Central Venous Catheter-related Infections Research Articles

#3055 Replacement of tunneled cuffed hemodialysis catheters on coated guidewire: a strategic approach to treat CVC-related infections

Abstract Background and Aims Infections of tunneled hemodialysis central venous catheters (CVCs) are a serious problem, and the outcome of dialysis patients strongly depends on their clinical management. Several specialists are involved in choosing the appropriate technical and clinical strategy but often there is no consensus among them on the proper management. We believe that the role of nephrologists must be pivotal in this setting throughout the entire process, from the choice of vascular access to the management of complications. Here, we present our experience using an approach to replace CVCs that was conceived to minimize the rate of infections. Method We propose a CVC replacement technique to minimize the risk of contamination by using a guidewire coating that allow no contact between the old and new CVC. We carried out a retrospective observational study of tunneled CVCs replacement with this technique performed at the Nephrology Unit of the "A. Gemelli Polyclinic" between January 2020 and June 2023. The following parameters were analyzed: age, sex, infection-supporting pathogen, CVC age, and dialysis age. Results During the reporting period, we carried out a total of 87 CVC guidewire replacement procedures for HD tunneled catheters defined “access to be preserved” using our technique. Among the patients (median age 70,6) undergoing this procedure, n=5 (5.75%) presented with endocarditis (n=4 by Staphylococcus aureus, n=1 by Pseudomonas aeruginosa). The follow-up ranged from 6 months to 3 years. During this time only one patient, with endocarditis, had a recurrent infection caused by Pseudomonas aeruginosa after 3 months from the CVC replacement whereas 12 patients presented a de novo CVC infection caused by a different pathogen (n=4 by Staphylococcus aureus, n=1 by Pseudomonas Aeruginosa. Conclusion Overall, our data are encouraging as the lower rate of recurrent infections in our cohort suggests that our CVC replacement technique can be potentially used even in case of dangerous pathogens.

Intravenous fosfomycin for treatment of severe infections caused by carbapenem-resistant Acinetobacter baumannii: a multicenter clinical experience

Backgroundsevere infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) have been increasingly reported over the past few years. Many in vivo and in vitro studies suggest a possible role of intravenous fosfomycin for the treatment of CRAB infections. Methodsthis multicenter, retrospective study included patients treated with intravenous fosfomycin for severe infections caused by CRAB admitted consecutively from December 2017 to December 2022 in four Hospitals in Italy. The primary goal of the study was to evaluate the risk factors associated with 30-day mortality in the study population. A propensity score matched analysis was added to the model. Resultsduring the study period, 102 patients with severe infection caused by CRAB treated with an intravenous fosfomycin-containing regimen were enrolled: ventilator-associated pneumonia (VAP) was diagnosed in 59% of patients, primary bacteremia in 22%, and CVC-related infection in 16%. All patients were treated with a regimen containing intravenous fosfomycin, mainly in combination with cefiderocol (n=54), colistin (n=48), and ampicillin/sulbactam (n=18). Forty-eight (47%) patients died within 30 days. Fifty-eight (57%) patients experienced a clinical therapeutic failure. Cox regression analysis showed that diabetes, primary bacteraemia, and a colistin-containing regimen were independently associated with 30-day mortality, whereas an adequate source control of infection, an early 24 h active in vitro therapy, and a cefiderocol-containing regimen were associated with survival. A colistin-based regimen, A. baumannii colonization and primary bacteremia were independently associated with clinical failure. Conversely, an adequate source control of infection, a cefiderocol-containing regimen, and an early 24 h active in vitro therapy were associated with clinical success. ConclusionsOur data showed different antibiotic regimens containing fosfomycin in combination treatment of severe infections caused by CRAB.

Clinical Adjudication of Hemodialysis Catheter-Related Bloodstream Infections: Findings from the REDUCCTION Trial.

