ibn Al-Bitar Teaching Hospital, Ibn Al-Nafis Teaching Hospital, Baghdad Teaching Hospital, Alkarama Teaching Hospital, AL-Kindy Teaching Hospital.The validity of the questionnaire was achieved through (13) of experts,(10) who working in Nursing college University of Baghdad and also(3)expert who work in Baghdad Teaching Hospital and Ibn Al-Bitar Teaching Hospital, The data collection instrument of choice was structure interview, the study starting from 15 December 2014 to 22 May 2015, collected data were analyzed with the assistance of a statistician using descriptive and inferential statistic. Result: Show that the study of the research in regard to nurses age (52%) of them were in age group (20-29) years, and more than one half (58%) of them were female, (54%) were nursing college graduate with no training session in especially in intensive care unit, also reveals that the nurses' knowledge in fair level (54%). Conclusion: This study concludes that the most of the nurses had a fair level of knowledge.

Application of infrared thermography in diagnosing peripherally inserted central venous catheter infections in children with cancer

Approach: Children affected by oncological diseases are often fitted with central venous catheters (CVCs). Catheter infection is a frequent complication, sometimes accompanied by thrombosis. A case/control-type pilot study of children with oncological diseases fitted with a CVC is here designed. Objective: The objective of this preliminary study is to use infrared thermography to discern whether there is an infection in patients with a CVC and, if so, to undertake a close follow-up of its evolution, after administering a therapy. Thermal asymmetry by mean and maximum temperatures (temperature affected ROI − temperature contralateral ROI) is measured. Main results: In all cases with catheter infection, thermal asymmetry values were higher than in controls without infection, allowing us to assess improvement after starting the treatment. Significance: These preliminary results are satisfactory because they reflect the advantages of using infrared thermography on oncological child patients, as it is a harmless, non-contact, accessible and quick technique, allowing us to reduce the use of ionizing radiation and quantify the clinical signs of inflammation, which are otherwise only qualitatively detectable in clinical examination. By doing so, it may be possible to anticipate infection and provide early treatment, and, moreover, to observe whether there is any complication after starting a treatment. More studies need to be undertaken with an extensive paediatric population to establish reference values.