Catheter Infection Rates Research Articles

Nutrition quality control in the prescription and administration of parenteral nutrition therapy for hospitalized patients.

Nutrition quality control in parenteral nutrition therapy (PNT) allows the identification of inadequate processes in parenteral nutrition (PN). The objective of this study was to assess the quality of PNT at a hospital with an established nutrition support team (NST). This observational, longitudinal, analytical, and prospective study examined 100 hospitalized PNT adult patients under the care of an NST for 21 days or until death/hospital discharge. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) 2007 guidelines for PNT prescription were followed. PNT indications were not in accordance with the A.S.P.E.N. 2007 guidelines in 15 patients. Among the remaining 85 patients, 48 (56.5%) did not receive adequate PNT (≥80% of the total volume prescribed). Non-NST medical orders, progression to and from enteral nutrition, changes in the central venous catheter, unknown causes, and operational errors (eg, medical prescription loss, PN nondelivery, pharmacy delays, inadequate PN bag temperature) were associated with PNT inadequacy (P < .005). Compared with patients who died, the discharged patients received PN volumes ≥80% on most days (P = .047). The quality indicators for nutrition therapy related to estimated energy expenditure and protein requirements and glycemia levels reached the expected targets; however, the central venous catheter infection rate was higher than 6 per 1000 catheters/d and did not meet the expected targets. Despite an established NST, there was a moderate level of PNT inadequacy in indications, administration, and monitoring. It is important to establish periodic meetings among different health professionals who prescribe and deliver PNT to define responsibilities and protocols.

A comparative study of central versus posterior approach for internal jugular hemodialysis catheter insertion.

Internal jugular (IJ) catheter insertion for hemodialysis (HD) is an indispensable procedure in the management of patients with renal failure. The central approach is favored over posterior approach to insert IJ catheters. There are no studies comparing the outcomes between the two approaches. The aim of this study was to compare central approach with posterior approach for IJ HD catheter insertion and to analyze various outcomes like procedure-related complication rates, catheter insertion failure rates, interruptions during dialysis due to blood flow obstruction and catheter infection rates between the two methods among patients receiving HD. All patients requiring IJ HD catheter insertion during a 1-month period were randomly assigned to undergo catheter insertion via either conventional central approach or posterior approach. Patients were followed-up till the removal of the catheter. Among 104 patients included in the study, 54 were assigned to the central approach group and 50 to the posterior approach group. The central approach group had higher rate of procedure-related complications (14.81% vs. 6%, P = 0.04). Catheter insertion failure rates were marginally higher in posterior approach group (20% vs. 12.96%, P = 0.07). One or more instance of interruption during HD due to obstruction in blood flow was more common in posterior approach (46% vs. 9.25%, P < 0.01). Catheter infection rates were similar between the two groups; 16.66% (n = 9) in central group vs. 14% (n = 7) in posterior group. Posterior approach is a reasonable alternative to conventional central approach in IJ cannulation for HD catheter. It is, however, associated with a significantly high rate of interruption in HD blood flow and catheter insertion failure rates. The posterior approach can be used in patients with local exit site infection or in failed attempts to cannulate IJ vein via the conventional central approach.

Experiences of the first PICC team in the Czech Republic.

The first specialist nursing team placing peripherally inserted central catheters (PICCs) in the Czech Republic was established in September 2012. During 2013 the team placed 167 PICCs and 162 midline catheters. In another 6 patients the insertion was not successful. PICCs were inserted mainly for oncology patients; while midline catheters were inserted for patients admitted to general wards. Average duration of catheter insertion was 91 days (range 7-285 days) for PICCs and 14 days (range 2-40 days) for midline catheters. During follow up of PICCs, catheter infection rate was 0.3/1000 days, vein thrombosis rate 0.4/1000 days, catheter occlusion 0.4/1000 days, and catheter displacement 0.33/1000 days. For midline catheters infection rate was 1.4/1000 days, vein thrombosis 5.2/1000 days, catheter occlusion 2.6/1000 days, and catheter displacement 2.2/1000 days. The authors hope that these results will motivate other hospitals in the Czech republic to establish PICC teams, as in other European countries.