Hemodialysis central venous catheter-related bloodstream infections (HD-CRBSI) are a significant source of morbidity and mortality among dialysis patients, but benchmarking remains difficult due to varying definitions of HD-CRBSI. This study explored the effect of clinical adjudication process on HD-CRBSI reporting. The REDUcing the burden of Catheter ComplicaTIOns: a National approach (REDUCCTION) trial implemented an evidence-based intervention bundle using a stepped-wedge design to reduce HD-CRBSI rates in 37 Australian kidney services. Six New Zealand services participated in an observational capacity. Adult patients with a new hemodialysis catheter between December 2016 and March 2020 were included. HD-CRBSI events reported were compared to the adjudicated outcomes using the endpoint definition and adjudication processes of the REDUCCTION trial. The concordance level was estimated using Gwet's agreement coefficient (AC1) adjusted for service-level effects and implementation tranches (Australia only), with the primary outcome being the concordance of confirmed HD-CRBSI. A total of 744 hemodialysis catheter-related infectious events were reported among 7,258 patients, 12,630 catheters and 1.3 million catheter-exposure days. The majority were confirmed HD-CRBSI, with 77.9% agreement and 'substantial' concordance (AC1=0.77, 95% confidence interval [CI]: 0.73, 0.81). Exit site infections have the highest concordance (AC1=0.85, 95% CI 0.78, 0.91); the greatest discordance was in events classified as Other (AC1=0.33, 95% CI 0.16, 0.49). The concordance of all hemodialysis catheter infectious events remained 'substantial' (AC1=0.80, 95% CI 0.76, 0.83) even after adjusting for the intervention tranches in Australia and overall service-level clustering. There was a substantial level of concordance in overall and service-level reporting of confirmed HD-CRBSI. A standardized endpoint definition of HD-CRBSI resulted in comparable hemodialysis catheter infection rates in Australian and New Zealand kidney services. Consistent endpoint definition could enable reliable benchmarking outside clinical trials without the need for independent clinical adjudication.

The accuracy of fully-automated algorithms for the surveillance of central venous catheter-related bloodstream infection in hospitalised patients.

Continuous surveillance for healthcare-associated infections such as central venous catheter-related bloodstream infections (CVC-BSI) is crucial for prevention. However, traditional surveillance methods are resource-intensive and prone to bias. This study aimed to develop and validate fully-automated surveillance algorithms for CVC-BSI. Two algorithms were developed using electronic health record data from 1000 admissions with a positive blood culture (BCx) at Karolinska University Hospital from 2017: (1) Combining microbiological findings in BCx and CVC cultures with BSI symptoms; (2) Only using microbiological findings. These algorithms were validated in 5170 potential CVC-BSI-episodes from all admissions in 2018-2019, and results extrapolated to all potential CVC-BSI-episodes within this period (n = 181,354). The reference standard was manual record review according to ECDC's definition of microbiologically confirmed CVC-BSI (CRI3-CVC). In the potential CVC-BSI-episodes, 51 fulfilled ECDC's definition and the algorithms identified 47 and 49 episodes as CVC-BSI, respectively. Both algorithms performed well in assessing CVC-BSI. Overall, algorithm 2 performed slightly better with in the total period a sensitivity of 0.880 (95%-CI 0.783-0.959), specificity of 1.000 (95%-CI 0.999-1.000), PPV of 0.918 (95%-CI 0.833-0.981) and NPV of 1.000 (95%-CI 0.999-1.000). Incidence according to the reference and algorithm 2 was 0.33 and 0.31 per 1000 in-patient hospital-days, respectively. Both fully-automated surveillance algorithms for CVC-BSI performed well and could effectively replace manual surveillance. The simpler algorithm, using only microbiology data, is suitable when BCx testing adheres to recommendations, otherwise the algorithm using symptom data might be required. Further validation in other settings is necessary to assess the algorithms' generalisability.

