Arterial catheter-related infection according to the catheter site

Abstract

Introduction There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

“…24 Such was the case in our control group, similar to published reports, 16,33,34 and much lower than reported by Esteve et al, 15 where improper handling of connectors was reported as a risk factor. The rate of blood culture contamination was similar to that reported by halm et al 35 In our trial, and in keeping with Koh et al, 36 increased manipulation of the arterial catheter by repeated blood extractions did not increase infection rates; however, this was a risk factor associated with infection by Rijnders.…”

Reply to Dr. Sakka

“…In conclusion, our contribution confirms the results of recent and large studies [5,6] reporting higher rate of colonization of peripheral arterial catheters inserted in critically ill patients via the femoral route. However, when the requirement for the best hemodynamic signal outweighs the infectious risks, the femoral route should be favored.…”

A snapshot of guideline compliance reveals room for improvement: A survey of peripheral arterial catheter practices in Australian operating theatres

“…Peripheral arterial catheters are widely used internationally and routinely inserted in the operating theatre (OT) for continuous haemodynamic monitoring and to provide convenient access for frequent arterial blood gas (ABG) analysis during major surgery (Harley 2000). Approximately, 8 million and 2Á5 million arterial catheters are inserted in the USA and Europe, respectively, each year for major surgery and critical care, with comparative widespread use in Australia (Gardner 1990, Scheer et al 2002, Lorente et al 2006, Australian Institute of Health & Welfare 2009). In spite of this extensive and well-documented global use of arterial lines, research about their management has not matched their universal application.…”