Central Venous Catheter Removal Research Articles

Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials

BackgroundThe majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal.MethodsWe conducted a retrospective cohort study from five multicenter randomized controlled trials with systematic catheter-tip culture of consecutive CVCs. Colonization was defined as growth of ≥103 colony-forming units per mL. Risk factors for colonization were identified in the training cohort (CATHEDIA and 3SITES trials; 3899 CVCs of which 575 (15%) were colonized) through multivariable analyses. After internal validation in 500 bootstrapped samples, the CVC-OUT score was computed by attaching points to the robust (> 50% of the bootstraps) risk factors. External validation was performed in the testing cohort (CLEAN, DRESSING2 and ELVIS trials; 6848 CVCs, of which 588 (9%) were colonized).ResultsIn the training cohort, obesity (1 point), diabetes (1 point), type of CVC (dialysis catheter, 1 point), anatomical insertion site (jugular, 4 points; femoral 5 points), rank of the catheter (second or subsequent, 1 point) and catheterization duration (≥ 5 days, 2 points) were significantly and independently associated with colonization . Area under the ROC curve (AUC) for the CVC-OUT score was 0.69, 95% confidence interval (CI) [0.67–0.72]. In the testing cohort, AUC for the CVC-OUT score was 0.60, 95% CI [0.58–0.62]. Among 1,469 CVCs removed for suspected CRI in the overall population, 1200 (82%) were not colonized. The negative predictive value (NPV) of a CVC-OUT score < 6 points was 94%, 95% CI [93%–95%].ConclusionThe CVC-OUT score had a moderate ability to discriminate catheter-tip colonization, but the high NPV may contribute to reduce unnecessary CVCs removal. Preference of the subclavian site is the strongest and only modifiable risk factor that reduces the likelihood of catheter-tip colonization and consequently the risk of CRI.Clinical Trials Registration: NCT00277888, NCT01479153, NCT01629550, NCT01189682, NCT00875069.

Risk factors for unplanned removal of central venous catheters in hospitalized children with hematological and oncological disorders.

Central venous catheters (CVCs) are essential devices in the treatment of pediatric patients with hematological and oncological disorders; however, the most suitable type of CVC for these patients remains unclear. We retrospectively compared risk factors for unplanned removal of two commonly used CVCs, peripherally inserted central catheters (PICCs) and tunneled CVCs, to propose which is the better device. We followed 89 patients fitted with a tunneled CVC (total 21,395 catheter-days) and 84 fitted with a PICC (total 9177 catheter-days) between January 1, 2013 and December 31, 2015, until catheter removal. Patients with a PICC had a significantly higher 3-month cumulative incidence of catheter occlusion (5.2% vs. 0%, p = 4.08 × 10-3) and total unplanned removals (29.0% vs. 6.9%, p = 0.0316) than those with tunneled CVCs. However, the cumulative incidence of central line-associated bloodstream infection did not differ significantly by CVC type. Multivariable analysis identified younger age (< 2years) [sub-distribution hazard ratio (SHR) 2.29; 95% confidence interval (CI) 1.27-4.14] and PICC (SHR 2.73; 95% CI 1.48-5.02) as independent risk factors for unplanned removal. Thus, our results suggest that tunneled CVCs are preferable in pediatric patients with hematological and oncological disorders requiring long-term, intensive treatment.

Efficiency of Actolind Solution in Reduction of Jugular Catheter Site Infection in Sudanese Patients with End Stage Renal Disease

