Venous Catheter Blood Research Articles

In vitro assessment of effect of initial specimen diversion device on detection of central venous catheter contamination or colonization.

The role of initial specimen diversion devices (ISDDs) in preventing contamination of central venous catheter (CVC) blood cultures is undefined. A model to simulate CVC colonization and contamination compared standard cultures with ISDD technique. ISDD detected 100% of colonized CVCs while decreasing false-positive cultures from 36% to 16%.

Patient Blood Management: Mixing Versus Discard Methods for Central Venous Catheter Blood Specimen Collection.

A quasi-experimental study comparing the mixing and discard methods of laboratory specimen techniques in an adult acute care setting was conducted over a 30-month period. Primary end points were delta hemoglobin (Hgb) and transfusion rates. Secondary end points were redraws related to hemolysis and erroneous results, noting central venous access device (CVAD) type. Primary objectives included the comparison of hospital-acquired anemia and transfusion rates utilizing Hgb and venous sampling methods as part of a patient blood management (PBM) program. Secondary objectives tracked the type of CVAD used to acquire venous specimens and the impact on hemolysis rates or erroneous results. Considerations include exploring the benefits of utilizing the mixing method related to cost savings. In summary, the mixing versus discard method eliminates wasting blood to reduce hospital-acquired anemia as part of a PBM program. CVAD type did not influence hemolysis rates or impact erroneous results. The mixing method is easy to implement in any health care setting. Cost savings are feasible by elimination of external venous or arterial blood management protection devices. Removal of add-on devices supports standards by decreasing access points to reduce infection risk. Results, although inconclusive to superiority, demonstrated noninferiority and encouraged consideration of the mixing method for laboratory specimen collection.

Novel Effects of Chlorhexidine Gluconate on Gram-Positive vs Gram-Negative Microorganisms

Abstract Introduction/Objective Chlorhexidine Gluconate (CHG) is a widely used antiseptic for the skin, oral areas, and cleansing oneself for surgery. Uses of CHG throughout healthcare centers have proven to reduce potential pathogens and lessen risks of central venous catheter blood infections. Gram-positive and gram-negative microorganisms can lead to major diseases such as prostatitis, candidiasis, endocarditis, and more. It is crucial to understand the effects that CHG has on these organisms so we can accurately apply it to treat these various illnesses. It also allows us to better understand the source of surgical site infections (SSIs) and prevent them. Methods/Case Report A minimum bactericidal concentration (MBC) was employed to see how various CHG concentrations (0% (control), 1%, 3%, 5%, 7%, and 9%) would affect the gram-positive (C. albicans and S. aureus) and gram-negative (P. aeruginosa and E. coli) microorganisms. First, a 1.0 McFarland suspension was created for each organism. Then, the various CHG concentration wells for each microorganism would be created within 96 well plates. In each well, there was always 300 μL of solution (containing the McFarland suspension and CHG liquid formula (HibiClensTM). After 4 minutes of CHG exposure in each well, an inoculating loop was used to streak a petri dish. One trial was completed after all concentrations were done for each microoganism. Each trial was incubated for 24 hours and there were a total of 6 trials. Results (if a Case Study enter NA) The substantial results challenged the previously assumed hypothesis that gram- negative microorganisms are more resistant to CHG. The separation between the two types of microorganisms became evident at even the 1% CHG concentration. C. albicans and S. aureus are thriving with averages of approximately 74,333 CFU/mL and 70,333.3 CFU/mL respectively for 1% CHG in comparison to the 1% CHG concentration for P. aeruginosa (2,500 CFU/mL) and E. coli (22,334.3 CFU/mL). Additionally. P. aeruginosa and E. coli had no colonies in any of the trials at 7% and 9% CHG, while C. albicans and S. aureus were present in numerous amounts. Conclusion Through numerous trials using an MBC as a new method, dose response curves for E. coli, P. aeruginosa, S. aureus, and C. albicans were deduced. The curves displayed how gram-positive microorganisms are more resistant to CHG than gram-negative microorganisms, defying what was previously assumed. In regards to various diseases and infections caused by these various bacteria, CHG may now be assesed for potential forms of treatment.