Central venous catheter-related bloodstream infections: Epidemiology and risk factors for hematogenous complications

BackgroundCentral catheter-related bloodstream infections (CRBIs) can lead to severe complications, including suppurative thrombophlebitis, endocarditis, and metastatic infections. While complications due to CRBIs caused by Staphylococcus aureus (SA) are well-known, there are limited data regarding CRBIs caused by other bacteria. MethodsThis 2-year retrospective single-center study of patients with CRBIs from a tertiary care hospital examined the hematogenous complications associated with CRBIs according to patient characteristics, central venous catheter (CVC) types, and causative bacteria. ResultsAll in all, 254 patients with confirmed CRBIs were included; 285 bacteria types were isolated, mainly Enterobacteriaceae (n = 94), coagulase-negative Staphylococci (CNS, n = 82), SA (n = 45), and non-fermenting Gram-negative bacteria (NGB, n = 45). Among the patients, 35 developed at least one hematogenous complication (14 %), including suppurative thrombophlebitis (n = 15), endocarditis (n = 7) and metastatic infections (n = 16). In multivariate analysis, hemodialysis, persistent bacteremia for at least 3 days, and CRBIs caused by SA were associated with increased risk for hematogenous complications, while previous curative anticoagulant treatment was associated with reduced risk. Diabetes, CVC maintenance, and hematogenous complications were associated with increased 3-month mortality. ConclusionA thorough investigation of hematogenous complications should be envisioned in patients with persistent bacteremia, particularly those with SA infections and those on hemodialysis.

Evidence-based nursing in the prevention of central venous catheter-related bloodstream infections.

Evidence-based nursing in the prevention of central venous catheter-related bloodstream infections.

A Case of Central Venous Catheter-Related Candida parapsilosis Fungemia Evolved to Disseminated Infection in a Neutropenic Patient with Blast Crisis of Chronic Myeloid Leukemia.

Central venous catheter-related infections are of particular importance in onco-hematological patients. Candida parapsilosis is generally reported as a mild pathogen, however it is able to effectively colonize intravascular devices and potentially give rise to sustained fungemias. Here we report a case of invasive, potentially lethal C. parapsilosis disseminated infection in a neutropenic patient affected by chronic myeloid leukemia with blast crisis. We underline the importance of removing the central venous catheter as potential source of infection as soon as possible during the course of candidemia, and not replacing it with other polyurethan intravascular devices, which pose a risk for the maintenance of the fungemia despite the administration of the best antifungal therapy available.

An analysis of central venous catheter-related bloodstream infections in patients treated in a Swedish Covid-19 intensive care unit.

Catheter-related bloodstream infection is a well-known, severe complication of central venous catheter insertion. Studies that have evaluated the coronavirus disease 2019 pandemic's influence on the incidence of catheter-related bloodstream infection in intensive care units are limited. Therefore, we conducted a retrospective study on catheter-related bloodstream infection in coronavirus disease 2019 intensive care unit with previously documented low incidence rates to evaluate the pandemic's impact. To evaluate the impact of the coronavirus disease 2019 pandemic on catheter-related bloodstream infection incidence in the intensive care unit. All central venous catheter-inserted patients aged ⩾18 years admitted to the intensive care unit with coronavirus disease 2019 pneumonia were included. The primary outcome was the incidence of catheter-related bloodstream infection, and the secondary outcome was the detection of catheter-related bloodstream infection-causative microorganisms. During the pandemic's first year, 124 patients were admitted, and 203 central venous catheters were inserted. Two patients developed catheter-related bloodstream infection. The incidence of catheter-related bloodstream infection was 0.79/1000 catheter days. The microorganisms responsible for catheter-related bloodstream infection were Staphylococcus epidermidis and Escherichia coli. This study revealed a low incidence of catheter-related bloodstream infection in the coronavirus disease 2019-intensive care unit, thus suggesting that coronavirus disease 2019 is not a risk factor for catheter-related bloodstream infection and indicating the high resilience of well-established routines aimed at catheter-related bloodstream infection prevention.

