Ruth Santacreu

Arterial catheter-related infection of 2,949 catheters

IntroductionWhich particular arterial catheter site is associated with a higher risk of infection remains controversial. The Centers for Disease Control and Prevention guidelines of 1996 and the latest guidelines of 2002 make no recommendation about which site or sites minimize the risk of catheter-related infection. The objective of the present study was to analyze the incidence of catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) of arterial catheters according to different access sites.MethodsWe performed a prospective observational study of all consecutive patients admitted to the 24 bed medical and surgical intensive care unit of a 650 bed university hospital during three years (1 May 2000 to 30 April 2003).ResultsA total of 2,018 patients was admitted to the intensive care unit during the study period. The number of arterial catheters, the number of days of arterial catheterization, the number of CRLIs and the number of CRBSIs were as follows: total, 2,949, 17,057, 20 and 10; radial, 2,088, 12,007, 9 and 3; brachial, 112, 649, 0 and 0; dorsalis pedis, 131, 754, 0 and 0; and femoral, 618, 3,647, 11 and 7. The CRLI incidence was significantly higher for femoral access (3.02/1,000 catheter-days) than for radial access (0.75/1,000 catheter-days) (odds ratio, 1.5; 95% confidence interval, 1.10–2.13; P = 0.01). The CRBSI incidence was significantly higher for femoral access (1.92/1,000 catheter-days) than for radial access (0.25/1,000 catheter-days) (odds ratio, 1.9; 95% confidence interval, 1.15–3.41; P = 0.009).ConclusionOur results suggest that a femoral site increases the risk of arterial catheter-related infection.

Chlorhexidine-silver sulfadiazine-impregnated venous catheters save costs

BACKGROUND Previous cost-effectiveness analyses have found that the use of chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters is associated with decreased catheter-related bloodstream infections (CRBSI) and central venous catheter (CVC)-related costs. However, in these analyses, the CVC-related cost included the increase of hospital stay. OBJECTIVE Our aim was to determine the immediate CVC-related cost (including only the cost of CVC, diagnosis of CRBSI, and antimicrobials for the treatment of CRBSI) of using a CHSS or a standard catheter in internal jugular venous access. METHODS We performed a prospective, observational, cohort study of patients admitted to the intensive care unit (ICU), Hospital Universitario de Canarias (Tenerife, Spain), who received 1 or more internal jugular venous catheters. RESULTS The study included 245 CHSS-impregnated catheters and 391 standard catheters. Exact logistic regression analysis showed that CHSS-impregnated catheters were associated with a lower incidence of CRBSI, controlling for catheter duration, than standard catheters (0 vs 5.04 CRBSI per 1,000 catheter-days, respectively; odds ratio, 0.80; 95% confidence interval: 0.712-0.898; P < .001). Poisson regression showed that CHSS-impregnated catheters were associated with lower CVC-related cost per day than standard catheters (€3.78 ± €4.45 vs €7.28 ± €16.71, respectively; odds ratio, 0.52; 95% confidence interval: 0.504-0.535; P < .001). Survival analysis showed that CHSS-impregnated catheters were associated with increased CRBSI-free time compared with standard catheters (χ(2) = 14.9; P < .001). CONCLUSION The use of CHSS-impregnated catheters reduced the incidence of CRBSI and immediate CVC-related costs in the internal jugular venous access.

Higher arterial catheter-related infection rates in femoral than in dorsalis pedis access.

Although there are many studies on arterial catheter-related infection (ACRI) there is little information on the relative risks associated with different catheter access sites. In previous studies we have shown a higher incidence of ACRI in femoral than in radial access sites. This prospective observational study was designed to compare the incidence of ACRI in patients on an intensive care unit with femoral versus dorsalis pedis access sites. We compared 1085 femoral arterial catheters inserted for a cumulative 6497 days with 174 dorsalis pedis catheters inserted for a cumulative 1050 days. We detected 33 cases of ACRI in the femoral access group (11 with bacteraemia and 22 with line site infection; 5.08 infections per 1000 catheter-days) but none in the dorsalis pedis access group. There were no significant differences between the two groups regarding age, sex, Acute Physiological Assessment and Chronic Health Evaluation (APACHE) II, diagnosis, previous arterial catheter insertion, use of mechanical ventilation, use of antimicrobials or catheter duration. Regression analysis showed a higher incidence of ACRI for femoral than for dorsalis pedis access sites (odds ratio: 7.6; 95% confidence interval: 1.37-infinite; P=0.01). These results suggest that dorsalis pedis arterial access should be used in preference to femoral arterial access in order to reduce the risk of ACRI.