Diagnostic efficiency of ultrasound diagnosis of venous catheters and venous catheter blood flow spectrum

BackgroundVenous catheter abnormalities are related to chromosomal abnormalities, in order to detect whether the fetus has congenital diseases as soon as possible. ObjectiveTo explore the image characteristics and diagnostic efficiency of ultrasound diagnosis of venous catheter abnormalities and venous catheter blood flow spectrum abnormalities. Method60 pregnant women were divided into a venous catheter abnormality group (n = 12) and a normal group (n = 48). Both groups underwent ultrasound examination. Collect abnormal fetal umbilical vein catheter and venous catheter blood flow spectrum parameters from the abnormal venous catheter group. Calculate the diagnostic efficiency and prognosis of two groups of patients. ResultIn this experiment, there were differences in peak atrial systolic velocity among participants, and the peak atrial systolic velocity in the group with abnormal venous catheters was lower than that in the normal group (P < 0.05). The positive detection rate of the normal group was 4.17%, and the negative detection rate was 95.83%. The positive detection rate of venous catheter abnormalities group was 66.67%, and the negative detection rate was 33.33%. The prognostic differences among participants in this experiment showed SSI (P<0.05). The proportion of abnormal prognosis of venous catheter abnormalities is higher than that of the normal group. ConclusionUltrasound diagnosis of fetal venous catheter abnormalities has high clinical value, which is beneficial for determining whether the fetus has congenital diseases through abnormal venous catheter blood flow spectrum.

Care bundle for the prevention of peripheral venous catheter blood stream infections at a secondary care university hospital: Implementation and results.

Venous catheterization for diagnostic and therapeutic purposes is part of routine hospital practice, as approximately 70% of hospitalized patients have a peripheral venous catheter (PVC). This practice, however, can lead to both local complications, (e.g., chemical, mechanical and infectious phlebitis) and systemic complications (e.g., PVC-related bloodstream infections [PVC-BSIs]). Surveillance data and activities are central to preventing nosocomial infections, phlebitis and improving patient care and safety. The aim of this study was to evaluate the impact of a care bundle on reducing PVC-BSI rates and phlebitis at a secondary care hospital in Mallorca, Spain. Three-phase intervention study targeting hospitalized patients with a PVC. The VINCat criteria were used to define PVC-BSIs and calculate incidence. In phase I (August-December 2015), we retrospectively analyzed baseline PVC-BSI rates at our hospital. In phase II (2016-2017), we conducted safety rounds and developed a care bundle with the goal of reducing PVC-BSI rates. In phase III (2018), we expanded the PVC-BSI bundle to prevent phlebitis and analyzed its impact. The incidence of PVC-BSIs decreased from 0.48 episodes per 1000 patient-days in 2015 to 0.17 episodes per 1000 patient-days in 2018. The 2017 safety rounds also detected a reduction in phlebitis (from 4.6% of 2.6%). Overall, 680 healthcare professionals were trained in catheter care and five safety rounds were conducted to assess bedside care. Implementation of a care bundle significantly reduced PVC-BSI rates and phlebitis at our hospital. Continuous surveillance programs are needed to adapt measures to improve patient care and guarantee safety.

612 - Reducing Central Line-Associated Bloodstream Infections (CLABSIs) through Standardizing Central Venous Catheter (CVC) Blood Draws and Chlorhexidine Gluconate (CHG) Treatment Usage

612 - Reducing Central Line-Associated Bloodstream Infections (CLABSIs) through Standardizing Central Venous Catheter (CVC) Blood Draws and Chlorhexidine Gluconate (CHG) Treatment Usage

Atomic force microscopy and scanning electron microscopy as alternative methods of early identification of pathogens causing catheter-related bloodstream infections of patients in ICU