209. Validation of a New Risk Stratification System-Based Management for Methicillin-Resistant Staphylococcus aureus Bacteremia: Analysis of a Multicenter Prospective Study

Abstract Background Distinguishing between complicated and uncomplicated Staphylococcus aureus bacteremia (SAB) is therapeutically essential. However, this distinction has limitations in reflecting the various manifestation of SAB. In the light of this, Koujizer et al. proposed a new risk stratification system for metastatic infection in SAB, which involves a stepwise approach to diagnosis and treatment. We tested this risk stratification system in methicillin-resistant SAB (MRSAB) patients. Methods We retrospectively analyzed data of a 3-year multicenter, prospective cohort of hospitalized patients with MRSAB. We classified the patients into three risk groups: low, indeterminate, and high, based on the new system and compared between-group management and outcomes, as well as microbiologic features. Results The demographic and baseline characteristics of patients are shown in Table 1. The most frequent source of MRSAB was central venous catheter-related infection (25.5%), followed by unknown origin (15.3%) and pneumonia (11.1%). Echocardiography was performed in 248 cases (65.3%). Of 380 patients with MRSAB, 6.3% were classified as low-, 7.6% as indeterminate-, and 86.1% as high-risk for metastatic infection (Figure 1). No metastatic infection occurred in the low-, 6.9% in the indeterminate-, and 17.7% in the high-risk groups (P=0.03) (Figure 2A). After an in-depth diagnostic work-up, patients were finally diagnosed as ‘without metastatic infection (6.3%)’, ‘with metastatic infection (15.8%)’, and ‘uncertain metastatic infection (77.9%)’. 30-day mortality increased markedly as the severity of diagnosis shifted from ‘without metastatic infection’ to ‘uncertain’ and ‘with metastatic infection’ (P=0.07) (Figure 2B). In multivariable analysis, independent factors associated with metastatic complications were suspicion of endocarditis in transthoracic echocardiography, clinical signs of metastatic infection, Pitt bacteremia score ≥4, and persistent bacteremia. Figure 1. Flowchart of risk stratification and final diagnosis Figure 2. Outcomes of metastatic infection and 30-day mortality. A, metastatic infection according to the risk stratification, B, 30-day mortality according to the final diagnosis Conclusion The new risk stratification system provides good discrimination in predicting metastatic complications, making it a reliable tool for guiding work-up and management of MRSAB. However, minimizing the number of ‘uncertain metastatic infection’ cases remains an area for improvement. Disclosures All Authors: No reported disclosures

Validity of16 AHRQ Patient Safety Indicators to identify in-hospital complications: a medical record review across nine Swiss hospitals.

The validity of the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) has been established in the USA and Canada. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different health-care settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied. We performed a medical record review using administrative and electronic medical record data from nine Swiss hospitals. Seven independent reviewers evaluated 1245 cases at various hospitals using retrospective data from the years 2014-18. True positives, false positives, positive predictive values (PPVs), and reasons for misclassification were compared across all investigated PSIs, and the documentation quality of the PSIs was examined. PSIs 6 (iatrogenic pneumothorax), 10 (postoperative acute kidney injury), 11 (postoperative respiratory failure), 13 (postoperative sepsis), 14 (wound dehiscence), 17 (birth trauma), and 18 and 19 (obstetric trauma with or without instrument) showed high PPVs (range: 90-99%) and were not strongly influenced by missing POA information. In contrast, PSIs 3 (pressure ulcer), 5 (retained surgical item), 7 (central venous catheter-related bloodstream infection), 8 (fall with hip fracture), and 15 (accidental puncture/laceration) showed low PPVs (range: 18-49%). In the case of PSIs 3, 8, and 12 (perioperative embolism/thrombosis), the low PPVs were largely due to the lack of POA information. Additionally, it was found that the documentation of PSI 3 in discharge letters could be improved. We found large differences in validity across the 16 PSIs in Switzerland. These results can guide policymakers in Switzerland and comparable health-care systems in selecting and prioritizing suitablePSIs for quality initiatives. Furthermore, the national introduction of a POA flag would allow for the inclusion of additional PSIs in quality monitoring.