Chlorhexidine-silver sulfadiazine-impregnated venous catheters are efficient even at subclavian sites without tracheostomy

BACKGROUND Chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters have been found to decrease the risk of catheter-related bloodstream infection (CRBSI) and central venous catheter (CVC)-related costs. However, there are no published data about cost-effectiveness of the use of CHSS-impregnated catheters in subclavian venous access without the presence of tracheostomy (thus, with a very low risk of CRBSI). That was the objective of this study. METHODS This was a retrospective study of patients admitted to a mixed intensive care unit who underwent placement of subclavian venous catheters without the presence of tracheostomy. RESULTS Patients with standard catheters (n = 747) showed a higher CRBSI incidence density (0.95 vs 0/1,000 catheter-days; P = .02) and higher CVC-related cost per day (

Lesser accidental arterial catheter removal with the femoral access than with the cubital, dorsalis pedis and brachial arterial accesses

3.78 ± 

Prolonged Intubation Rates After Coronary Artery Bypass Surgery and ICU Risk Stratification Score

7.43 vs

Higher Incidence of Catheter-Related Bacteremia in Jugular Site with Tracheostomy than in Femoral Site

3.31 ± 

Efficiency of chlorhexidine–silver sulfadiazine-impregnated venous catheters at subclavian sites

2.72; P < .001) than patients with a CHSS-impregnated catheter (n = 879). Exact logistic regression analysis showed that catheter duration (P = .02) and the type of catheter used (P = .01) were associated with the risk of CRBSI. Kaplan-Meier method showed that CHSS-impregnated catheters were associated with more prolonged CRBSI-free time than standard catheters (log-rank = 9.76; P = .002). Poisson regression analysis showed that CHSS-impregnated catheters were associated with a lower central venous catheter-related cost per day than standard catheters (odds ratio, 0.87; 95% confidence interval, 0.001-0.903; P < .001). CONCLUSIONS The use of CHSS-impregnated catheters is an effective and efficient measure for the prevention of CRBSI even at subclavian venous access sites without the presence of tracheostomy.

Catheter-related bloodstream infection according to central venous accesses

Arterial catheterization is a frequent proceeding in critically ill to obtain repetitively blood sampling and continuous monitoring of systemic arterial pressure arterial. The incidence of accidental catheter removal (ACR) in arterial catheters has been scarcely studied, and we did not find studies comparing the ACR incidence between femoral, cubital, dorsalis pedis and brachial arterial sites. The importance of ACR lies in that could cause severe complications, such as severe external haemorrhage and vascular damage, and some could be potentially life-threatening. Thus, due to the scarce published data and the possibility of severe complications in relation to ARC of arterial catheters we proposed this study. The objective of this study was to compare the incidence of ACR in femoral, cubital, dorsalis pedis and brachial arterial sites. We performed a retrospective study over seven years of all patients who were undergoing to femoral, cubital, dorsalis pedis or brachial arterial catheterization during their stay in the polyvalent Intensive Care Unit of the Hospital Universitario de Canarias, Tenerife, Spain. The study was approved by the institutional review board. The following data were collected: age, sex, diabetes mellitus, APACHE-II, diagnosis group, catheter access, catheter insertion and removal dates, and cause of catheter removal (planned or accidental). We considered accidental catheter removal as the presence of an unplanned removal produced by the patient or the staff. The ACR can be performed by the patient, either by taking hold of it with their hands or by making voluntary movements that led directly the removal. The ACR can be performed by the staff as consequence of inadequate handling. The catheters removed due to obstruction of the catheter were not considered as ACR. Statistical analyses were performed with SPSS 12.0.1 (SPSS Inc., Chicago, IL), LogXact 4.1 (Cytel Co., Cambridge, MA) and StatXact 5.0.3 (Cytel Co., Cambridge, MA). Continuous variables are reported as medians and percentiles 25th--75th, and were compared using Mann--Whitney test. Categorical variables are reported as frequencies and percentages, and were compared using Chi-square test. The incidence of ACR between groups was compared using Cox regression. The magnitude of the effects is expressed as Hazard Ratio (HR) and 95% confidence interval (CI). A p-value less than 0.05 was considered statistically significant. Were included a total of 2199 arterial catheters and remain in situ during 13,237 days. We detected 116 ACR, thus the 5.3% arterial catheters were accidentally removed and we had 0.88 ACR per 100 days of arterial catheterization. We found 49 events of ACR in 1250 (3.9%) arterial femoral catheters during 7524 days of catheterization (0.65 events of ACR per 100 days of catheterization), 39 events of ACR in 583 (6.7%) arterial cubital catheters during 3513 days of catheterization (1.11 events of ACR per 100 days of catheterization), 15 events of ACR in 198 (7.6%) arterial dorsalis pedis catheters during 1187 days of catheterization (1.26 events of ACR per 100 days of catheterization) and 13 events of ACR in 168 (7.7%) arterial brachial catheters during 1013 days of catheterization (1.28 events of ACR per 100 days of catheterization), As shown in Table 1, there were no significant differences between femoral, cubital, dorsalis pedis and brachial arterial catheters in age, sex, diabetes mellitus, APACHE-II, diagnosis group and duration of the catheter. However, there were found statistically significant differences in the percentage of catheters with ACR (p = 0.01) and in the ACR incidence per 100 days of catheterization (p = 0.02) between the different arterial sites. Cox regression analysis showed a lower ACR incidence in femoral than in cubital (Hazard Ratio = 0.608; 95% CI = 0.399--0.926; p = 0.02), dorsalis pedis (Hazard Ratio = 0.534; 95% CI = 0.299--0.952; p = 0.03) and brachial (Hazard Ratio = 0.500; 95% CI = 0.271--0.922; p = 0.03) arterial catheters (Table 2). To our knowledge, this is the first study comparing ACR incidence between femoral, cubital, dorsalis pedis and brachial arterial sites. The most relevant finding of our study is that femoral arterial catheter showed a lower ACR incidence that cubital, dorsalis pedis and brachial arterial catheters. In our study, we found that the 5.3% of arterial catheters were accidentally removed and an ACR rate of 0.88 events per 100 days of arterial catheterization. Our ACR rate is