Evaluation of strategies for central venous catheter replacement

Olson, Merle E.; K, Lam; Gp, Bodey; Eg, King; Jw, Costerton

doi:10.1097/00003246-199206000-00017

Cited by 31 publications

(14 citation statements)

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“…There were several key differences between the study by Maki respect to the development of catheter-related sepsis. Also, 20%-24% of central catheters were inserted in "old" sites over a guidewire, a practice that is likely associated with a higher risk of catheter-related sepsis [23,24]. We chose to study a more homogenous population of only centrally placed venous catheters inserted in fresh sites.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Trial of 10% Povidone‐Iodine versus 0.5% Tincture of Chlorhexidine as Cutaneous Antisepsis for Prevention of Central Venous Catheter Infection

et al. 2000

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A multicenter prospective, randomized, controlled trial, with 0.5% tincture of chlorhexidene versus 10% povidone-iodine as cutaneous antisepsis for central venous catheter (CVC) insertion, was conducted for patients in intensive care units. Of 374 patients, 242 had a CVC inserted for >3 days and were used for the primary analysis. Outcomes included catheter-related bacteremia, significant catheter colonization (> or = 15 colony-forming units [cfu]), exit-site infection, serial quantitative exit-site culture (every 72 h), and molecular subtyping of all isolates. Patients in both study groups were comparable with respect to age, sex, underlying disease, length of hospitalization, reason for line insertion, and baseline APACHE II score. Documented catheter-related bacteremia rates were 4.6 cases per 1000 catheter-days in the chlorhexidine group (n=125) and 4.1 cases per 1000 catheter-days in the povidone-iodine group (n=117; not significant [NS]). Significant catheter-tip colonization occurred in 24 (27%) of 88 patients in the povidone-iodine group and in 31 (34%) of 92 patients in the chlorhexidine group (NS). A mean exit-site colony count of 5.9 x 10(5) cfu/mL per 25 cm(2) of the surface area of skin in the povidone-iodine group versus 3.1 x 10(5) cfu/mL per 25 cm(2) in the chlorhexidine group (NS) was found. There was a trend toward fewer exit-site infections in the chlorhexidine group (0 of 125 patients) versus those in the povidone-iodine group (4 of 117 patients; P=.053). Results of an intention-to-treat analysis were unchanged from the primary analysis. No difference was demonstrable between 0.5% tincture of chlorhexidine and 10% povidone-iodine when used for cutaneous antisepsis for CVC insertion in patients in the intensive care unit.

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Section: Discussionmentioning

confidence: 99%

Prospective Randomized Trial of 10% Povidone‐Iodine versus 0.5% Tincture of Chlorhexidine as Cutaneous Antisepsis for Prevention of Central Venous Catheter Infection

et al. 2000

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“…Rather, this model simulates the in vivo environment that the catheter is expected to be in contact with up to the projected life of the device. This feature of the model is important in that the risks of CRBSI increase as the duration of implantation increases [34, 35], and the replacement of PICCs is not a recommended strategy [17, 34] underlying the need for devices with long-acting antimicrobial coatings and models that can accurately evaluate these technologies.…”

Section: Discussionmentioning

confidence: 99%

“…This fact often leads to the failure of conventional antibiotic therapy and necessitates the removal of infected devices. Removal of the infected device is often not practical (as in the case in pace makers or artificial joints) or not at good strategy as this can lead to the production of detached, slime-enclosed, antibiotic-resistant aggregates that can initiate endocarditis or pneumonia by dissemination in the blood stream [17]. With this in mind, medical device manufacturers and researchers in biofilm microbiology have developed strategies and technologies to prevent the initial colonization and prevent the subsequent biofilm colonization of various implant medical devices.…”

Section: Introductionmentioning

confidence: 99%

AnIn VivoRabbit Model for the Evaluation of Antimicrobial Peripherally Inserted Central Catheter to Reduce Microbial Migration and Colonization as Compared to an Uncoated PICC

Allan¹,

Giare-Patel

Olson

2012

Journal of Biomedicine and Biotechnology

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Infection is the leading complication associated with intravascular devices, and these infections develop when a catheter becomes colonized by microorganisms. To combat this issue, medical device manufacturers seek to provide healthcare facilities with antimicrobial medical devices to prevent or reduce the colonization. In order to adequately evaluate these devices, an in vivo model is required to accurately assess the performance of the antimicrobial devices in a clinical setting. The model presented herein was designed to provide a simulation of the subcutaneous tunnel environment to evaluate the ability of an antimicrobial peripherally inserted central catheter (PICC), coated with chlorhexidine based technology, to reduce microbial migration and colonization compared to an uncoated PICC. Three samples of control, uncoated PICCs and three samples of coated PICCs were surgically tunneled into the backs of female New Zealand White rabbits. The insertion sites were then challenged with Staphylococcus aureus at the time of implantation. Animals were evaluated out to thirty days and sacrificed. Complete en bloc dissection and evaluation of the catheter and surrounding tissue demonstrated that the chlorhexidine coated catheter was able to significantly reduce microbial colonization and prevent microbial migration as compared to the standard, un-treated catheter.

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“…Organisms such as Staphylococcus epidermidis secrete a glycocalyx biofilm or slime, which once embedded in this fibrin sheath makes microorganisms more resistant to phagocytosis and less susceptible to antimicrobial agents. The guidewire exchange of infected lines has resulted in a high risk of CVC-related bloodstream infections with pneumonia and the rapid colonization of the new catheter, by embolization of the infected endoluminal biofilm [23,24].…”

Section: Occlusion Dangersmentioning

confidence: 99%

Clogbusting: time for a concerted approach to catheter occlusions?

Hardy

Ball

2005

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Catheter occlusion is a common problem costing considerable time and money for patients and healthcare professionals, requiring pro-action rather than reaction. None of the existing approaches is a complete answer, and further, coordinated research effort is needed. Endoluminal brushing is gradually gaining acceptance as a 'catch-all' solution once the catheter malfunctions, but understanding how and why catheters become blocked, and developing strategies to prevent occlusion would be a more scientific approach.

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Evaluation of strategies for central venous catheter replacement

Cited by 31 publications

References 0 publications

Prospective Randomized Trial of 10% Povidone‐Iodine versus 0.5% Tincture of Chlorhexidine as Cutaneous Antisepsis for Prevention of Central Venous Catheter Infection

Prospective Randomized Trial of 10% Povidone‐Iodine versus 0.5% Tincture of Chlorhexidine as Cutaneous Antisepsis for Prevention of Central Venous Catheter Infection

AnIn VivoRabbit Model for the Evaluation of Antimicrobial Peripherally Inserted Central Catheter to Reduce Microbial Migration and Colonization as Compared to an Uncoated PICC

Clogbusting: time for a concerted approach to catheter occlusions?

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