An Interactive E-learning Platform-Based Training to Improve Intensive Care Professionals' Knowledge Regarding Central Venous Catheter-Related Infections.

Introduction The presence of a central venous catheter (CVC) leads to a high risk for blood infections, which are associated with increases in morbidity, mortality, and costs. This study aims to assess intensive care unit (ICU) nurses' and physicians' knowledge regarding the Centers for Disease Control and Prevention (CDC) guidelines for preventing CVC-related infections before and after an interactive distance education delivered through the e-learning platform Teleprometheus. Materials and methods The study was conducted among 85 nurses and physicians in Nicosia's General Hospital Intensive Care Unit (NGH-ICU) and high dependency unit (HDU). A validated questionnaire was used to assess nurses' and physicians' knowledge. Results Prior to the online interactive distance education, the mean total knowledge score was x̄ = 4.8 (SD = 2.46), while after, the mean total knowledge score increased to x̄ = 8.9 (SD = 2.38) (p<0.001). ICU physicians had a higher mean total knowledge score (x̄ = 10.20) than ICU nurses (x̄ = 8.75) after the intervention. There was no correlation between years of experience in the ICU and the level of knowledge (r = 0.048). The interactive distance education was positively evaluated by the participants, through a questionnaire, specially designed for this study. Discussion The most important findings were that (a) the level of knowledge of the participants improved with a statistically significant difference after the completion of the e-course, (b) the level of knowledge of the participants, after the completion of the e-course, was much higher from other studies, (c) there was no correlation between the years of experience of ICU health professionals and their level of knowledge, and (d) the interactive distance e-course was positively evaluated and satisfied the participants. Conclusion The current study demonstrates that in high-intensity work environments, such as ICUs, adopting e-learning approaches seems morenecessary than ever.

Ethanol Lock for Prevention of CVC-Related Bloodstream Infection in Pediatric Patients: A Systematic Review and Meta-Analysis.

Ethanol lock therapy (ELT) can be used in patients with an indwelling central line to assist in the prevention of central venous catheter (CVC)-associated infections. However, its efficacy has not been consistently demonstrated in the pediatric population. The primary objective of this review and meta-analysis was to determine the efficacy and safety of ELT in prevention of central line-associated bloodstream infection (CLABSI) in the pediatric population. A search was conducted with the PubMed, CINAHL, PSCYInfo, Cochrane Library, and Academic Search Premier databases from inception through January 21, 2022. Studies were included if they reported incidence of CVC-related infections with ELT in pediatric patients. Meta-analyses used random-effects models according to the heterogeneity of all included studies. Of 736 studies, 25 met inclusion criteria for review and 10 for inclusion in the meta-analysis. Meta-analysis with pre- and post-ELT treatment showed that use of ELT significantly decreased mean CVC-related infections when compared with pre-treatment with no ELT with a mean difference of -5.79 (95% CI, -9.08 to -2.51; p < 0.001). The number of CVC infections also significantly decreased (OR, 0.42; 95% CI, 0.23-0.75; p = 0.004). Increased risk of thrombosis and increased frequency of catheter breakage, repair, and replacement were noted in several studies. Ethanol lock therapy is effective in preventing infection related to central venous catheter use in pediatric patients. Further study is warranted to determine the optimal protocol for, and incidence of, adverse events related to use of ELT.

Central venous catheter related bloodstream infections - evaluation of possible measures of prevention

Central venous catheter related bloodstream infections - evaluation of possible measures of prevention

Central Venous Catheter-related Bloodstream Infections Caused by Enterobacterales in Pediatric Oncology Patients: Catheter Salvage or Removal.

