Catheter Infection Risk Related to the Distance Between Insertion Site and Burned Area

Abstract

A prospective observational study of central venous catheters (CVC) was carried out in order to determine if a CVC inserted near an open burn wound increases catheter infection risk in burned patients. The study was carried out during a 12-month period (1998-1999) at the Benaim Foundation's Burn Unit in Buenos Aires (C.E.P.A.Q.). Eighty-three CVCs were inserted in 20 burned patients during the study period. Twenty-six catheters were inserted near an open wound (NOW) and 57 far from an open wound (FOW). NOW CVCs were considered when 25 cm2 surrounding the catheter's insertion site overlapped the wound. Colonization rates were 84% (22/26 CVCs) in those inserted NOW and 47% (27/57 CVCs) in FOW (P = 0.001). Colonization relative risk of NOW-CVCs was 1.79 (95% confidence interval, 1.3-2.46). Bacteremia rates were 27% (7/26 CVCs) in CVCs inserted NOW and 6% (3/57 CVCs) in FOW (P = 0.004). Bacteremic risk of NOW-CVCs was 5.12 (95% confidence interval, 1.44-18.22). Colonization rates were higher and sooner in NOW-CVCs than in FOW-CVCs. We suggest that insertion of catheters near an open burn wound should be avoided and, if inevitable, should not be left in place for period exceeding 3 days.

Infecciones en los niños quemados: análisis epidemiológico y de los factores de riesgo

“…[11][12][13][14] Ramos y cols. 15 realizaron un estudio para evaluar la relación entre la distancia de inserción del catéter al área quemada y la infección en adultos. Se documentó que la colonización del catéter cercano al área quemada fue más frecuente, por lo que concluyeron que debería evitarse la inserción del catéter cercana al área quemada o hacer recambios frecuentes.…”

Catheter-related infections in a northwestern São Paulo reference unit for burned patients care

“…Although subclavian vein is the safest access to prevent infection, many catheters had to be placed in burned areas, usually associated with high bacterial counts, a well-known risk factor for such infections in these patients. 6 Moreover, the overwhelming majority of catheters in the present study were placed longer than 10 days, contributing to extensive handling and thus colonization. To overcome this problem, King and collaborators 7 proposed a three-day programmed catheter changes in burned patients.…”

“…Therefore, catheter related-infections are associated with important morbidity and mortality, increased hospital staying, and elevated health care costs. 6 Nevertheless, preventive recommendations in catheter-related infections are still rare and confl icting in this group of patients, justifying the need for further epidemiological and clinical characterization of such occurrences. 7 Herein we present the results of a retrospective study aiming at describing the epidemiological and clinical features of catheter-related infections in a reference burn care center unit in Southeast Brazil.…”

Sítio de inserção do cateter venoso no paciente queimado e ocorrência de infecção: revisão sistemática de literatura

“…Quanto aos delineamentos dos estudos incluídos na presente revisão, de acordo com a questão norteadora, oito foram classificados como observacionais (FRANCESCHI et al, 1989;ASKEW et al, 1990;MURR et al, 1991;KEALEY et al, 1995;STILL et al, 1998;RAMOS et al, 2002;O'MARA et al, 2007;FEARONCE et al, 2010;) e um como observacional do tipo descritivo (CAMPOS-JUNIOR et al, 2010). Durante a etapa de coleta de dados, dificuldades foram encontradas para definir o tipo de delineamento de alguns dos estudos analisados, devido à falta de informações na descrição metodológica do estudo.…”

“…Dois deles (KEALEY et al, 1995;ASKEW et al, 1990) relataram diferenças não significantes das taxas de infecção. Outros dois estudos (FRANCESCHI et al, 1989;RAMOS et al, 2002) As recomendações do CDC para inserção dos CVC são que, em pacientes adultos, a punção na femoral deve ser evitada e a preferência deve ser pela inserção na veia subclávia, para minimizar o risco de infecção (O'GRADY et al, 2011). Revisões sistemáticas com meta-análise de estudos sobre infecção relacionada ao cateter em pacientes críticos também encontraram que a inserção do CVC na veia subclávia estava associada à menor risco de infecção quando comparada à inserção na jugular e femoral (RAMRITU et.…”