Background: Hemodialysis (HD) is the most extensively used dialysis method globally, and it necessitates vascular access. Arteriovenous fistulas (AVF), arteriovenous grafts, and central venous catheters (CVC), which can be tunneled or not, are all methods for gaining access. Vascular access is a major risk factor for bacteremia, hospitalization, and mortality among HD patients. The efficacy of Actolind solution in suppressing jugular catheter infection sites in patients with positive jugular catheter culture swab was investigated, as well as the efficiency of Actolind solution opposed to iodine. Methodology: This was a prospective, randomized, comparable efficacy clinical trial completed at the renal unit of the Port Sudan teaching hospital's renal dialysis center. The patient group was recruited from across the Red Sea State. A retrospective study of 50 End Stage Renal Disease (ESRD) patients who were either on upkeep HD or were scheduled to receive a kidney transplant as soon as possible. Sociodemographics, comorbidities, and microbiological growth outcomes were gathered prior to and after the interventional procedure. Results: According to the results, the male to female ratio was 4:1. There were 39 males and 11 females. All of the patients had ESRD, with 10 of them being hypertensive and diabetic, 34 being diabetic solely, and 16 being hypertension exclusively. Gram positive bacteria, gram negative bacteria, and yeasts constituted 32 (64%), 20 (40%), and 6 (12%) of the cultivars, respectively. Seven patients out of fifty had mixed infections (14%). Forty-one wound swab results after intervention were negative, while nine patients had persistent infection confirmed by positive cultures. Conclusion: Removal of CVC due to infection or catheter malfunction occurred less often with Actolind-based lock solutions. We present the prospective comparing Actolind - and iodine -based lock solutions yet. However, due to the retrospective observational nature of this study, conclusions with regard to superiority should be considering.

Hemothorax Occurring After Central Venous Catheter Removal: A Case Report

Background: Central venous catheterizations are used frequently in critical care unit. The procedure is associated with various complications ranging from mechanical ones during insertion and the possibility of vessel laceration and dissection to infections, not to forget haemothorax and pneumothorax that may require chest tube insertion. However, some complications may also origin from its removal. Case Report: This is a case of a 72-year-old patient with multiple comorbidities admitted to the Intensive Care Unit (ICU) for respiratory distress. A central line was inserted because a peripheral line was hard to establish, and as a consequence of catheter removal, he had a massive right-sided hemothorax. Conclusion: Central venous line removal could cause fatal complications such as massive hemothorax that should be looked for. We emphasize monitoring of patients after catheter removal because the uncommon nature of this complication can lead to diagnosis delay and even misdiagnosis.

Paradoxical venous air embolism detected with point-of-care ultrasound: a case report

Venous air embolism (VAE) is an uncommon event consistent in the entrainment of air from any communication between the environment and the venous vasculature that could occur during central venous catheter (CVC) manipulation, and might trigger circulatory shock within minutes depending on the amount of air embolized. We present a case of a critical care patient who presented sudden clinical hemodynamic deterioration after the removal of central venous catheter. Hemodynamic evaluation with point-of-care ultrasound (POCUS) showed bubbles in both right and left heart cavities wherewith air embolism facilitated by heart septal defect was suspected. Therefore, the patient was reintubated, supported with vasopressors and a new CVC was inserted to proceed with air aspiration. Shortly after, the patient’s hemodynamic status improved in terms of vital signs stabilization. 6 h after the event with optimal perfusion markers and diminished sedation, the patient showed left hemiparesis therefore a cerebral magnetic resonance (MRI) was also performed showing hyperintensity in the right precentral gyrus, so ischemic stroke without hemorrhagic transformation diagnosis was made, because of paradoxical embolism. This case report demonstrates the value of POCUS application as a diagnostic tool in the hemodynamically unstable patient.

Peripheral intravascular catheter-associated bloodstream infection in the medical–surgical ICU