Bacterial Colonization and Infection Rate of Epidural Catheters used for Postoperative Analgesia

Bacterial Colonization and Infection Rate of Epidural Catheters used for Postoperative Analgesia

Mandated self-reporting of ventilator-associated pneumonia bundle and catheter-related bloodstream infection bundle compliance and infection rates.

As quality measures increasingly become tied to payment, evaluating the most effective ways to provide high-quality care becomes more important. To determine whether mandated reporting for ventilator and catheter bundle compliance is correlated with decreased infection rates, and to determine whether labor-intensive audits are correlated with compliance. Multiyear retrospective review of aggregated data from all patients admitted to 15 intensive care units in a Veterans Affairs hospital setting (the Veterans Integrated Service Network 16) from 2009 to 2011. Ventilator-associated pneumonia and catheter-related bloodstream infections. Mean rates of ventilator-associated pneumonia and catheter-related bloodstream infection were analyzed by year. Relationships between infection rates, self-reported compliance, and audits were analyzed by Pearson correlation. During the study period, ventilator-associated pneumonia decreased from 2.50 to 1.60 infections per 1000 ventilator days (P = .07). The rate of pneumonia was not correlated with self-reported compliance overall (R = 0.19) or by individual year (2009, R = 0.30; 2010, R = 0.24; 2011, R = 0.46); there was a correlation in cardiac intensive care units (R = -0.70) but not other types of intensive care units (mixed, R = -0.18; medical, R = 0.42; surgical, R = 0.34). Catheter-related bloodstream infections decreased from 2.38 to 0.73 infections per 1000 catheter days (P = .04). The rate of catheter infection was not correlated with self-reported compliance overall (R = -0.18), by individual year (2009, R = -0.39; 2010, R = -0.42; 2011, R = 0.37), or by intensive care unit type (mixed, R = -0.19; cardiac, R = 0.55; medical, R = 0.17; surgical, R = -0.44). Current mandated self-reported compliance and audit measures are poorly correlated with decreased ventilator-associated pneumonia or catheter-related bloodstream infection.

PS-220 Nosocomial Infections Due To Multidrug-resistant Microorganisms In Neonates

Aim We aimed to evaluate nosocomial infection (NI) rate and antimicrobial susceptibilities of microorganisms causing NI in our Neonatal Intensive Care Unit (NICU). Material and method NI afflicting infants admitted to NICU of Bahcesehir University Goztepe Medicalpark Hospital between January 2012 and December 2012 were assessed using Centre For Disease Control And Prevention (CDC) criteria. Only culture-positive infants were enrolled. Results Of 328 infants, 49.1% were preterm. Thirty-five nosocomial infections occurred in 19 (6.4%) patients. Incidence density was 6.8/1000 patient-days. Attact rate per patient was 1.84. Two infants (10.5%) succumbed to death, one with a liver abscess due to Staphylococcus epidermidis, other with Candida albicans sepsis. Ventilator associated-pneumonia (VAP) rate (n = 4) 2.3/1000, sepsis rate (n = 19) 5.7/1000, UTI rate (n = 10) 1.5/1000, wound infection rate (n = 1) 0.1/1000, catheter infection rate (n = 2) 4/1000 and meningitis rate were (n = 1) 0.1/1000. Of 35 nosocomial agents 22 (62.8%) were gram negative (10 Klebsiella spp, 4 Enterobacter, 3 Acinetobacter, 3 E. coli, 2 Peudomonas), 10 (28.5%) were gram positive and 3 (8.6%) were Candida spp. All gram negatives were resistant to cephalosporins. Thirty-one percent of gram negative bacteria were resistant to carbapenems. Carbapenem-resistant gram negative agents were namely Acinetobacter baumanii complex, Pseudomonas aeruginosa and Enterobacter cloacea complex, All bacteria were susceptible to colistine. Conclusion ESBL positive and carbapenem-resistant gram negative bacteria are threats for NICU. It is of vital importance to implement reasonable antibiotherapy strategies and to propagate standart infection control measures.

