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EVIDENCE BASED DATA
Year : 2007  |  Volume : 51  |  Issue : 4  |  Page : 347 Table of Contents     

Vascular catheters and infection


M.D, FICS, FAMS, Senior Prof. & Head, Department of Anaesthesiology, R.N.T.Medical College, Udaipur (Raj.), India

Date of Web Publication20-Mar-2010

Correspondence Address:
Pramila Bajaj
25, Polo Ground, Udaipur (Raj.)
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Bajaj P. Vascular catheters and infection. Indian J Anaesth 2007;51:347

How to cite this URL:
Bajaj P. Vascular catheters and infection. Indian J Anaesth [serial online] 2007 [cited 2019 Sep 22];51:347. Available from: http://www.ijaweb.org/text.asp?2007/51/4/347/61164

The number of estimated deaths from vascular cath­eter infections is 500-4000 annually [1],[2] . Pittet and Wenzel [3] reported that catheter infection carries an odds ratio for death as high as 20.45 (95% confidence interval, 18.9­22.1). Therefore, vascular catheter-related infections clearly are frequent and lethal.

It is not clear that placing a vascular catheter at a specific site increases the risk of infection. Merrer et al2 showed an increase in infections in catheters placed in the femoral vein in a randomized, multicenter investiga­tion. However, junior physicians placed the catheters, and minor and major infections were assessed. Other in­vestigations have not found that femoral venous cath­eters become infected more often [4] .

Most recently, a prospective investigation of the colonization and infection rate of subclavian, internal jugu­lar, and femoral vein catheters was performed at a single institution [4] . The investigation included surveillance of 831 venous catheters and 4735 catheter days in 657 critically ill patients. The incidence of overall venous catheter in­fection was 2.3% or 4.01/1000 catheters days and the colonization rate was 2.9% of the catheters or 5.07/1000 catheter day [4] . The incidence of infections of patients with one catheter in the femoral vein was 1.4% or 2.9/1000 catheter days. In comparison, patients with one subcla­vian venous catheter had an infection rate of 0.9/1000 days or 0.5%. Patients with one internal jugular venous catheter had an infection rate of 0/1000 days or 0%. These rates were not statistically different.

When patients had catheters in more than one site, there also was no statistical difference in the rates of infection or colonization [4] .

This epidemiologic investigation performed at one center suggests that all three venous insertion sites have the same risk of catheter infection when catheter insertion is performed by senior operators, strict sterile insertion tech­nique is utilized and standardized continuous catheter care is done by trained ICU nurses [4] . Notably the protocol for insertion demands the use of 2% iodine tincture to clean the skin at the insertion site and that operators wear sterile surgical gowns, gloves, and masks and utilize a large drape. Iodine ointment was placed at the insertion site and trans­parent dressing was used to maximally visualize the inser­tion site. Evaluation of line infection was based on the semi-quantitative technique of Maki et al. [5]

Anaesthesiologists placing central lines in the oper­ating room will be held to the same standard as intensivist. Therefore, anaesthesiologists need to use the same pro­tocols that ICU physicians use to maximize the sterility of venous lines. Those protocols uniformly demand the use of sterile gowns, gloves, masks, and large drapes during insertion [6] . All three venous sites, internal jugular, subcla­vian, and femoral, appear similar in terms of rate of infec­tions [4] . Antibiotic-coated haemodialysis catheters decrease the rate of infections in patients with acute renal failure [7] . The use of antibiotic-coated venous catheters has been shown to be efficacious; experts have recommended the use of chlorhexidine / silver sulfadiazine catheter in high risk patients requiring catheterization for up to 10 days [1] .

 
   References Top

1.Saint S, Savel RH, Matthay MA. Enhancing the safety of criti­cally ill patients by reducing urinary and central venous cath­eter-related infections. Am J Respir Crit Care Med 2002;165:1475-9.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001;286:700-7.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Pittet D, Wenzel RP. Nosocomial bloodstream infections: secu­lar trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:1177-84.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Deshpande KS, Hatem C, Ulrich HL, et al. The incidence of infectious complications of central venous catheters at the sub­clavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 2005;33:13-20.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977;296:1305-9.  Back to cited text no. 5  [PUBMED]    
6.Hu KK, Veenstra DL, Lipsky BA, Saint S. Use of maximal sterile barriers during central venous catheter insertion : clinical and economic outcomes. Clin Infect Dis 2004; 39: 1441-5.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.ChatzinikolaouI,FinkelK,HannaH,etal.Antibiotic-coatedhemodi­alysis catheters for the prevention of vascular catheter-related infec - tions : a prospective, randomized study.Am J Med 2003;115:352-7.  Back to cited text no. 7      




 

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