Background: Prompt removal of unnecessary central venous catheters (CVC) may reduce central-line–associated bloodstream infection (CLABSI). Primary non–central-line–associated hospital-acquired bloodstream infection (BSI), including peripheral intravascular (PIV) catheter-associated bloodstream infection (PIVABSI) remains a problem. Hospitals use CLABSI surveillance data to measure patient safety, yet this measure alone fails to describe the burden of total intravascular device-related infection. We described non-CLABSI primary BSI due to PIV in our medical–surgical ICU population. Methods: Hospital-wide surveillance for primary hospital-acquired BSI, including CLABSI, was conducted in accordance with NHSN protocol. We measured PIV catheter days and central-line days using a database including nursing device documentation and patient census data to count the number of patients with 1 or more devices in place in each location, counted at the same time each day. By substituting the role of the CVC with short or midline PIV in NHSN CLABSI surveillance protocols, we performed surveillance for PIVABSI. We defined PIVABSI as a patient without CVC and either a short or midline catheter in place for &gt;2 calendar days on the date of BSI. Patients with BSI and both CVC and PIV were counted as CLABSI. We compared CVC and PIV utilization and the incidence density of CLABSI and PIVABSI in 8 medical and surgical ICUs at our large teaching hospital. We used OpenEpi version 3.01 software to test the hypothesis that the incidence density of CLABSI would be significantly different from that of PIVABSI. Results: From January to September 2021, there were 16 CLABSIs and 12 primary non–central-line–associated hospital-acquired BSIs, all 12 were PIVABSIs. Of these 12, 8 had &gt;1 PIV in place and none were midlines. There were 13,418 central-line days, 10,897 short and midline peripheral IV days, and 22,415 patient days, resulting in device utilization ratios of 0.60 and 0.49, respectively. The incidence density of CLABSI was 1.2 per 1,000 central-line days, although the incidence density of PIVABSI was 1.1 per 1,000 peripheral IV days (P = .84). There was no difference in pathogens between the 2 groups. Conclusions: PIVABSI represented more than one-third of the total primary hospital-acquired BSIs in our medical and surgical ICUs. Total BSI surveillance is feasible. Efforts to reduce CLABSI should be part of a broader strategy to decrease total hospital-acquired BSI from all vascular access devices.Funding: NoneDisclosures: None

Incidence and risk factors of deep vein thrombosis after extracorporeal life support.

BackgroundDeep vein thrombosis (DVT) after decannulation of extracorporeal life support (ECLS) is not uncommon. Moreover, the impact of anticoagulation and potential risk factors is unclear. Furthermore, it is unclear if cannula‐associated DVT is more common in ECLS patients compared to critically ill patients without ECLS.MethodsAll adult patients who were successfully weaned from ECLS and were screened for DVT following decannulation were included in this observational cohort study. The incidence of post‐ECLS‐DVT was assessed and the cannula‐associated DVT rate was compared with that of patients without ECLS after central venous catheter (CVC) removal. The correlation between the level of anticoagulation, risk factors, and post‐ECLS‐DVT was determined.ResultsWe included 30 ECLS patients and 53 non‐ECLS patients. DVT was found in 15 patients (50%) of which 10 patients had a DVT in a cannulated vein. No correlation between the level of anticoagulation and DVT was found. V‐V ECLS mode was the only independent risk factor for post‐ECLS‐DVT (OR 5.5; 95%CI 1.16–26.41). We found no difference between the ECLS and non‐ECLS cohorts regarding cannula‐associated DVT rate (33% vs. 32%).ConclusionPost‐ECLS‐DVT is a common finding that occurs in half of all patients supported with ECLS. The incidence of cannula‐associated DVT was equal to CVC‐associated DVT in critically ill patients without ECLS. V‐V ECLS was an independent risk factor for post‐ECLS‐DVT.

Central-line-associated bloodstream infections and central-line-associated non-CLABSI complications among pediatric oncology patients.