Central Venous Catheter Placement by Advanced Practice Nurses Demonstrates Low Procedural Complication and Infection Rates—A Report From 13 Years of Service*

To report procedural characteristics and outcomes from a central venous catheter placement service operated by advanced practice nurses. Single-center observational study. A tertiary care university hospital in Sydney, Australia. Adult patients from the general wards and from critical care areas receiving a central venous catheter, peripherally inserted central catheter, high-flow dialysis catheter, or midline catheter for parenteral therapy between November 1996 and December 2009. None. Prevalence rates by indication, site, and catheter type were assessed. Nonparametric tests were used to calculate differences in outcomes for categorical data. Catheter infection rates were determined per 1,000 catheter days after derivation of the denominator. A total of 4,560 catheters were placed in 3,447 patients. The most common catheters inserted were single-lumen peripherally inserted central catheters (n = 1,653; 36.3%) and single-lumen central venous catheters (n = 1,233; 27.0%). A small proportion of high-flow dialysis catheters were also inserted over the reporting period (n = 150; 3.5%). Sixty-one percent of all catheters placed were for antibiotic administration. The median device dwell time (in d) differed across cannulation sites (p < 0.001). Subclavian catheter placement had the longest dwell time with a median of 16 days (interquartile range, 8-26 d). Overall catheter dwell was reported at a cumulative 63,071 catheter days. The overall catheter-related bloodstream infection rate was 0.2 per 1,000 catheter days. The prevalence rate of pneumothorax recorded was 0.4%, and accidental arterial puncture (simple puncture-with no dilation or cannulation) was 1.3% using the subclavian vein. This report has demonstrated low complication rates for a hospital-wide service delivered by advance practice nurses. The results suggest that a centrally based service with specifically trained operators can be beneficial by potentially improving patient safety and promoting organizational efficiencies.

A comparative study of peripherally-inserted and Broviac catheter complications in home parenteral nutrition patients

Peripherally inserted central venous catheters (PICC) have become increasingly popular for medium to long-term parenteral nutrition (PN) but there is limited data on the complication rates in this sub-group. We aimed to compare the rates of complications associated with tunneled catheters (Broviac) and PICC in home PN (HPN) patients. All adult patients in an HPN program with a new Broviac or new PICC between 2009 and 2011 were included in this prospective observational study. Complication rates were compared by using Poisson regression and Kaplan Meier survival curves were used to compare the first complications that occurred. 204 catheters (133 Broviac and 71 PICC) were inserted in 196 adult patients. Mean follow-up from catheter insertions to their removal was 276 ± 219 days for Broviac (n = 86) vs. 74 ± 140.70 days for PICC (n = 56); p < 0.001. Complications were similar between Broviac and PICC (91/133 vs. 26/71). Catheter infection rate was lower in PICC (1.87 vs. 1.05 per 1000 catheter-days; p = 0.01). Catheter obstruction rates were similar for both catheters. Only PICC experienced venous thrombosis (0.4/1000). The proportion of catheters removed was lower in the Broviac group than in the PICC group (62.4% vs. 78.8%; p = 0.01) but those removed for complications were not different (28.6.7%vs. 25.3%; p = 0.64). In HPN patients, overall complications were similar in both the PICC and the Broviac groups. However, the Broviac catheter could be associated with an increase in catheter infection.

