Guidewire catheter exchange with triple culture technique in the management of catheter sepsis

Abstract

We report 70 total parenteral nutrition (TPN) patients who received guidewire catheter exchange for suspected sepsis during their hospitalization. To diagnose catheter-related sepsis (CRS) and catheter infection (CI), we used a system of pre- and postexchange catheter blood cultures and a catheter tip culture. There were 27 catheter exchanges with positive cultures. The rate of definite CRS/CI (eight instances) was 6.8% of catheters exchanged and 3.5% of all catheters at risk. Probable CRS/CI (11 instances) was seen in 9% of exchanged catheters and 5% of at risk catheters. Thus, 19/27 positive cultures were presumed to represent definite or probable CRS/CI. Coagulase negative Staphylococcus (SCN) was the most frequently isolated organism. Simple catheter exchange was usually effective treatment of CRS/CI when SCN was the offending organism. The salvage rate of catheters exchanged for suspected sepsis or after a positive blood culture was 84%. Only 7% of exchanged catheters had to be removed. Guidewire exchange with triple culture technique was without mechanical complications. We recommend this technique to monitor central venous catheters in patients receiving TPN since it is simple, essentially painless to perform, and easily interpreted.

Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America

“…Microbiologic data suggestive of true CRBSI caused by potential skin flora rather than contamination include the following: multiple blood samples with positive culture results obtained from different sites; quantitative blood cultures performed on samples drawn from a catheter with growth of >15 cfu/mL of blood or isolation of the same organism from a catheter culture and a percutaneous blood culture, especially if a culture performed on blood drawn from the catheter shows growth at least 2 h earlier than a culture performed on blood drawn from a peripheral vein [72]. Although several studies suggest that catheter exchange over a guidewire can be used successfully to manage CRBSI associated with long-term catheters [73], most of these were small, uncontrolled studies with poor definitions, and none of these studies used antimicrobial catheters as a replacement for the infected catheter [73–77]. Management of CRBSI for patients with a long-term CVC or implantable device is summarized in tables 5 and 6 and in figure 2.…”

Novel approach using antimicrobial catheters to improve the management of central line‐associated bloodstream infections in cancer patients

“…The results of several studies suggest that CVC exchange is useful in the treatment of patients with CLABSIs 14‐20. However, most of these studies were open trials (without comparators such as CVC removal), included small numbers of CLABSI episodes (mostly coagulase‐negative Staphylococcus CLABSIs), or used loose definitions of CLABSI.…”

Detection and Prevention of Central Venous Catheter‐Related Infections

“…A widely practiced technique intended to reduce the incidence of mechanical complications associated with central venous catheterization is the use of Seldinger guide wire exchanges in lieu of routine catheter replacement at a new site. 16,[23][24][25]39,45,49,56,69,70,[110][111][112] This allows a new catheter to be substituted with substantially less risk of insertion-related complications. However, the new catheter is inserted over a guide-wire that might have been contaminated during the removal of the previous catheter.…”

“…This procedure has also been used diagnostically in cases of suspected catheterrelated infection. 16,23,45 Cobb et al recently compared scheduled catheter replacement with replacement of catheters prompted by clinical indications of infection. 56 They were unable to demonstrate any difference in catheter-related infection rates using these two methods; however, the number of infections in each subgroup was small.…”

“…particularly associated with intravascular catheters and parenteral nutrition.l>4,6,[9][10][11][12]16,20,25,27,34,[37][38][39]41,42,45,50,51,53,66,67,69,71,72 DIAGNOSIS OF CATHETER-ASSOCIATED INFECTION Physical inspection of the insertion site for signs of local infection, such as erythema, induration, tenderness, and increased warmth, correlates poorly with the presence of catheter-related infection 18,73. Drainage or expression of frankly purulent material is indicative of…”