To assess central venous catheter (CVC) harm in pediatric oncology patients, we explored risks for central-line-associated bloodstream infections (CLABSIs) and central-line-associated non-CLABSI complications (CLANCs). Retrospective cohort study. Midwestern US pediatric oncology program. The study cohort comprised 592 pediatric oncology patients seen between 2006 and 2016. CLABSIs were defined according to Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) definitions. CLANCs were classified using a novel definition requiring CVC removal. Patient-level and central-line-level risks were calculated using a negative binomial model to adjust for correlations between total events and line numbers. CVCs were inserted in 62% of patients, with 175,937 total catheter days. The inpatient CLABSI and CLANC rates were 5.8 and 8.5 times higher than outpatient rates. At the patient level, shared risks included acute myeloid leukemia (AML) and age <1 year at diagnosis. At the line level, shared risks included age <1 year at diagnosis, non-mediports, and >1 lumen. AML was a CLABSI-specific risk. CLANC-specific risks included non-brain-tumor diagnosis, younger age at diagnosis or central-line placement, and age <1 year at diagnosis or line placement. Multivariable risks were for CLABSI >1 lumen and for CLANC age <1 year at placement. Among patients with CVCs, CLABSI and CLANC rates were similar, higher among inpatients than outpatients. For both CLABSIs and CLANCs, infants and patients with AML were at higher risk. In both univariate and multivariate models, lines with >1 lumen were associated with CLABSIs and placement during infancy with CLANCs.

Pulseless Electrical Activity Following Subclavian Central Line Removal in a Patient with Cervical Spine Injury

Protocolised removal of central venous catheter is of paramount importance, as the procedure is implicated with numerous complications which are witnessed as well as reported in literature. Unprecedented events like bradycardia, arrhythmias, cardiac arrest as a result of air embolism, carotid sinus hypersensitivity, embolisation from the vascular end of the catheter, dislodgment of an atherosclerotic plaque or thrombus in the carotid artery precipitated during central line removal have been highlighted. Following is a brief account of cardiac arrest following Subclavian central line removal in a patient with cervical spine injury. In addition to above factors is pertinent to note that patients with High Spinal Cord Injury, above fourth dorsal vertebra have a decreased sympathetic outflow, leading to parasympathetic dominance, which may have resulted in baroreceptor mediated vagal stimulation and reflex bradycardia which progressed to junctional rhythm and pulseless electrical activity. Being aware of these serious potential complications while removing the central venous catheters and prevention of the same is of vital importance. The trainees and nursing staff should be educated regarding being vigilant and monitoring these patients.

Sensorial saturation improves infants’ procedure-related pain behaviour in the cardiac intensive care unit: A quasi-experimental study

BackgroundPainful procedures are unavoidable when providing critical care to infants in intensive care units. These adverse experiences during infancy can lead to later hyperalgesia and poor neurodevelopmental outcomes. Thus, appropriate interventions are required to relieve infant pain during these procedures. ObjectivesThis study evaluated the effectiveness of sensorial saturation in reducing pain for infants during jugular central venous catheter removal procedures in intensive care units. MethodsThis study involved a quasi-experimental, repeated-measures design. Data were collected from participants sequentially recruited from April to June 2019 (control period) and July to September 2019 (experimental period). Participants included 78 infants younger than 1 year with congenital heart disease. The control group (n = 38) received a general nursing intervention using swaddling, a common child-care practice that consists of wrapping infants to restrict movements, whereas the experimental group (n = 40) received sensorial saturation using oral sugar, body massage, and verbal interaction. Infants' physiological reactions to procedural pain were measured by changes in heart rate, oxygen saturation, and respiratory rate. Infants’ procedural pain and behavioural indicators were measured using the Modified Behavioural Pain Scale. Data were analysed using descriptive statistics, independent t-tests, χ2 tests, and repeated-measures analysis of variance. ResultsCompared with the control group, the experimental group had lower heart rates (F = 53.15, p < .001), respiratory rates (F = 15.19, p < .001), and behavioural pain scores (F = 45.21, p < .001), both during and after the procedure. ConclusionsSensorial saturation can be used as a nursing intervention in infants. Given the many invasive procedures that are part of infant clinical care, sensorial saturation may be a safe analgesic alternative. The findings of this study could lead to the development of evidence-based clinical practice guidelines for the nonpharmacological management of acute pain in infants.

Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey.