Abstract Introduction Vascular catheters are an indispensable element of the therapy of patients in intensive care. Their use is associated with the possibility of complications, including infectious. According to various sources, the incidence of catheter-related bloodstream infections (CRBSIs) ranges from 0.1 to 22.7 per 1,000 catheter days. Materials and Methods The central venous catheter tip culture samples were collected from 24 patients with suspected catheter-related bloodstream infection, from three intensive care units (ICUs). The results of microscopic examinations: atomic force microscope (AFM) and scanning electron microscope (SEM) were compared with the results of microbiological analysis of the central venous catheter tip and blood collected from the catheter. Results The microscopic examination and microbiological analysis of both the blood and central venous catheter samples confirmed the presence of microorganisms in 16 cases (double positive result). Our study was conducted in a short period of time (up to 6 hours) and it gave an initial answer to the question about the type of microorganisms colonising the central venous catheter. In one patient the infection was not caused by removal of the central venous catheter. However, not all results were fully consistent within the two diagnostic methods. The colonisation of the central venous catheter with Pseudomonas aeruginosa and Staphylococcus epidermidis was microbiologically confirmed, but it was not confirmed by the microscopic examination of the sample collected from patient No. 20. However, the examination enabled preliminary assessment of the microorganism colonising the catheter, which may have caused the blood infection. It cannot be ruled out that Pseudomonas aeruginosa bacilli were grown on the catheter that came into contact with blood from another source of infection, e.g. the respiratory, nervous or urinary systems. Information on the presence of cocci-shaped bacteria forming characteristic clusters or rods may enable initial diagnosis of catheter-related bloodstream infection if it is accompanied by typical clinical symptoms. Alternative diagnostics also provides valuable information on the presence of biofilm, which is a factor hindering the body’s response to infection and penetration of antibiotics. Conclusions Our pilot study presents new diagnostic possibilities of microscopic imaging with the atomic force microscope (AFM) and scanning electron microscope (SEM) to identify pathogens on routinely used disposable medical devices, such as the central venous catheter. On the other hand, this range of diagnostics reveals the potential to constantly improve medical materials which come into direct contact with patients’ tissues. It is important to create a database of microscopic images, which would be a repeatable diagnostic pattern and fully correlated with the results of microbiological analysis, because it would facilitate initial quick diagnosis of a potential CRBSI.

Circulating Tumor Cells Enumeration from the Portal Vein for Risk Stratification in Early Pancreatic Cancer Patients.

Simple SummaryEffective biomarkers are needed to enable personalized medicine for pancreatic cancer patients. This study analyzes the prognostic value, in early pancreatic cancer, of circulating tumor cells and clusters from the central venous catheter and portal blood. Circulating tumor cells were isolated using an immunomagnetic selection and were detected by microscopy using immunocytochemistry staining. In conclusion, the circulating tumor cell number in portal blood identifies a death risk in patients with early pancreatic cancer.Background. Effective biomarkers are needed to enable personalized medicine for pancreatic cancer patients. This study analyzes the prognostic value, in early pancreatic cancer, of single circulating tumor cell (CTC) and CTC clusters from the central venous catheter (CVC) and portal blood (PV). Methods. In total, 7 mL of PV and CVC blood from 35 patients with early pancreatic cancer were analyzed. CTC were isolated using a positive immunomagnetic selection. The detection and identification of CTC were performed by immunocytochemistry (ICC) and were analyzed by Epi-fluorescence and confocal microscopy. Results. CTC and the clusters were detected both in PV and CVC. In both samples, the CTC number per cluster was higher in patients with grade three or poorly differentiated tumors (G3) than in patients with well (G1) or moderately (G2) differentiated. Patients with fewer than 185 CTC in PV exhibited a longer OS than patients with more than 185 CTC (24.5 vs. 10.0 months; p = 0.018). Similarly, patients with fewer than 15 clusters in PV showed a longer OS than patients with more than 15 clusters (19 vs. 10 months; p = 0.004). These significant correlations were not observed in CVC analyses. Conclusions. CTC presence in PV could be an important prognostic factor to predict poor prognosis in early pancreatic cancer. In addition, the number of clustered-CTC correlate to a tumor negative differentiation degree and, therefore, could be used as a diagnostic biomarker for pancreatic cancer.

How Do We Monitor Oxygenation during the Management of PPHN? Alveolar, Arterial, Mixed Venous Oxygen Tension or Peripheral Saturation?