A Performance Improvement Initiative to Determine the Impact of Increasing the Time Interval Between Changing Centrally Placed Intravascular Catheters

Existing practice guidelines designed to minimize invasive catheter infections and insertion-related complications in general intensive care unit patients are difficult to apply to the burn population. Burn-specific guidelines for optimal frequency for catheter exchange do not exist, and great variation exists among institutions. Previously, the authors' practice was to follow a new site insertion at 48 hours by an exchange over a guidewire, which was followed 48 hours later by a second guidewire exchange (48h group). As a performance improvement initiative, the authors attempted to determine whether there would be any advantage or disadvantage to extending these intervals to 72 hours (72h). All patients with centrally placed intravascular catheters from October 2007 to August 2008 were included in the 48h group, and all patients with catheters placed from September 2008 to December 2009 comprised the 72h group. Catheter infection rates were determined using the National Healthcare Safety Network definition for central line-associated bloodstream infections (CLABSIs) and calculated as CLABSIs/1000 catheter days. The two groups were not significantly different for age, sex, burn etiology, total burn size, or percent third-degree burn. There were 3.1 CLABSIs/1000 catheter days for the 48h group and 2.8 CLABSIs/1000 catheter days for the 72h group (NS). The authors conclude that increasing the central catheter change interval from 48 to 72 hours did not result in any increase in their CLABSI rate. Implementation of this change in practice is expected to decrease supply costs by $28,000 annually in addition to reducing clinical support services needed to perform these procedures.

Obesity Has Minimal Impact on Clinical Outcomes in Children with Inflammatory Bowel Disease

PurposeChildhood obesity is an increasing problem in affluent societies throughout the world. We sought to identify the impact of obesity on the outcome of inflammatory bowel disease (IBD) and determine differences (if any) between ulcerative colitis (UC) and Crohn’s disease (CD). MethodsThe 2009 Kids’ Inpatient Database was explored for all children (≤20years) admitted with IBD. ICD-9 codes were used to identify obesity and complications, including hemorrhage, perforation, and complex fistulas. Logistic regression analysis accounting for demographics, underlying disease, surgical procedures, and obesity was performed to identify factors associated with complication development. Data are expressed as odds ratios (OR) and a 95% confidence interval (CI). A P value of 0.05 was regarded as significant. ResultsFrom 12,465 admissions, 164 children were obese (1.3%), with no difference between CD and UC (1.3% vs. 1.4%; P=0.60). Girls had a two-fold increase in obesity (OR: 2.06, CI: 1.48–2.86; P<0.01). Obesity had no effect on elective/emergent admission rate (OR: 0.85, CI: 0.54–1.35; P=0.49), perforation (OR: 0.76, CI: 0.13–4.46; P=0.76), hemorrhage (OR: 0.64,CI: 0.34–1.21; P=0.17), complex fistula (OR: 1.19, CI: 0.45–3.17; P=0.72), or requirement for surgery (OR: 0.80, CI: 0.48–1.31; P=0.37). While the overall clinical morbidity rate was 10.7%, obesity was not associated with the development of overall complications (OR 1.20, CI: 0.75–1.93; P=0.45) or length of stay (6.36 vs. 6.10days; P=0.61). Obesity increased the rate of central venous catheter (CVC) infections (OR: 10.98, CI: 2.50–48.20; P<0.01). ConclusionsObesity was more prevalent in girls with IBD. While obesity did not alter disease severity, rate of surgical intervention, or hospital length of stay, it was associated with higher CVC infections.

Tunneled Internal Jugular Hemodialysis Catheters: Impact of Laterality and Tip Position on Catheter Dysfunction and Infection Rates

PurposeTo determine rates of dysfunction and infection for tunneled internal jugular vein hemodialysis catheters based on laterality of insertion and catheter tip position. Materials and MethodsRetrospective review of a procedural database for tunneled internal jugular vein hemodialysis catheter placements between January 2008 and December 2009 revealed 532 catheter insertions in 409 patients (234 male; mean age, 54.9 y). Of these, 398 catheters were placed on the right and 134 on the left. The catheter tip location was categorized as superior vena cava (SVC), pericavoatrial junction, or mid- to deep right atrium based on review of the final intraprocedural radiograph. The rates of catheter dysfunction and catheter-related infection (reported as events per 100 catheter-days) were analyzed. ResultsCatheters terminating in the SVC or pericavoatrial junction inserted from the left showed significantly higher rates of infection (0.50 vs 0.27; P = .005) and dysfunction (0.25 vs 0.11; P = .036) compared with those inserted from the right. No difference was identified based on laterality for catheter tip position in the mid- to deep right atrium. Left-sided catheters terminating in the SVC or pericavoatrial junction had significantly more episodes of catheter dysfunction or infection than catheters terminating in the mid- to deep right atrium (0.84 vs 0.35; P = .006), whereas no significant difference was identified for right-sided catheters based on tip position. ConclusionsWhen inserted from the left internal jugular vein, catheter tip position demonstrated a significant impact on catheter-related dysfunction and infection; this relationship was not demonstrated for right-sided catheters.