Candidemia may present as severe and life-threatening infections and is associated with a high mortality rate. This study aimed to evaluate the risk factors associated with 30-day mortality in patients with candidemia. A multi-center prospective observational study was conducted in seven university hospitals in six provinces in the western part of Turkey. Patient data were collected with a structured form between January 2018 and April 2019. In total, 425 episodes of candidemia were observed during the study period. Two hundred forty-one patients died within 30days, and the 30-day crude mortality rate was 56.7%. Multivariable analysis found that SOFA score (OR: 1.28, CI: 1.154-1.420, p < 0.001), parenteral nutrition (OR: 3.9, CI: 1.752-8.810, p = 0.001), previous antibacterial treatment (OR: 9.32, CI: 1.634-53.744, p = 0.012), newly developed renal failure after candidemia (OR: 2.7, CI: 1.079-6.761, p = 0.034), and newly developed thrombocytopenia after candidemia (OR: 2.6, CI: 1. 057-6.439, p = 0.038) were significantly associated with 30-day mortality. Central venous catheter removal was the only factor protective against mortality (OR: 0.34, CI:0.147-0.768, p = 0.010) in multivariable analysis. Candidemia mortality is high in patients with high SOFA scores, those receiving TPN therapy, and those who previously received antibacterial therapy. Renal failure and thrombocytopenia developing after candidemia should be followed carefully in patients. Antifungal therapy and removing the central venous catheter are essential in the management of candidemia.

Infectious outcomes of fibrin sheath disruption in tunneled dialysis catheters.

Fibrin sheath (FS) formation around tunneled central venous catheters (CVC) increases the risk of catheter-related bloodstream infections due to bacterial adherence to a biofilm. We sought to investigate whether FS disruption (FSD) at the time of CVC removal or exchange affects infectious outcomes in patients with CVC-related infections. Retrospective cohort study of 307 adult maintenance hemodialysis patients aged 18 years or older at a single center academic-based hemodialysis program (UHN, Toronto) who developed CVC-related infections requiring CVC removal or exchange between January 2000 and January 2019. Exposure was FSD at the time of CVC removal or exchange. Outcomes were infectious metastatic complications, recurrent infection with the same organism within 1 year, or death due to infection. We created a Markov Multi-State Model (MMSM) to assess patients' trajectories through time as they transitioned between states. A time-to-event analysis was performed, adjusted for clinically relevant factors. There was no significant relationship between FSD status at the time of CVC removal, the development of infectious complications in the multivariable model (adjusted HR = 0.71, 95% CI 0.09-5.80, p = 0.76), or mortality from infection (HR = 0.84, 95% CI 0.34-2.11, p = 0.73). FSD at the time of CVC removal was not associated with increased risk of infectious complications or death due to infection. Further prospective study is needed to determine whether FSD contributes to reducing CVC infectious related complications.

Evaluation of central line salvage for mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) management practices in patients with hematologic malignancies

Patients with underlying hematologic malignancy (HM) and/or allogeneic hematopoietic stem cell transplant (HCT) recipients are at risk for mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) secondary to bacterial translocation. There is sparse data comparing MBI-LCBI management practices, in particular central venous catheter (CVC) salvage versus removal. We created a 22-item poll of Infectious Disease specialists at major US cancer centers on management controversies. Response rate was 44% (31/70). CVC salvage was a common practice among 87.5%. This was followed by a single center retrospective study (2017–2019) comparing outcomes related to CVC practices. We identified 115 patients, 52% (60/115) admitted for chemotherapy and 33% (38/115) for allogeneic HCT. The majority of patients (78%, 90/115) had their CVC removed. There was no difference in 72 h defervescence, microbiological clearance, in-hospital mortality, and 90-day recurrent infection between CVC salvage versus removal. CVC salvage is a safe approach in certain clinical scenarios.

