Multilumen Central Venous Catheters Research Articles

Influence of insertion site on central venous catheter colonization and bloodstream infection rates

To compare colonization and catheter-related bloodstream infection (CR-BSI) rates among three insertion sites (subclavian, internal jugular, femoral) used for central venous catheter (CVC) placement. Twenty-four-month prospective study, with relative effects analyzed by Cox proportional hazards regression. Eight-bed intensive care unit. Four hundred and ten critically ill patients requiring CVC placement. All short-term multi-lumen CVCs, including antimicrobial-coated devices, were studied with management standardized. Six hundred and five CVCs (4,040 catheter days) were analyzed. Colonization and CR-BSI incidence were, respectively, 15.1 (95% CI 13.5-21.0) and 1.8 (95% CI 1.2-4.2) per 1,000 catheter-days. Colonization was higher at the internal jugular (HR 3.64; 95% CI 1.32-10.00; p=0.01) and femoral (HR 5.15; 95% CI 1.82-14.51; p=0.004) sites than at the subclavian site. The femoral site carried a greater risk of being colonized by non-S. epidermidis species than the subclavian and internal jugular sites combined (HR 4.15; 95% CI 1.79-9.61; p=0.001). CVCs inserted in the Department of Emergency Medicine were more colonized than those inserted in the ICU or operating room (HR 2.66; 95% CI 1.27-5.56; p=0.01), and CVCs were less colonized in females than in males (HR 0.49; 95% CI 0.26-0.89; p=0.02). No difference in CR-BSI rates was noted between the three sites. Colonization was lowest at the subclavian site. Regional differences exist with respect to type of pathogen isolated. Colonization was influenced by insertion location and gender. The incidence of CR-BSI was not different.

Comparison of oligon central venous catheters with standard multilumen central venous catheters in cardiac surgery ICU patients

Catheter-related infections account for a large part of all nosocomial infections, and clinical studies have suggested that impregnation of catheters with antiseptics or antibiotics could decrease the rates of colonization. The purpose of this study was to assess the efficacy of oligon catheters to reduce bacterial colonization.

Bloodstream infection related to catheter connections: a prospective trial of two connection systems

Bloodstream infections (BSIs) related to central venous catheters (CVCs) and arterial catheters (ACs) are an increasing problem in the management of critically ill patients. Our objective was to assess the efficacy of a needle-free valve connection system (SmartSite), Alaris Medical Systems, San Diego, CA, USA) in the prevention of catheter-related bloodstream infection (CR-BSI). Patients admitted to an intensive care unit were prospectively assigned to have a CVC and AC connected with either a needle-free valve connection system (NFVCS) or a three-way stopcock connection (3WSC). The characteristics of the patients were similar in the two groups. Before manipulation, the NFVCS was disinfected with chlorhexidine digluconate 0.5% alcoholic solution. The 3WSC was not disinfected between use but it was covered with a protection cap. A total of 799 patients requiring the insertion of a multilumen CVC or AC for >48h from 1 April 2002 to 31 December 2003 were included. CR-BSI rates were 4.61 per 1000 days of catheter use in the disinfected NFVCS group and 4.11 per 1000 days of catheter use in the 3WSC group (P=0.59). When CVC-BSIs and AC-BSIs were analysed separately, the rate of CVC-BSI was 4.26 per 1000 days of catheter use in the NFVCS group, compared with 5.27 in the 3WSC group (P=0.4). The incidence rate of AC-BSI was 5.00 per 1000 days of catheter use in the NFVCS group, compared with 2.83 in the 3WSC group (P=0.08). The use of NFVCS does not reduce the incidence of catheter-related bacteraemia. The arterial catheter (AC) is a significant source of infection in critically ill patients.

Communication between channels of a multilumen central venous catheter

Communication between channels of a multilumen central venous catheter

Comparison of silver-impregnated with standard multi-lumen central venous catheters in critically ill patients*

