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Ronco, Claudio

doi:10.1186/cc3890

Cited by 23 publications

(9 citation statements)

References 11 publications

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“…World over, the reported incidence of exit site infections vary from 6 to 15%, catheter tip infections from 4 to 15% and of CRBSIs from 1 to 13%. [ 16 17 ] While the IJV route is implicated to be more commonly associated with greater infectious complications,[ 1 18 ] in our patients, both routes of CVC insertion showed similar incidences of all three infectious complications.…”

Section: Discussionmentioning

confidence: 60%

Mechanical and infectious complications of central venous catheterizations in a tertiary-level intensive care unit in northern India

2012

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Background:Central venous catheters (CVC) are associated with mechanical, infectious and thrombotic complications.Aims:To study (a) the incidence of mechanical and infectious complications of CVC insertions and to compare, (b) the rates of these complications between the internal jugular venous (IJV) and the subclavian venous (SCV) accesses.Settings and Design:An adult intensive care unit of a tertiary care hospital. Prospective, observational study.Methods:All landmark-based CVC insertions performed between 1st October 2008 and 30th September 2009 were prospectively studied for mechanical and infectious complications.Statistical Analysis:SPSS software for Windows, Version SPSS 16.0, and Epi Info (3.5.1) software.Results:Four hundred and eighty central venous catheterizations were studied (IJV route, 241 and SCV route, 239). Mechanical complications occurred in 86 patients (17.9%, bleeding complications-48, catheter-related complications-27 and pneumothorax-11). The IJV route was associated with a significantly higher incidence of bleeding complications (P=0.009). Forty-seven patients had infectious complications (9.79%), like exit site infections (n=17), catheter tip infections (n=22) and catheter-related bloodstream infections (CRBSIs) (n=8). The risks of infectious complications increased significantly if the CVC was in situ for longer than 7 days (P=0.009), especially with IJV cannulae. The incidence density of CVC tip infections was 7.67 per 1000 catheter days and of CRBSIs was 2.79 per 1000 catheter days.Conclusions:Bleeding complications occurred more frequently with IJV insertions and infectious complications occurred more commonly in cannulae that were left in situ for longer than 7 days.

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Section: Discussionmentioning

confidence: 60%

Mechanical and infectious complications of central venous catheterizations in a tertiary-level intensive care unit in northern India

2012

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“…In addition, we believe the decision on immediate CVC removal or watchful waiting in patients with suspected CRI should take into account the following aspects for each patient: first, vascular accessibility, as new vascular catheterization may be very difficult in some cases due to poor vascular access; second, the risk of mechanical complications during new canalization that may even be life-threatening (for example, patients with coagulopathy or severe respiratory disease); third, the possibility that the CVC may not be the origin of the suspected CRI. In this regard, CVCs placed in the jugular vein of tracheostomized patients [ 16 ] or those placed in the femoral vein present a higher risk of CRBSI [ 17 ]; however, the risk of CRBSI decreases with the use of antimicrobial-impregnated catheters [ 18 ] and dressings [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Should central venous catheter be systematically removed in patients with suspected catheter related infection?

Lorente

Martı́n²,

Vidal

et al. 2014

Crit Care

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IntroductionBest clinical practice for patients with suspected catheter-related infection (CRI) remains unclear according to the latest Infectious Diseases Society of America (IDSA) guidelines. Thus, the objective of this study was to analyze clinical practice concerning the central venous catheter (CVC) and its impact on prognosis in patients with suspected CRI.MethodsWe performed a prospective, multicenter, observational study in 18 Spanish Intensive Care Units (ICUs). Inclusion criteria were patients with CVC and suspected CRI. The following exclusion criteria were used: age less than 18 years; pregnancy; lactation; human immunodeficiency virus; neutropenia; solid or haematological tumor; immunosuppressive or radiation therapy; transplanted organ; intravascular foreign body; haemodynamic instability; suppuration or frank erythema/induration at the insertion site of the CVC, and patients with bacteremia or fungemia. The end-point of the study was mortality at 30 days of CRI suspicion.ResultsThe study included 384 patients. In 214 (55.8%) patients, CVC was removed at the moment of CRI suspicion, in 114 (29.7%) CVC was removed later and in 56 (14.6%) CVC was not removed. We did not find significant differences between survivors (n =311) and non-survivors (n =73) at 30 days according to CVC decision (P =0.26). The rate of confirmed catheter-related bloodstream infection (CRBSI) was higher in survivors than in non-survivors (14.5% versus 4.1%; P =0.02). Mortality rate was lower in patients with CRBSI than in the group of patients whose clinical symptoms were due to other causes (3/48 (6.25%) versus 70/336 (20.8%); P =0.02). We did not find significant differences in mortality in patients with confirmed CRBSI according to CVC removal at the moment of CRI suspicion (n =38) or later (n =10) (7.9% versus 0; P =0.99).ConclusionIn patients with suspected CRI, immediate CVC removal may be not necessary in all patients. Other aspects should be taken into account in the decision-making, such as vascular accessibility, the risk of mechanical complications during new cannulation that may be life-threatening, and the possibility that the CVC may not be the origin of the suspected CRI.

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“…The risk of infection is affected by the catheter placement site, being more common after femoral (and, to a lesser extent, internal jugular vein) catheterization than after subclavian vein catheterization. 7 Thus, only patients with jugular vein catheters were included in the present study. The duration of catheterization is also a significant risk factor; CRBSI rates increase after six days of catheterization.…”

Section: Discussionmentioning

confidence: 99%

Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms

et al. 2018

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Objective:We compared the protective effects of secure Chlorhexidine Gluconate (CHG)-containing dressings with those of non-antimicrobial transparent dressings.Methods:This prospective, comparative, single-center clinical study was conducted in a tertiary pediatric intensive care unit from October 2014 to March 2017. The inclusion criterion was catheterization of the jugular vein for ≥48 hour. The study was conducted in two phases. Non-antimicrobial standard dressings were applied both before and after the CHG- dressing phase to negate any coincidental temporal effect. During the standard-dressing phases, the dressings did not include any antimicrobial; transparent CHG-impregnated dressings were applied during the test phase. All patients were divided into two groups by the type of dressing applied (standard and CHG-containing dressings).Results:The standard- and CHG-dressing groups contained 68 and 63 patients, respectively. The median durations of catheterization were 13 (8–22) and 14 (2–28) days, respectively (p>0.05). The Catheter-Related Bloodstream Infection (CRBSI) rate was somewhat lower in the CHG-dressing group (20.6 vs. 26.5%), but the difference was not statistically significant (p>0.05). In the CHG-dressing group, CRBSIs caused by Gram-positive microorganisms totaled 0%, but the figure was 8.8% in the control group (p=0.028).Conclusions:CHG dressings reduced CRBSIs caused by Gram-positive microorganisms.

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Untitled

Cited by 23 publications

References 11 publications

Mechanical and infectious complications of central venous catheterizations in a tertiary-level intensive care unit in northern India

Mechanical and infectious complications of central venous catheterizations in a tertiary-level intensive care unit in northern India

Should central venous catheter be systematically removed in patients with suspected catheter related infection?

Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms

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