Prevention of Peritoneal Dialysis Catheter Infections in Saudi Peritoneal Dialysis Patients: The Emergence of High-Level Mupirocin Resistance

Exit-site infection (ESI) and peritonitis remain the major causes of morbidity and mortality in peritoneal dialysis (PD) patients. This study compared the effectiveness of local mupirocin ointment and gentamicin cream in preventing both gram-positive and gram-negative bacterial infections in PD patients. Patients from two centers (n = 203) were assigned to daily mupirocin ointment or gentamicin cream application. Infections were tracked prospectively by organisms and expressed as episodes per patient-year for both ESI and peritonitis. The rate of gram-positive ESI was 0.31/episode/patient-year and 0.22 episodes/patient-year (p<0.05), whereas the rate of gram-negative ESI was 0.28 episode/patient-year and 0.11 episode/patient-year (p<0.01) in the mupirocin group and gentamicin group, respectively. Gram-positive ESI occurred in 17.1% vs 10.2% of patients (p<0.05), whereas 20% of and 5.1% of patients (p<0.001) had gram-negative ESI in the 2 groups respectively. S.aureus was cultured at exit-site in the mupirocin group in 27.8% patients, 60% (16.7% of the total Gram-positive isolates) of them being with high-level mupirocin-resistance. Pseudomonas aeruginosa was cultured in 21.8% of ESI in the mupirocin group, and in only 6.7% in the gentamicin group (p<0.01). Peritonitis rates were lower using gentamicin cream, 0.17 episode/patient-year compared with mupirocin, 0.39 episode/patient-year (p<0.01). With multivariate analysis, only gentamicin exit-site use was a significant predictor for lower catheter infection rate. Prolonged use of mupirocin for ESI-prophylaxis is associated with the emergence of mupirocin-resistant S. aureus. Gentamicin cream is superior to mupirocin ointment in the prevention of PD catheter infections.

Peripherally Inserted Central Catheters for Long‐term Parenteral Nutrition in Infants With Intestinal Failure

Infants with intestinal failure often require long-term central access for delivery of parenteral nutrition (PN). Traditionally, surgically placed central venous catheters (CVCs) have been used; however, the complications associated with these catheters can lead to significant morbidity. Peripherally inserted central catheters (PICCs) are potentially superior to CVCs because they tend to be smaller, and can be placed without general anesthesia. The purpose of the study is to report the use of PICCs for long-term administration of PN in infants with intestinal failure and compare with previously published catheter infection and venous thrombosis rates. A 4-year review of infants younger than 12 months with intestinal failure and a PICC for PN delivery was performed to determine the incidence of catheter-related bloodstream infections (CRBSIs) and PICC-associated venous thrombosis. The complication rates were compared with those reported for CVCs and PICCs in the pediatric literature. A total of 45 infants with intestinal failure, receiving PN through a PICC were included in the study. Data from 95 PICCs accounting for 10,189 catheter days were collected. The overall incidence of CRBSI was 5.3/1000 catheter days and the incidence of venous thrombosis was 2.0/1000 catheter days. PICCs offer an advantage over CVCs in that they can often be inserted without a general anesthesia and do not require manipulation of the vein. Given the low rate of CRBSI and venous thrombosis, we recommend PICCs for infants with intestinal failure requiring PN.