To evaluate a new silver-impregnated multi-lumen central venous catheter for reducing catheter-related colonization in intensive care patients. Multicenter, prospective, randomized, controlled clinical study. Ten adult intensive care units (multidisciplinary, medical and surgical, university and nonuniversity hospitals) in eight institutions. A total of 577 patients who required 617 multi-lumen central venous catheters between November 2002 and April 2004 were studied. Intensive care adult patients requiring multi-lumen central venous catheters expected to remain in place for >or=3 days were randomly assigned to undergo insertion of silver-impregnated catheters (silver group) or standard catheters (standard group). Catheter colonization was defined as the growth of >or=1,000 colony-forming units in culture of the intravascular tip of the catheter by the vortexing method. Diagnosis of catheter-related infection was performed by an independent and blinded expert committee. A total of 320 catheters were studied in the silver group and 297 in the standard group. Characteristics of the patients, insertion site, duration of catheterization (median, 11 vs. 10 days), and other risk factors for infection were similar in the two groups. Colonization of the catheter occurred in 47 (14.7%) vs. 36 (12.1%) catheters in the silver and the standard groups (p = .35), for an incidence of 11.2 and 9.4 per 1,000 catheter days, respectively. Catheter-related bloodstream infection was recorded in eight (2.5%) vs. eight (2.7%) catheters in the silver and the standard groups (p = .88), for an incidence of 1.9 and 2.1 per 1,000 catheter days, respectively. The use of silver-impregnated multi-lumen catheters in adult intensive care patients is not associated with a lower rate of colonization than the use of standard multi-lumen catheters.

Influence of infusion flow rates on central venous pressure measurements through multi-lumen central venous catheters in intensive care

To study the influence on central venous pressure (CVP), measured at the distal port, of crystalloid infusions administered through the proximal port(s) of a central venous multi-lumen catheter. Thirty-one intensive care patients. CVP was measured at the distal port of a multi-lumen catheter inserted in the subclavian or internal jugular vein. Using the proximal port(s), saline (0.9%) was infused at rates varying from 2 ml/h to 14,340 ml/h. CVP measured before the infusion and during infusion (after 30 s to 1 min) were not significantly different. Positive pressure ventilation with PEEP (5.6 +/- 2.5 cmH(2)O) and/or norepinephrine infusion (0.25 +/- 0.21 microg kg(-1) min(-1)) did not produce any significant change in CVP during infusion. The administration of crystalloids at different flow rates through the proximal port(s) of a multi-lumen catheter placed in the superior vena cava does not affect CVP measurement at the distal port, even in mechanically ventilated patients or patients receiving vasopressors.

Complications and survival of multilumen central venous catheters used for total parenteral nutrition.

In a prospective study of 879 triple-lumen catheters, 219 pulmonary artery catheters, 31 double-lumen and six single-lumen catheters used for the administration of total parenteral nutrition over a 1-year period, the overall complication rate was 12.5 per cent (14.7 complications per 1000 catheter-days) and the catheter-related sepsis rate 4.4 per cent (5.2 per 1000 catheter-days). The probability of development of catheter-related sepsis did not increase with the duration of catheterization. There were no differences in the rate of complications associated with 427 catheters changed by replacement at a new site compared with 159 lines changed over a guidewire. These data support the use of multilumen central venous catheters for the administration of total parenteral nutrition. They suggest that a routine weekly change of line is unnecessary; catheters should be changed only on the development of a complication. When it is required, a catheter should be changed by replacement over a guidewire.

Diagnosis of Catheter-Related Bloodstream Infections Among Pediatric Oncology Patients Lacking a Peripheral Culture, Using Differential Time to Detection

Current methods for in situ diagnosis of catheter-related bloodstream infections require concurrent collection of central venous catheter (CVC) and peripheral vein (PV) blood cultures. Both the pain and inconvenience of PV cultures are undesirable. A prospective study was conducted (August 2002 to March 2004) to assess the accuracy of diagnosing catheter-related bloodstream infections based on the difference in time to detection of blood cultures drawn concurrently from 2 lumens of a multilumen CVC. This difference in time to detection between 2 lumens was compared with results of the standard criterion with paired CVC and PV blood cultures. Twenty-one infectious episodes were categorized as catheter-related bloodstream infections and 38 as non-catheter-related bloodstream infections. With a cutoff in difference in time to detection between 2 lumens of > or =180 minutes, the sensitivity of this test to diagnose a catheter-related bloodstream infection was 61% (95% confidence interval, 39-80%) and the specificity was 94% (95% confidence interval, 82-99%). In 4 of 7 episodes with false-negative results, the colony counts in cultures from both lumens were >400 colony-forming units/mL (maximal value reported), indicating the limitation of this method when both lumens of the catheter are colonized. With the pretest probability of catheter-related bloodstream infections ranging from 28% to 54%, the positive predictive value of a difference in time to detection between 2 lumens of > or =180 minutes for diagnosis of catheter-related bloodstream infections ranged from 81% to 93% and the negative predictive value ranged from 67% to 86%. Within the context of its limitations, this novel method provides an alternative for diagnosing catheter-related bloodstream infections among patients with a CVC, without PV cultures.

