|EVIDENCE BASED DATA
|Year : 2007 | Volume
| Issue : 4 | Page : 347
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 Publication||20-Mar-2010|
25, Polo Ground, Udaipur (Raj.)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bajaj P. Vascular catheters and infection. Indian J Anaesth 2007;51:347
The number of estimated deaths from vascular catheter infections is 500-4000 annually , . Pittet and Wenzel  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  .
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  . 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  . 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  .
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  . 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. 
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  . All three venous sites, internal jugular, subclavian, and femoral, appear similar in terms of rate of infections  . Antibiotic-coated haemodialysis catheters decrease the rate of infections in patients with acute renal failure  . 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  .
| References|| |
|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. [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. [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. [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. [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. [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. [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. |