Symptomatic pulmonary embolus after catheter removal in children with catheter related thrombosis: A report from the CHAT Consortium

BackgroundAppropriate timing of central venous catheter (CVC) removal, in relation to start of anticoagulation, in children after the diagnosis of a CVC‐related thrombosis (CRT) is not well established. ObjectivesThis retrospective cohort study evaluated the incidence of symptomatic pulmonary embolism (PE) after CVC removal using data from the multi‐institutional Children’s Hospital‐Acquired Thrombosis (CHAT) Consortium Registry. Patients/MethodsThe CHAT Registry consists of data from children aged 0–21 years with a hospital‐acquired venous thromboembolism. Eligible subjects were those with CRT diagnosed <3 days after CVC removal. Subjects were excluded if the CRT was due to a failed CVC insertion. Subjects were divided into three groups: those with CVC removal without anticoagulation, those with CVC removal <48 h after starting anticoagulation, and those with CVC removal ≥48 h after starting anticoagulation. ResultsA total of 687 CRT events from 663 subjects were included. A majority of CRT events were in subjects with peripherally inserted central catheters (62.3%, n = 428). For the 611 CRT events in which the CVC was removed, there was only one case of symptomatic PE (0.16%), which occurred <48 h after initiation of anticoagulation. ConclusionsWhile current guidelines suggest anticoagulation before CVC removal in the setting of a CRT to prevent embolization, CVC removal is not associated with symptomatic PE regardless of duration of anticoagulation before CVC removal.

988. Is There Value of Infectious Diseases Consultation in Candidemia? A Single Center Retrospective Review From 2016-2019

BackgroundCandidemia is the second most common cause of healthcare-associated bloodstream infections in the US with mortality of approximately 25%. Studies demonstrate lower candidemia mortality with infectious diseases consultation (IDC). We evaluated effects of IDC on mortality and guideline-adherence at our institution to determine if mandatory IDC was warranted.MethodsWe retrospectively reviewed adults hospitalized with candidemia (≥ 1 blood culture positive for Candida) between 1/1/2016-12/31/2019. Exclusion criteria included age < 19 years, polymicrobial blood culture, or death or hospice within 48 hours. Primary outcome was all-cause 30-day mortality. Secondary outcomes included guideline-adherence and treatment choice. Guideline-adherence was assessed with a modified EQUAL Candida score (Table 1). Descriptive statistics were performed.Table 1. Original vs Modified EQUAL Candida Score Abbreviations. CVC: central venous catheter, BCx: blood cultureResultsOf 187 patients reviewed, 92 episodes of candidemia with 94 species of Candida were included. Patient characteristics are shown in Table 2. Central venous catheters (CVCs) were present in 66 (71.7%) patients and were the most common infection source (N=38 [41.3%]) followed by intra-abdominal (N=23 [25%]). The most isolated species were Candida glabrata (40/94 [42.6%]) and C. albicans/dublienensis (35/94 [37.2%]). 30-day mortality was 21.7%. IDC was performed in 84 (91.3%) cases. Outcomes are in Table 3. Mortality was not different between IDC vs no IDC (18 [21.4%] vs 2 [25%]); other comparisons were numerically different but not significant: repeat blood culture (98.8% vs 87.5%), echocardiography (70.2% vs 50%), CVC removal (91.7% vs 83.3%), and initial treatment echinocandin (67.9% vs 50%). All patients received antifungal therapy. IDC resulted in more ophthalmology consultations (77.4% vs 12.5%, p< 0.01). Mean modified EQUAL Candida score was higher with IDC (17.4 vs 13.9, p< 0.01).Table 2. Patient Characteristics Abbreviations. TPN: total parenteral nutrition, ICU: intensive care unit, AIDS: acquired immunodeficiency syndromeTable 3. Outcomes Abbreviations. NS: non-significant, CVC: central venous catheterConclusionIDC was common in candidemic patients and not associated with significant differences in outcomes. Current antimicrobial stewardship and consultation practices at our center do not warrant mandated IDC for candidemia.Disclosures Trevor C. Van Schooneveld, MD, FACP, BioFire (Individual(s) Involved: Self): Consultant, Scientific Research Study Investigator; Insmed (Individual(s) Involved: Self): Scientific Research Study Investigator; Merck (Individual(s) Involved: Self): Scientific Research Study Investigator; Rebiotix (Individual(s) Involved: Self): Scientific Research Study Investigator