Colonization and Bloodstream Infection in Single- Versus Multi-lumen Central Venous Catheters

Colonization and Bloodstream Infection in Single- Versus Multi-lumen Central Venous Catheters

Safety and Feasibility of Using a Central Venous Catheter for Rapid Contrast Injection Rates

Our aim was to determine the safety and feasibility of using a central venous catheter for rapid contrast injections during CT. An in vitro experiment was performed using a 7-French Arrow-Howes multilumen central venous catheter. Each catheter port was tested by varying contrast agent flow rates delivered by a power injector. Contrast media specifications were kept similar to routine clinical practice. The in vivo experiment included 104 cases in which rapid contrast injections, 3.0-5.0 mL/sec, were delivered through a central venous catheter for dynamic CT examinations. Patient monitoring for early complications of contrast extravasation, cardiac arrhythmia, and allergic reactions was performed. Contrast injections were monitored for pressure limitation, automatic flow-rate adjustment, and catheter injury. Chart review was performed for delayed complications of mediastinal hematoma, infection, or catheter malfunction. During the in vitro experiment, all desired flow rates, 3.0-9.9 mL/sec, could be delivered through the central venous catheter with no catheter injury. No immediate or early patient or catheter complications were observed during the in vivo experiment. Follow-up evaluation revealed that 18 blood cultures and one catheter culture were positive for bacterial growth. In a subgroup of 43 patients, five contrast injections were pressure-limited by the power injector, and only one had the flow rate automatically adjusted to 3.6 mL/sec from 4.0 mL/sec. Rapid contrast injection rates, at 3.0-5.0 mL/sec, through the Arrow-Howes multilumen central venous catheter are feasible and safe in the clinical setting. However, a strict protocol should be followed to avoid possible serious complications.

Prevention of catheter-related bloodstream infection in critically ill patients using a disinfectable, needle-free connector: A randomized controlled trial

Objective The aim of this study was to assess the efficacy of a disinfectable, needle-free connector in the prophylaxis of catheter-related bloodstream infection. Methods A randomized controlled trial was performed in a polyvalent intensive care unit. Patients who needed multilumen central venous catheters were randomly assigned to a study or a control group. All catheters were inserted and manipulated according to the Centers for Disease Control and Prevention (CDC) recommendations. Study group patients were equipped with catheters with disinfectable, needle-free connectors whereas control group patients were equipped with catheters with 3-way stopcocks. Two peripheral blood cultures and a semiquantitative culture of the catheter tip were performed on removal of the catheter. Results The study included 243 patients, with a total of 278 central venous catheters. The catheters' mean insertion duration was 9.9 days. Both groups were comparable regarding patient and catheter characteristics. Incidence rate of catheter-related bloodstream infection was 0.7 per 1000 days of catheter use in the study group, compared with 5.0 per 1000 days of catheter use in the control group ( P = .03). Conclusions To add a disinfectable, needle-free connector to the CDC recommendations reduces the incidence of catheter-related bloodstream infection in critically ill patients with central venous catheters.

Colonization and bloodstream infection with single- versus multi-lumen central venous catheters: a quantitative systematic review.

There is a controversy as to whether the number of lumens in the central venous catheters may impact the incidence of catheter-related bloodstream infection. We performed a systematic search (MEDLINE, PREMEDLINE, Cochrane Library, EMBASE, BIOSIS Previews, CINAHL, HealthSTAR/Ovid healthstar, bibliographies, any language, to April, 2003) for full reports on randomized comparisons of single-lumen and multi-lumen catheters. Trials had to report on dichotomous data of catheter colonization or bloodstream infection. Meta-analyses were performed using a fixed effect model. Data were expressed as odds ratio (OR) and number-needed-to-treat (NNT) with 95% confidence interval (CI). Five randomized trials (1987-1995) with data on 255 single-lumen and 275 multi-lumen catheters were analyzed. Average insertion times were 8 to 21 days with multi-lumen catheters and 9 to 24 days with single-lumen catheters. In 4 trials, 23 of 176 (13.1%) multi-lumen and 26 of 177 (14.7%) single-lumen catheters were colonized (OR, 0.92; 95% CI, 0.49-1.72). In 5 trials, bloodstream infection occurred with 23 of 275 (8.4%) multi-lumen and with 8 of 255 (3.1%) single-lumen catheters (OR, 2.58; 95% CI, 1.24-5.37; NNT, 19; 95% CI, 11-75). For every 20 single-lumen catheters inserted, one bloodstream infection will be avoided that would have occurred had multi-lumen catheters been used. The risk of catheter colonization is not decreased. Although these conclusions are based on limited data, single-lumen catheters should be used whenever feasible.