Oxygen is a pulmonary vasodilator and plays an important role in mediating circulatory transition from fetal to postnatal period. Oxygen tension (PO2) in the alveolus (PAO2) and pulmonary artery (PaO2) are the main factors that influence hypoxic pulmonary vasoconstriction (HPV). Inability to achieve adequate pulmonary vasodilation at birth leads to persistent pulmonary hypertension of the newborn (PPHN). Supplemental oxygen therapy is the mainstay of PPHN management. However, optimal monitoring and targeting of oxygenation to achieve low pulmonary vascular resistance (PVR) and optimizing oxygen delivery to vital organs remains unknown. Noninvasive pulse oximetry measures peripheral saturations (SpO2) and a target range of 91–95% are recommended during acute PPHN management. However, for a given SpO2, there is wide variability in arterial PaO2, especially with variations in hemoglobin type (HbF or HbA due to transfusions), pH and body temperature. This review evaluates the role of alveolar, preductal, postductal, mixed venous PO2, and SpO2 in the management of PPHN. Translational and clinical studies suggest maintaining a PaO2 of 50–80 mmHg decreases PVR and augments pulmonary vasodilator management. Nevertheless, there are no randomized clinical trials evaluating outcomes in PPHN targeting SpO2 or PO2. Also, most critically ill patients have umbilical arterial catheters and postductal PaO2 may not be an accurate assessment of oxygen delivery to vital organs or factors influencing HPV. The mixed venous oxygen tension from umbilical venous catheter blood gas may assess pulmonary arterial PO2 and potentially predict HPV. It is crucial to conduct randomized controlled studies with different PO2/SpO2 target ranges for the management of PPHN and compare outcomes.

P1316PREDICTORS OF ARTERIO-VENOUS FISTULA FAILURE: A POST-HOC ANALYSIS OF THE FAVOURED STUDY

Abstract Background and Aims An autologous arteriovenous fistula (AVF) is the preferred haemodialysis vascular access but successful creation is hampered by high rates of AVF failure. This study aimed to evaluate patient and surgical factors associated with AVF failure to improve vascular access selection and outcomes. Method This is a post-hoc analysis of all participants of FAVOURED, a multi-centre, double-blind, multinational, randomized placebo-controlled trial evaluating the effect of fish oil and/or aspirin in preventing AVF failure in patients receiving haemodialysis. The primary outcome of AVF failure was a composite of fistula thrombosis and/or abandonment and/or cannulation failure at 12 months post AVF creation and secondary outcomes included individual outcome components. Patient data (demographics, comorbidities, medications and laboratory data) and surgical factors (surgical expertise, anaesthetic, intraoperative heparin use) were examined using multivariable logistic regression analyses to evaluate associations with AVF failure. Results Of 536 participants, 253 patients (47%) experienced AVF failure during the study period. The mean age was 55 ± 14.4 years, 64% were male, 45% were diabetic and 4% had peripheral vascular disease. Factors associated with AVF failure included female sex (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.20-2.67), lower diastolic blood pressure (DBP; OR for higher DBP 0.98, 95% CI 0.97-0.99), presence of central venous catheter (OR 1.50, 95% CI 1.02-2.20, p=0.04) and aspirin requirement (OR 1.61, 95% CI 1.01-2.57). Conclusion Female sex, requirement for aspirin therapy, requiring haemodialysis via a central venous catheter and lower diastolic blood pressure were factors associated with higher odds of AVF failure. These associations have potential implications for vascular access planning and warrant further studies.

Malassezia furfur Emergence and Candidemia Trends in a Neonatal Intensive Care Unit During 10 Years: The Experience of Fluconazole Prophylaxis in a Single Hospital.

Background:Because Candida spp is a major cause of mortality and morbidity in preterm infants, fluconazole prophylaxis has been suggested by some experts and hospital policy. In our hospital, fluconazole prophylaxis was used in eligible preterm infants and set as the neonatal intensive care unit (NICU) practice in 2014.Purpose:This study focused on fungal bloodstream infections and aimed to evaluate the benefit and harm of fluconazole prophylaxis.Methods/Search Strategy:This retrospective, descriptive study involved medical record reviews in our hospital from April 2005 to October 2016. NICU patients were included if Candida species, yeast-like organisms, or Malassezia species were cultured from their venous catheter tips or blood cultures.Findings/Results:After fluconazole prophylaxis, cases of Candida spp decreased and those of Malassezia furfur emerged. We reviewed 19 cases of catheter-related M furfur colonization and 1 case of M furfur fungemia. The gestational age was 27.3 ± 2.0 weeks and birth weight was 959.2 ± 229.8 g. Hyperalimentation with lipid infusion was used in all cases. All of the neonates survived with antifungal agent use.Implications for Practice:This study highlights that prophylactic fluconazole may be an associated factor of Malassezia colonization; M furfur remains a potential concern for fungemia in the care of premature infants and thus requires our attention.Implications for Research:Future studies should further investigate the incidence and impact of noncandidal fungal infections with fluconazole prophylaxis use in premature infants.

