Assessment of Catheter-Associated Infection Risk with the Hickman Right Atrial Catheter

Fuchs, Peter; Gustafson, Marie E.; King, James T.; Goodall, Patrick T.

doi:10.1017/s0195941700060161

Cited by 47 publications

(16 citation statements)

References 9 publications

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“…Although guidelines for the management of bacterial infections with central catheters do exist, these are mainly directed at inpatient management, and encompass catheters used for a combination of acute and chronic needs, including total parenteral nutrition (TPN), che-motherapeutics, parenteral antibiotics, and hemodialysis [3][4][5][6][7][8][9][10][11][12][13][14]. We reviewed all cases of silastic right atrial catheter-related bacterial infections in our pediatric patients undergoing chronic hemodialysis on an outpatient basis to determine the circumstances in which it might be possible to manage such patients without catheter removal.…”

Section: Introductionmentioning

confidence: 99%

Management of hemodialysis catheter-related bacteremia - a 10-year experience

Chawla¹,

Nevins²

2000

Pediatric Nephrology

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Between January 1986 and December 1995, 18 episodes of bacteremia occurred in our pediatric patients undergoing chronic hemodialysis on an outpatient basis. Seven episodes were caused by coagulase-negative Staphylococcus, 6 by Staphylococcus aureus, 2 by Mycobacterium, and 1 each by Pseudomonas, Xanthomonas, and Enterococcus. In 6 cases, the catheter was retained with antimicrobial therapy alone, whereas 12 cases required removal of the catheter after some period of time. The subset of cases in which catheter removal was necessary included 2 cases of Mycobacterium fortuitum complex and 5 cases of Staphylococcus aureus. We found that Staphylococcus aureus bacteremia may be cleared with antibiotic therapy alone in a minority of cases (17%). In the 6 cases in which catheters were retained and infections cleared, the maximum length of time to sterilization of blood with appropriate antibiotics was 48 h.

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Section: Introductionmentioning

confidence: 99%

Management of hemodialysis catheter-related bacteremia - a 10-year experience

Chawla¹,

Nevins²

2000

Pediatric Nephrology

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“…Thus, the attitudes of medical teams are based on their own experience. Wide variations are observed in the frequency of heparinization in practice: it ranges from twice daily [22], through daily [1,4,5,7,13,19,24,25,27,29,30], every 3 days [20], every 4 days [15], every 6 days [11], once a week [8,17,18] and twice a month [23] to every month [3]. No scheme has emerged as the best, which may explain the lack of general agreement.…”

Section: Discussionmentioning

confidence: 99%

Suppression of heparinization of central venous catheters between cycles of chemotherapy

Delva¹,

Gamelin²,

Lortholary³

et al. 1998

Support Care Cancer

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A phase I study to evaluate heparinization of tunnelled subclavian catheters (TSC) was conducted in 42 patients who each had a TSC for chemotherapy. They were enrolled in the study from August 1994 to December 1995. The inclusion criteria were: age 18-70, no general anticoagulant treatment, TSC used only for chemotherapy, informed consent. Heparinization was performed at the end of each cycle and then at increasing intervals: 11, 13, 15, 17, 19, and 21 days. A 21-day interval was intended to mimic the suppression of heparinization between cycles. Heparinization was performed with a 250 IU/ml heparin solution. Anti-Xa activity was studied before each heparinization. For each interval, at least 5 patients were followed up for two cycles. If no blockages were present progression to the next step was authorized. If one blockage was observed 5 additional patients were required to have their TSCs heparinized after the same interval. Two blockages (block) after the same interval meant that the previous interval was recorded as the longest tolerable. There were no blocks with the 11-day interval (6 patients), 1 block after 13 days (10 patients), 1 block after 15 days (10 patients), and no blocks after 17 days (5 patients), 19 days (6 patients), or 21 days (5 patients). The median anti-Xa activity (curative rate 0.2-0.6) was, respectively 11 days 6.74; 13 days 5.47; 15 days 4.71; 17 days 3.61; 19 days 3.67; 21 days 5.10 (NS). Heparinization between two cycles of chemotherapy is unnecessary. A high level of heparin activity persisted constantly inside the catheter lumen through the 3-week observation period.

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“…Difficult cannulations, severe infectious underlying illnesses, immune deficiency or cannulations carried out under emergency conditions or by inexperienced doctors, predispose patients to infectious CVC complications in PE [17], [18], [19]. …”

Section: Central Venous Accessmentioning

confidence: 99%