Impact of NOD2 polymorphisms on infectious complications following chemotherapy in patients with acute myeloid leukaemia

We sought to investigate the relationship between polymorphisms of the NOD2 gene and infectious complications following intensive induction chemotherapy in patients with acute myeloid leukaemia (AML). We hypothesised that single nucleotide polymorphisms (SNPs) of the NOD2 gene are associated with a higher rate of infections during the phase of severe neutropenia. In 131 AML patients receiving induction therapy, the presence of the three most frequent polymorphisms of NOD2 (Arg702Trp, Gly908Arg, Leu1007fsinsC) was analysed. SNP analyses by means of genomic PCR incorporating fluorescence-labelled probes with characteristic melting curves were performed using the LightCycler platform. Our data suggest a significantly lower probability of mucositis or enteritis in AML patients lacking any of the three evaluated NOD2 polymorphisms. Furthermore, bloodstream cultures of AML patients carrying either a missense or a frameshift mutation of NOD2 were significantly more frequently tested positive concerning Streptococcus spp. In contrast, the presence of NOD2 polymorphisms had no impact on such important infectious complications as systemic inflammatory response syndrome or sepsis, the rate of central venous catheter infections or the incidence of pneumonia including fungal infections. Our data represent one of the first reports investigating the impact of polymorphisms of the innate immune system on infectious complications in patients with neutropenia following chemotherapy. A correlation between NOD2 polymorphisms and infectious events in AML patients is demonstrated.

Abstract No. 323 - Evaluation of catheter infection rates in patient after conversion of temporary to tunneled dialysis catheters versus de novo placement

Purpose Prior studies have reported infection rates of converting non tunneled dialysis catheters (NTDC) to tunneled dialysis catheters (TDC) vs. de novo placement of TDCs while using povidone-iodine as the sterilization agent. Chlorhexidine, as per the CDC guidelines, has been exclusively used as our sterilizing agent since 2005. Therefore, our study aims to determine whether there is a difference in infection rates between conversion and de novo placement when utilizing chlorhexidine. Materials and Methods A retrospective analysis of adult patients was performed evaluating a cohort of patients who underwent placement of a NTDC which was subsequently converted to a TDC and a second cohort who underwent de novo TDC placement from 1/1/2009 to 8/10/2012. To assess the rate of infection, the following data points were collected: date of procedure(s), indication, outcomes, site of catheter insertion, lab values pre and post procedure, imaging, complications, infection rates within the life of the initially placed catheter, length of catheter use before exchange (catheter days) and survival. Catheter-related infections were defined as any patient with an indwelling catheter that had positive blood cultures, positive tip cultures, or documented pus at the insertion site of the catheter. Results The conversion cohort was composed of 205 patients, 141 of which were lost to follow-up, leaving 64 patients within this group. (A majority of our patients receive dialysis at outside facilities, which accounts for the high number of patients lost to follow-up.) The de novo cohort included 60 randomly selected patients. Of the 64 patients who underwent conversion, 24 developed a catheter related infection, with a calculated infection rate of .27 events per 100 catheter days. Of the 60 de novo catheter events, 19 developed infection with a calculated infection rate of .26 events per 100 catheters days. Conclusion In this series, there is no difference in infection rates between conversion of NTDCs to TDCs vs. de novo TDC placement when utilizing chlorhexidine as the sterilzation agent. However, these infection rates are superior to those reported when using povidone-iodine.

A prospective observational study on 249 subcutaneous central vein access ports in a Swedish county hospital

Background. Reliable central vein access is a fundamental issue in modern advanced oncological care. The aim of this study was to determine the incidence of complications and patient perception regarding central vein access ports. Methods. We prospectively studied 249 single lumen access ports implanted between 1 July 2008 and 15 March 2010 in a mixed patient population at a 500-bed secondary level hospital in Sweden. We determined the number of catheter days, infection rate and mechanical complications, as well as patient satisfaction regarding the access port, over a six-month follow-up period. Results. Two hundred and forty-four different patients received 249 ports yielding a total of 37 763 catheter days. Ultrasound and fluoroscopic guidance was used in 98% of procedures. Vein access was obtained percutanously by an anaesthesiologist in all cases. There was no case of pneumo- or haemothorax. The incidence of catheter-related bloodstream infection, was 0.05/1000 catheter days and the incidence of pocket/tunnel infection was 0.39/1000 catheter days. Clinically apparent deep vein thrombosis occurred in four patients (1.6%). Patient satisfaction was overall high. Conclusion. These results confirm that our team-based approach with written easily accessible evidence-based guidelines and a structured education programme leads to a very low complication rate and a high degree of patient satisfaction.