Analysis of survival for patients in relation to central venous catheter and nosocomial blood stream infections: A case study of Aga Khan University Hospital, Nairobi

Background: This study was focussed on survival rates of patients admitted to acute care units who utilized medical devices known as central venous catheters (CVC). CVCs are useful devices in clinical care; however some infections such as central line associated bloodstream infections (CLABSI) may occur, which are associated with increased lengths of stay and costs as well as higher morbidity and mortality rates. The overall objective of the present study was to determine survival probabilities and hazard rates for patients who used CVC devices and compare the subgroups by infection status. Methods: The study was focused on all patients who were admitted to Critical Care Units between 8th December 2012 and 31st March 2016 and utilized CVC devices. It was a retrospective study. Survival analysis techniques, test of equality of proportions, Man-Whitney test and Chi–square test of independence were used. Results: A total of 363 out of 1089 patients included in the study died during hospitalization. 47 patients developed nosocomial CLABSI. The average duration was 18.19 days and median of 12 days for hospitalized patients who did not develop a nosocomial CLABSI compared to an average of 56.79 days and a median of 51 days for those who did. There was a significantly higher proportion of mortality of those who developed nosocomial CLABSI compared to those that didn’t (p-value=0.01379). The results indicate that there was a significant association between infection status and discharge status, and significant difference to the survival rates of the patients based on infection status. Conclusions: There is a significant impact on mortality and morbidity of patients who develop nosocomial CLABSI. The duration of hospitalization by patients who developed CLABSI was significantly higher compared to patients who did not. Increased length of stay leads to higher cost of hospitalization.

Evaluation of a new venous catheter blood draw device and its impact on specimen hemolysis rates

ObjectivesBlood collections from peripheral intravenous catheters offer several benefits to patients, including reduced needle punctures and patient discomfort, but they risk reducing the quality of blood specimens analyzed by the laboratory. In an effort to balance analytical quality of test results with patient-centered care initiatives, a needle-less blood collection device called PIVO™ was evaluated at two institutions. The primary objective of this study was to assess the ability of the PIVO™ device to provide high-quality blood specimens for laboratory testing compared to current blood collection methods. MethodsBlood specimens drawn using the PIVO™ device were prospectively flagged. A retrospective review was performed comparing the degree and rate of hemolysis for PIVO™ blood collections to both concurrent and historical hemolysis rates for other collection methods. ResultsApproximately 7600 PIVO™ blood draws were performed across the two institutions. The hemolysis rates of samples collected with PIVO™ were evaluated using 2380 flagged collections, containing approximately 1200 test orders requiring hemolysis index measurements. The hemolysis rate of PIVO™-flagged samples (1.8%) was statistically superior to the venipuncture and central line blood collection methods (3.3%), reducing the risk of hemolysis during a venous blood draw by 39%. ConclusionsPIVO™ collections facilitated improvement in the rate and degree of sample hemolysis when compared to venipuncture and central line blood collections. These findings suggest that PIVO™ is capable of delivering samples that are superior to current blood collection methods in terms of hemolysis rate as well as reducing the number of invasive venipunctures required for laboratory testing.

Assessing Estimates of Patient Safety Derived From Coded Data.

The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSI) with the goal of detecting and preventing adverse events using administrative data. Use of PSIs to measure safety and quality of care raises questions since they rely heavily on coded data. The goal of this paper is to review literature on AHRQ PSIs, specifically their accuracy in detecting adverse events, and how recent coding changes affect the accuracy of these estimates. The Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS) contains data on more than seven million hospital stays yearly. Trending these estimates over time indicate there has been a decrease in rates for the majority of PSIs, with Accidental Puncture or Laceration, Central Venous Catheter Blood Stream Infections, Iatrogenic Pneumothorax, and Deaths from complications decreasing significantly each year from 2008-2012. Birth Trauma, Retained Foreign Bodies, Post-op Sepsis and Post-Op Respiratory Failure PSIs show no improvement from 2008-2012. A literature review on accuracy of PSIs and the affect of the Present on Admission (POA) indicator on PSI estimates reveals mixed results. PSIs serve as a useful tool in identifying problem areas in quality of care but should be used cautiously in determining hospital performance.