The aim was to determine whether salvage treatment with systemic antibiotics is a safe and effective strategy for Enterobacterales bloodstream infections (BSI) in pediatric oncology patients with a central venous catheter (CVC). A retrospective study was performed on oncology and stem cell recipient patients with a CVC and blood culture with Enterobacterales, at the Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands. Analyses were performed for all BSI and for episodes meeting central line-associated bloodstream infection (CLABSI) criteria. The cumulative incidence of an event (ie, removal, intensive care admission or death) was estimated after blood culture collection for episodes primarily treated with antibiotics. The effect of prognostic factors on the hazard of the event of interest was assessed by estimating a Cox proportional hazard regression model. In total, 95 CVC-related Enterobacterales BSIs in 82 patients were included; 12 (13%) BSIs required immediate CVC removal and for 83 (87%) BSIs CVC salvage was attempted. The cumulative incidence of events at 60 days was 53.0% [95% confidence interval (CI): 41.7-63.1] for BSIs (n = 83), and 64.4% (95% CI: 48.3-76.7) for CLABSIs (n = 45). The events occurred after a median of 6 (Q1-Q3: 2-15) and 6 (Q1-Q3: 2-20) days for BSIs and CLABSIs, respectively. Intensive care admission after salvage treatment was required in 16% of the BSIs and CLABSIs, resulting in death in 5% and 2% of cases, respectively. No significant association between risk factors and events was found. The cumulative incidence of an event at 60 days after salvage treatment for Enterobacterales CLABSIs and BSIs in pediatric oncology patients is high. Immediate CVC removal appears recommendable for this patient group.

Chlorhexidine gluconate-coated gel pad dressings for prevention of central venous catheter-related bloodstream infections in patients with hematologic diseases or autologous stem cell transplantation: A registry-based matched-pair analysis.

Chlorhexidine gluconate (CHG)-coated gel pad dressings for central venous catheter (CVC) may prevent CVC-related bloodstream infections (CRBSI). However, real-world data showing beneficial effects in patients with hematologic malignancies are scarce. In a matched-pair analysis with data from a multicenter CVC registry, non-tunneled jugular and subclavian vein CVC in adults with hematologic malignancies or germ cell tumors (including patients receiving autologous hematopoietic stem cell transplantation [ASCT]) with CHG were compared with non-CHG dressings. The primary endpoint was definite CRBSI rate within 14 days (dCRBSI14) of CVC insertion; secondary endpoints were combined rate of definite or probable CRBSI within 14 days (dpCRBSI14), overall (dpCRBSI), and CRBSI incidences of all estimates. In total, 2070 CVCs were assessed. There was no statistically significant difference in dCRBSI14 (2.3% vs. 3.5%) between patients with and without CHG gel dressings. Likewise, with regards to dpCRBSI14 (6.2% vs. 6.3%) and the overall dpCRBSI rate (9.2% vs. 10.5%), no significant difference was detected. Furthermore, dCRBSI14 incidence (2.0 vs. 3.2/1000 CVC days), dpCRBSI14 incidence (5.4 vs. 5.6/1000 CVC days), and overall CRBSI incidence (5.5 vs. 6.0/1000 CVC days) showed no significant differences. CRBSI rates were not reduced by the use of CHG gel dressings in patients with hematologic malignancies and/or ASCT.

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.

Impact of the insertion site of central venous catheters on central venous catheter-related bloodstream infections in patients with cancer: results from a large prospective registry.

Overall, insertion of central venous catheter (CVC) into femoral veins (FV) has been shown to be associated with a higher risk of infection compared with subclavian and internal jugular (IJV/SCV) CVC, but no data are available on the impact of the FV insertion site on the CVC-related bloodstream infections (CRBSI) risk in patients with cancer. The objective of the study is to compare CRBSI rates and incidences of FV with those of internal jugular and subclavian vein (IJV/SCV CVC) as observed in the prospective SECRECY registry. SECRECY is an ongoing observational, prospective, clinical CRBSI registry active in six departments of hematology/oncology in Germany. Each case of FV CVC was matched at a ratio of 1:1 to a case with IJV/SCV CVC. The propensity score was estimated using a multivariable logistic regression model adjusting for age, sex, cancer type, and duration of indwelling catheter. Of 4268 CVCs included in this analysis, 52 (1.2%) were inserted into the FV and 4216 (98.8%) into the IJV/SCV. 52 cases of FV CVC were matched with 52 IJV/SCV CVC. There was no significant difference in the CRBSI rate (3.8% vs. 9.6%), the CRBSI incidence (5.7 vs. 14.2/1000 CVC days), and the median CVC time (5.5 vs. 5days) between the FV and the IJV/SCV group. Based on this data, inserting FV CVCs in patients with cancer does, at least in the short-term, not appear to be associated with an increased risk of CRBSI as compared to IJV/SCV CVC.