Rates of infection for single-lumen versus multilumen central venous catheters: A meta-analysis

Since the introduction of multilumen central venous catheters two decades ago, there has been controversy whether the additional lumens place patients with these catheters at higher risk for infection. Our objective was to determine the risk of catheter-related bloodstream infection (CRBSI) and catheter colonization in multilumen catheters compared with single-lumen catheters. Studies were identified by a computerized search of MEDLINE, EMBASE, CINAHL, Current Contents, and PREMEDLINE databases and by review of bibliographies and expert consultation. Studies comparing the prevalence of CRBSI or catheter colonization among single-, double-, and triple-lumen central venous catheters were included. We excluded studies if they included central venous catheters that were long-term, cuffed, tunneled, or coated with antibiotic or antiseptic agents. Two independent reviewers abstracted data on: 1) risk factors for CRBSI and colonization, 2) outcome definitions used, 3) the absolute prevalence of CRBSI and catheter colonization, and 4) study design and quality. A total of 15 studies met inclusion criteria. Summary odds ratios were calculated using a random-effects model. Although CRBSI was more common in multilumen catheters (summary odds ratios, 2.15; 95% confidence interval, 1.00-4.66), catheter colonization was not (summary odds ratios, 1.78; 95% confidence interval, 0.92-3.47). Tests for heterogeneity, however, suggested substantial variation by study. When only studies of higher quality were included, multilumen catheters were found not to be associated with a significant increase in CRBSI prevalence (summary odds ratios, 1.30; 95% confidence interval, 0.50-3.41). Multilumen central venous catheters may be associated with a slightly higher risk of infection when compared with single-lumen catheters; however, this relationship diminishes when only high-quality studies that control for patient differences are considered. The slight increase in infectious risk when using multilumen catheters is likely offset by their improved convenience, thereby justifying the continued use of multilumen vascular catheters.

Multi-lumen central venous catheters increase the risk of bloodstream infection: evidence from a systematic review

Multi-lumen central venous catheters increase the risk of bloodstream infection: evidence from a systematic review

A prospective, randomized, controlled trial comparing transparent polyurethane and hydrocolloid dressings for central venous catheters

Background: This study was undertaken to determine the frequency of skin colonization, hub colonization, and central venous catheter colonization in transparent hydrocolloid versus standard polyurethane dressings. Methods: Adult patients requiring the insertion of a multilumen central venous catheter in an intensive care unit were randomized to receive either a standard polyurethane dressing or a transparent hydrocolloid dressing. Cultures were obtained from 125 skin insertion sites, 141 catheter hubs, 128 catheter tips, and blood samples from 132 patients. Extensive data on patient and catheter characteristics were collected. Results: Skin and hub cultures revealed no significant difference in degree of colonization. However, the hydrocolloid group had a significantly higher level of catheter colonization than the polyurethane group ( P = .048). Conversely, there was a significantly higher frequency of positive blood cultures in the polyurethane group ( P = .03), although the majority were considered to be potential contaminants. There were only 6 cases in which the same species was simultaneously isolated from a positive blood culture and a colonized catheter, 5 from the hydrocolloid group and 1 from the polyurethane group. Conclusions: The results of this study suggest that an increased risk of catheter colonization is associated with the use of hydrocolloid dressings, despite previous research suggesting that they significantly reduce microbial growth compared with standard polyurethane. The clinical significance of increased numbers of positive blood cultures in the polyurethane group requires further examination, although distinguishing between contamination and true infection in intensive care settings continues to be methodologically challenging. Further studies are required to determine whether these findings are generalizable across different study settings and whether similar outcomes are obtained when different brands of hydrocolloid dressing are used. (AJIC Am J Infect Control 1999;27:488-96)

Multilumen central venous catheters in children: relative potential to perforate vessels. An in vitro study.