The Impact of the Protocol of Central Line Bundle Care on Catheter Related Blood Stream Infection

Hospital acquired infection is a serious problem in the intensive care unit, and a major cause of morbidity and mortality of Intensive Care Unit patients. Application of the central line bundle has demonstrated striking reduction in the rate of catheter infections in hospitals. This study aimed to determine the impact of central line bundle care on catheter associated blood stream infection. Prospective randomized blinded clinical trial was performed. Sixty patients were randomly allocated into two groups. Group I: (n=30) patients who underwent catheter insertion using hospital procedure for central line and antibiotic coated catheter, Group II: (n=30) patients who underwent catheter insertion using bundle care protocol and silver coated catheter. Mean duration of catheters in bundle cared group were 11.07 ± 4.9 days while 11.4 ± 4.3 days in hospital technique group. Colonization was detected in 78.6% of antibiotic coated catheter (Group I) and 21.4% of silver coated catheter (Group II). Common microorganisms were 25.20% Acinetobacter, 24.39% Klebsiella, and 12.20% Staphylococcus epidermidis. Applications of bundle care protocol for Central Venous Catheter reduce the incidence rate of catheter-related infection. Furthermore, the use of silvercoated Central Venous Catheter is superior to antimicrobial-coated catheter in the prevention of catheter related infection.

Patency of Femoral Tunneled Hemodialysis Catheters and Factors Predictive of Patency Failure

To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Mean catheter primary patency failure time was 96.3days (SE 17.9days). Primary patency at 30, 60, 90, and 180days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p=0.009), were of increasing age at the time of insertion (p=0.002) and that those who had diabetes (p=0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.

Central Venous Catheter-related Blood Stream Infections in Children Undergoing Hematopoietic Stem Cell Transplant for Primary Immunodeficiency and Other Nonmalignant Disorders

A single-center experience of catheter-related blood stream infections in children undergoing hematopoietic stem cell transplant for primary immunodeficiency is described. The rate of definite central venous catheter infections was 5.31/1000 line days. Staphylococcus epidermidis was the most commonly identified organism. Teicoplanin resistance occurred in 17% of S. epidermidis infections. The central catheter was removed in 21% of infections.

Femoral central venous catheters are not associated with higher rates of infection in the pediatric critical care population

Adult data show a difference in central venous catheter (CVC) infection rates between 3 major sites: subclavian (SC), internal jugular (IJ), and femoral veins. We hypothesized that in patients in pediatric intensive care units (PICUs), there is no difference in rates of CVC infection among these three sites, but specifically the femoral compared to all other sites. In this retrospective cohort study, data from January 1999 to January 2008 were collected prospectively for internal review and quality assurance. All PICU patients with a CVC were enrolled. The rate of CVC infection was determined using Cox regression survival analysis to account for various durations of CVC placement at the various sites, then adjusted for severity of illness, number of lumens, and patient age. Mortality was compared in patients with a CVC infection versus those without. A total of 4,512 patients with a CVC were enrolled. No site was associated with an increased risk of infection compared with the other sites, with hazard ratios of 0.951 (95% confidence interval [CI], 0.612-1.478) for the SC site, 0.956 (95% CI, 0.593-1.541) for the IJ site, and 1.120 (95% CI, 0.753-1.665) for the femoral site. No significant association between mortality and presence of CVC infection was found when adjusted for age, severity of illness, and duration of CVC placement. An association was found between the presence of a CVC infection and prolonged PICU length of stay (3.98 days longer; P < .001). Femoral CVCs are not associated with higher rates of infection in the PICU. In addition, the presence of CVC infection does not affect mortality, but is associated with longer PICU admission.