Incision Precision of a Novel Wire-Guided Scalpel During Central Venous Catheter Placement: A Randomized Observational Trial

To determine whether the wire-guided scalpel (GuideBlade) improves incision precision, reduces the need to revise dermatotomy incision, improves the first-time success rate of a central venous catheter (CVC) placement, and decreases CVC-related complications. A randomized 2-arm observational trial. At University of California Irvine Medical Center. Patients (n=63) undergoing surgery requiring placement of a CVC as part of the standard of care recruited from August 1, 2021, to December 31, 2021. After randomization, either the GuideBlade (intervention) or the standard #11 scalpel (control) was used during CVC placement before surgery. The number of dermatotomy attempts was higher using the GuideBlade (1.6 ± 1.0) compared to the standard #11 scalpel (1.4 ± 0.6); however, the difference did not reach statistical significance (p=0.19). Similarly, the number of dilation attempts demonstrated no significant difference between the GuideBlade (1.2 ± 0.4) and the standard scalpel (1.1 ± 0.4; p=0.65). No CVC-related infections or complications were documented. No superiority was observed with using the GuideBlade compared to the standard scalpel during central line insertion by novice users. User unfamiliarity and inadequate training may have contributed to this finding, highlighting the importance of proper technique and user experience.

Study of the effectiveness of antimicrobial dressings with chlorhexidine bigluconate in the prevention of catheter-related blood-stream infections in pediatric intensive care units

Introduction. Nosocomial infections are risk factors associated with in-hospital mortality. Among other factors, these infections are strongly associated with invasive devices. In pediatric patients, a central venous catheter (CVC) is one of the most common causes of catheter-related bloodstream infection (CRBSI).&#x0D; Background. To investigate the effectiveness of antimicrobial chlorhexidine dressings compared with standard dressings in the prevention of central venous catheter-related bloodstream infections.&#x0D; Methods. 20 children who were treated in the intensive care unit were randomly divided into two groups of 10: a group that used chlorhexidine dressings and a group that used standard dressings (comparison group). Patient care was carried out in accordance with asepsis and antisepsis rule. The primary outcomes were a comparative study of microbiological researches of peripheral blood blood culture and catheter blood sample. But the final results were cultures from the tip of the catheter (at least 5 cm) after removal of the catheter in case of clinical symptoms of KAIK or in case of planned removal of the catheter due to the lack of its further need.&#x0D; Results. Catheter colonization occurred in 3 patients in the control group (3 %) and in 2 patients in the chlorhexidine dressing group (2 %). Catheter-related bloodstream infections occurred in 3 patients in the control group (3%), and in patients in the chlorhexidine group, no microorganisms were isolated by microbiological examination of the implantation sites (0 %). Although more patients in the comparison group had catheter-related bloodstream infections, the difference in infection rates between the two groups was insignificant (P = 0.07).&#x0D; Conclusions. The use of chlorhexidine-impregnated dressings reduced the incidence of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in the pediatric intensive care unit, but there was no significant difference compared with the use of standard dressings. This study needs further study in pediatric patients.

Which trial do we need? Scheduled central venous catheter removal vs. routine clinical care for prevention of central venous catheter-related bloodstream infections in patients with haematologic malignancies

Which trial do we need? Scheduled central venous catheter removal vs. routine clinical care for prevention of central venous catheter-related bloodstream infections in patients with haematologic malignancies