Salvage of central line in case of catheter - associated blood stream infections (clabsis) a prospective observational study in adult patients on long-term home parenteral nutrition (HPN)

Rationale: CLABSI is a major complication in HPN and frequently leads to central venous catheter (CVC) removal. We developed a salvaging attitude in long term HPN patients due to the necessity of venous preservation. The main objective of this study is to determine the prognosis of CLABSI.

Unusual complications of the central venous catheterization in trauma patients

Central venous catheters (CVCs) are commonly used in patients with trauma. The placement and removal of the CVCs can result in various complications regardless of the skill of the professionals. Herein, two cases of rare complications are presented— an inadvertent subclavian artery catheterization and a cerebral air embolism after a CVC removal. Moreover, practical solutions for each complication are provided in detail.

Acutely ill hematology/oncology patients with central-line associated bloodstream infections and the impact of timing of catheter removal on outcomes

Hematology/oncology patients are at risk for central line-associated bloodstream infections (CLABSI). The purpose was to determine if infection-related mortality, persistent bacteremia, and recurrent bacteremia were decreased with early central venous catheter (CVC) removal. A case-matched, retrospective cohort study was conducted comparing patients with early catheter removal (≤12 hours) to late catheter removal (>12 hours) in hematology/oncology patients with CLABSI from June 1, 2015 to May 31, 2018. Patients were case-matched based on intensive care unit admission and presence of shock to control for severity of illness. Of 148 patients meeting study inclusion, 128 (86.5%), had their CVC removed during hospitalization (median 11.8 hours). The majority had a hematologic malignancy (90.5%). Following case-matching, 48 patients remained in each group. The primary outcome of infection-related mortality, persistent bacteremia, or recurrent bacteremia occurred more frequently in the late catheter removal group compared to the early catheter removal group although this was not statistically significant (18.8% vs 8.3%, P=.136). A lower incidence of infection-related mortality, persistent bacteremia, and recurrent bacteremia was found in patients early catheter removal; however the sample size was not adequate to detect statistical differences. Investigators should continue to evaluate if early catheter removal confers a benefit in a larger patient population.

Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days

Purpose of ReviewWhile reducing unnecessary days present of central venous catheters (CVCs) is part of central line associated bloodstream infection (CLABSI) best practices, there is limited information regarding compliance with this recommendation as well as addressing barriers to compliance.Recent FindingsSignificant work has been directed towards daily audits of necessity and improving communication between members of the medical team. Other critical interventions include utilization of the electronic health record (EHR), leadership support of CLABSI reduction goals, and avoiding CVC placement over more appropriate vascular access.SummaryInstitutions have varied approaches to addressing the issue of removing idle CVCs, and more standardized approaches in checklists as well as communication, particularly on multidisciplinary rounds, will be key to CVC removal. Utilization of the EHR for reminders or appropriate documentation of necessity is a factor. Avoidance of placing a CVC or appropriateness of the CVC is also important to consider.

Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021.

Patients with haematological malignancies, haemopoietic stem cell transplant recipients and patients requiring admission to intensive care settings are at high risk for invasive candidiasis (IC). Over the past decade, there has been increased reporting of non-albicans species and fluconazole resistance in Australia. These guidelines provide updated evidence-based recommendations for the diagnosis and management of IC in adult and paediatric haematology, oncology and intensive care settings. Optimal pharmacological and non-pharmacological management are discussed. Recent studies strengthen the recommendation for an echinocandin agent as first-line therapy for high-risk patients with IC. Mortality benefit has also been demonstrated for non-pharmacological management, including removal of central venous catheters, infectious diseases consultation and use of care bundles. Healthcare facilities managing immunocompromised patient populations should therefore adopt implementation strategies for these multimodal interventions.