Because cardiovascular perforation by a central venous catheter (CVC) is a serious complication of catheterization in pediatric patients, we conducted an in vitro study of the relative potential for perforation of a standard material by the tips of multilumen pediatric catheters. Since we could not simulate vessel tissue, we hypothesized that testing catheters on a standard material would show whether catheters varied in tendency to perforate such a material and thus indicate a "relative potential for perforation." Each CVC protruding from a support tube was suspended in a water-filled Plexiglas chamber at a 90 degrees incident angle to a polyethylene film, which was made to bulge 6 mm into the CVC tip 120 times per minute by hydropressure. Perforation of the polyetheylene film was documented on a time-based, strip-chart recording of pressure change on the opposite side of the film. We recorded the number of pulsations required for the following catheters to perforate the polyethylene: Arrow flex tip, Cook polyurethane, Viggo hydrocath polyurethane, and Cook silicone CVCs of 4- and 5-Fr size with 2 or 3 lumens (n = 5 catheters of each type, each catheter being tested 5 times). The number of pulsations to perforation ranged from 1 +/- 0.4 SD to > 7000. This in vitro study of the worst-case condition (90 degrees incident angle between CVC tip and polyethylene film) indicates that pediatric multilumen CVCs vary significantly in their relative potential to perforate a standard material. We suggest that, when central venous catheterization is contemplated in children, in addition to insertion site, catheter length, and depth of insertion, the type of catheter is another variable to consider in order to minimize the chance of cardiovascular perforation by the CVC tip.

Capillary blood versus arterial or venous blood for tacrolimus monitoring in liver transplantation.

Tacrolimus has been found to be useful in clinical solid organ transplantation. A very careful monitoring of the tacrolimus levels and dose adjustments are essential, at least in the immediate post-liver transplantation, situation. However, quite often after liver transplantation, patients have limited venous access for daily monitoring of tacrolimus levels. When the blood is sampled from a multilumen central venous catheter, used also for intravenous administration of tacrolimus, falsely elevated concentrations of tacrolimus have been observed. The present study examines the concentration of tacrolimus in capillary blood samples obtained from finger stick and compares its concentrations in simultaneously drawn samples from arterial line, peripheral venous puncture, and multilumen centrally placed venous catheter from the port used for tacrolimus infusion and the port not used for tacrolimus infusion. Ten adult post-liver transplantation recipients were studied. Whole blood concentration of tacrolimus in capillary blood was comparable to that of arterial blood, as well as to that of peripheral venous blood samples (r2 = 0.99; P = 0.72). Concentrations of tacrolimus in venous blood drawn from the port of the multilumen catheter used for intravenous tacrolimus infusion were 3-23 times higher (P = 0.0015), while the concentrations of venous blood drawn from the port not used for tacrolimus infusion were 1.7-4.5 times higher (P = 0.016), as compared with arterial, capillary, or peripheral venous whole blood concentrations.

Ideal Position of Central Venous Catheters: Length of Catheter in Relation to Height of Patient

One hundred patients of either sex undergoing elective cardiac operation were divided randomly into 2 groups. In both groups, the right internal jugular vein was cannulated using the Seldinger technique and multilumen central venous catheters. The length of catheter inserted in Group A was height of the patient in centimeters divided by 10, and Group B height in centimeters divided by 12. Ideal catheter tip position could be obtained in 94% of the patients in Group B, but only 36% in Group A ( p < 0.001).

Complications and survival of multilumen central venous catheters used for total parenteral nutrition A P SAVAGE, M PICARD, C C HOPKINS, ET AL Massachusetts General Hospital and Harvard Medical School, Boston

Complications and survival of multilumen central venous catheters used for total parenteral nutrition A P SAVAGE, M PICARD, C C HOPKINS, ET AL Massachusetts General Hospital and Harvard Medical School, Boston

Triple- vs Single-Lumen Central Venous Catheters

To evaluate a new multilumen central venous catheter we prospectively compared the infection rates of 63 single-lumen and 157 triple-lumen catheters in 145 critically ill patients. Using acute physiology scores, severity of illness was shown to be similar in the two patient groups. There were no significant differences in the rate of catheter colonization or catheter-related sepsis comparing single-lumen with triple-lumen catheters. However, the use of total parenteral nutrition or insertion at the femoral vein site significantly increased the rate of colonization. The only factor that was clearly associated with catheter sepsis was the duration of catheterization. Catheter sepsis increased from 1.5% to 10% when the period of catheterization exceeded 6 days. We conclude that the use of triple- and single-lumen central venous catheters in critically ill patients entails similar risks of infection.