The design and clinical application of a new type of disposable heparin free dialysis tube

Objective To investigate the clinical effect of a new type of disposable heparin free dialysis tube in uremic patients without heparin dialysis. Methods A total of 110 patients without heparin dialysis were divided into control group and observation group by random digits table method with 55 cases each. Based on the same pre dialysis and dialysis for heparin saline flushing of discontinuous saline on the control group using the traditional dialysis pipe for hemodialysis without heparin, the observation group used disposable non heparin dialysis pipe for hemodialysis without heparin. The number of patients with venous catheter blockage, blood loss and completion of dialysis time in two groups was recorded. Results The number of patients with venous catheter blockage, blood loss and completion of dialysis time was 6, 6, 47 cases in control group and 0, 0, 54 cases in observation group. The differences were statistically significant (χ2=4.407, 4.407, 4.356, P<0.05). Conclusions The new disposable heparin free dialysis tube can reduce the loss of blood and prolong the treatment time, and the operation is simple, safe and effective, and has good application value and application prospect. Key words: Renal dialysis; Nursing care; Coagulation; Vein pot; Without heparin

Plastic Blood Gas Syringes and Measurement Error in Central Venous Oxygen Saturations.

Measurement of central venous oxygen (SvO2) levels remains an important method for the detection of circulatory shock. Plastic blood gas syringes have supplanted glass. These syringes are, however, permeable to atmospheric oxygen. Common sampling practices, including a delay between blood aspiration and analysis and continuous mixing of the sample, may promote equilibration of the blood sample with atmospheric oxygen and could result in over estimation of SvO2 levels. Pulmonary artery or central venous catheter blood samples were taken from 21 critically ill patients. Two venous blood gas samples were collected simultaneously in plastic syringes. One sample was continuously mixed through a gentle rotation. The other sample was not mixed. Blood gas analyses were undertaken on both samples at baseline and at 5, 10, 15, and 20 min. Compared with baseline levels, the SvO2 increased significantly over time for both continuously mixed and nonmixed samples (P < 0.0001). The rate of the increase was 2-fold greater for continuously mixed samples (P < 0.0001). For continuously mixed samples, the SvO2 was 63% at baseline, 65% at 5 min, 70% at 10 min, 74% at 15 min, and 78% at 20 min. For the nonmixed samples, the levels were 63%, 64%, 66%, 68%, and 70%, respectively. This is the first report documenting that plastic blood gas syringes systematically overestimate SvO2 levels when there is a delay in analysis or continuous mixing of the sample. Overestimation of SvO2 levels may harm patients as circulatory shock may not be recognized and treated.

Characteristics of Upper Extremity Deep Vein Thrombosis in Hospitalized Patients. a Review of 8350 Admissions from the 2012 National Inpatient Sample

Background: The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing due to the increased use of central venous catheters. In contrast to lower extremity DVT (LEDVT), there is limited data to guide management, with many current management recommendations based on extrapolation from LEDVT studies. The aim of this study is to evaluate the characteristics and mortality associated with hospitalized patients with UEDVT from a large national database.Methods: Using the 2012 National Inpatient Sample (NIS), admissions with the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for UEDVT (453.82) were extracted, and data collected on age, sex, length of stay, mortality, and associated diagnoses and procedures. LEDVT (ICD-9-CM 453.40) data were extracted for comparison. Collected data were used to calculate odds ratios with corresponding 95% confidence intervals and p-values to show associations where applicable.Results: Of the 7,296,968 unweighted admissions in the 2012 NIS, 8,350 were associated with UEDVT, and 18,194 were associated with LEDVT (prevalence of 0.11% vs 0.25%, respectively). UEDVT and LEDVT rates were similar in men and women. However, compared to LEDVT, patients with UEDVT were younger (61yr vs. 67 yr; p<0.0001), had longer mean LOS (14 days (range 0-309) vs. 5 days (range 0-345); p<0.0001), and higher inpatient mortality (7.75% vs 5.34%; OR 1.45, 95% CI 1.31, 1.61; p<0.0001). Pulmonary embolism was less common in UEDVT than in LEDVT (6.2% vs. 25%; OR 0.24, 95% CI 0.22, 0.27; p<0.0001), but significantly more common than the general hospitalized population (6.2% vs. 0.08%; OR 7.7, 95% CI 7.04, 8.42; p<0.0001). Malignancy was slightly more common in patients with UEDVT compared to those with LEDVT (30.1% vs 27.1%; OR 1.11, 95% CI 1.05, 1.17; p=0.0002). UEDVT was associated with central venous catheter placement (OR 10.1, 95% CI 9.56, 10.68; p<0.0001), other venous catheter placement (OR 21.9, 95% CI 20.9, 22.9; p<0.0001), and red blood cell transfusion (OR 3.6, 95% CI 3.47, 3.83; p<0.0001) in the hospitalized population. Procedures most commonly associated with LEDVT were interruption of the vena cava, red blood cell transfusion and other venous catheter placement.Conclusions: UEDVT was less common than LEDVT, and associated with central venous catheter placement and blood transfusions in hospitalized patients. UEDVT tended to occur in younger patients with longer LOS, and was associated with a higher mortality and a slightly higher prevalence of malignancies than LEDVT. PE was less common during admissions with UEDVT than LEDVT, however UEDVT admissions were associated with an increased incidence of PE compared to the general inpatient population. The results of this large epidemiologic study of UEDVT in hospitalized patients contribute to our understanding of this increasingly common disease and will help define strategies for prophylaxis and treatment. DisclosuresNo relevant conflicts of interest to declare.

Reducing Routine Central Venous Catheter Blood Sampling: An Initiative to Decrease Catheter Occlusion and Infection

Reducing Routine Central Venous Catheter Blood Sampling: An Initiative to Decrease Catheter Occlusion and Infection

Central venous catheter dressing durability: an evaluation.

Skin organisms at the insertion site are frequently implicated in central venous catheter blood stream infections (CVC BSIs) yet few studies have compared the durability of CVC dressings in critically ill patients. To undertake an evaluation of the durability and associated costs of different CVC dressings. Dressing duration was captured prospectively using a pro forma on four different dressings on five critical care units over a 12-month period. Staff received training on CVC dressing evidence-based practices and a 'how to guide' was implemented. A total of 1229 CVC dressings were observed from 590 CVCs. One dressing had a median (IQR) duration of 68.5 h (range, 32-105 h) compared to a median duration of 43.5, 46.0 and 40.5 h for the other dressings (P <0.001). The mean time to change a CVC dressing was 13.5 min and the cost of a dressing change was in the range of £1.97-4.97. During the 12-month study period we observed a downward trend in CVC BSIs. Despite few dressings remaining adherent for 7 days, the low rates of CVC BSI observed suggests good dressing practices. One dressing appeared more durable than the others, although it was still below the recommended standard and more expensive.

Skin colonisation at the catheter exit site is strongly associated with catheter colonisation and catheter-related sepsis.

The commonest mode of catheter colonisation is via the extraluminal route with skin bacteria. Catheter-related sepsis causes significant mortality and morbidity in neonates. Our aim was to study the relationships between culture-positive catheter exit site skin swabs, percutaneous central venous catheter segments and blood to determine the magnitude of associations between exit site skin colonisation, catheter colonisation and catheter-related sepsis. In a prospective study, an exit site skin swab and three formerly in vivo catheter segments (proximal, middle and tip) were taken for culture at catheter removal. In those neonates who were clinically unwell at catheter removal, a peripheral blood culture was also collected. Univariate and multivariate analyses were used to study associations. Skin swabs were culture positive in 39 (21%) of 187 catheter removals. With a culture-positive skin swab, the risk of associated catheter colonisation was nearly eight times higher (OR: 7.84, 95% CI: 3.59-17.15) and the risk of definite catheter-related sepsis with the same organism was nearly 10 times higher (OR 9.86, 95% CI: 3.13-31.00). Culture-positive skin swabs from the catheter exit site were strongly associated with catheter colonisation and with definite catheter-related sepsis with the same organism. These data provide further evidence supporting catheter colonisation via the extraluminal route and highlight the importance of optimising skin disinfection before catheter insertion.