Infectious risk associated with arterial catheters compared with central venous catheters*

Abstract

After participating in this activity, the participant should be better able to:1. Illustrate factors associated with arterial catheter-related colonization.2. Explain risk factors associated with central venous catheter-associated colonization.3. Use this information in a clinical setting.Unless otherwise noted below, each faculty or staff's spouse/life partner (if any) has nothing to disclose.Dr. Timsit has disclosed that he received grants/research fees from Jousea-Cilog, Pfizer, and MSD; was a consultant/advisor for 3M, Core Fusion, and Sanofi-Pasteur; and was on the speaker's bureau for Astelles. He is currently receiving grants/reserach fees from Ethicon; is a consultant/advisor for 3M and Core Fusion; and is on the speaker's bureau for Astelles. The remaining authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.All faculty and staff in a position to control the content of this CME activity have disclosed that they have no financial relationship with, or financial interests in, any commercial companies pertaining to this educational activity.Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit. Background: Scheduled replacement of central venous catheters and, by extension, arterial catheters, is not recommended because the daily risk of catheter-related infection is considered constant over time after the first catheter days. Arterial catheters are considered at lower risk for catheter-related infection than central venous catheters in the absence of conclusive evidence. Objectives: To compare the daily risk and risk factors for colonization and catheter-related infection between arterial catheters and central venous catheters.Methods: We used data from a trial of seven intensive care units evaluating different dressing change intervals and a chlorhexidine-impregnated sponge. We determined the daily hazard rate and identified risk factors for colonization using a marginal Cox model for clustered data.Results: We included 3532 catheters and 27,541 catheter-days. Colonization rates did not differ between arterial catheters and central venous catheters (7.9% [11.4/1000 catheter-days] and 9.6% [11.1/1000 catheterdays], respectively). Arterial catheter and central venous catheter catheterrelated infection rates were 0.68% (1.0/1000 catheter-days) and 0.94% (1.09/ 1000 catheter-days), respectively. The daily hazard rate for colonization increased steadily over time for arterial catheters (p ‫؍‬ .008) but remained

Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

“…We found a higher incidence of colonization than for non-RRT catheters [e.g., 11.1 per 1000 catheter-days were reported in Lucet et al (15)], but paradoxically the incidence of clinically important catheter-related bloodstream infection was proportionally low. Using the equation derived from 29 papers of non-RRT catheters (16): BSI ϭ 0.73 ϩ 0.17 CTC (where BSI denotes bloodstream infection and CTC denotes colonization incidences), we would have expected 7.3 catheter-related bloodstream infection per 1000 catheter-days, which lies outside our 95% CI.…”

Closed Blood Conservation Device for Reducing Catheter-Related Infections in Children After Cardiac Surgery

“…However, in a prospective study 25 of 212 intensive care unit patients with placement of both arterial and central venous catheters, the cumulative incidence of catheter-related BSI for arterial catheters was 7.7%, comparable to an incidence of 9.4% for central venous catheters (P=.45). Several studies [9][10][11] confirmed that risk for infection associated with arterial catheters was similar to the risk associated with central venous catheters. Thus, prevention of catheter-related BSI has become an important issue in medical practice.…”

“…Catheter-related bloodstream infections (BSIs) are a common and serious complication of intravascular catheters and are associated with increased morbidity, mortality, length of hospital stay, and medical costs. [1][2][3][4][5] Although previous studies [6][7][8] indicated a low risk for infections associated with use of arterial catheters, recent studies [9][10][11] showed that the risk for arterial catheter-related infection was high, comparable to the risk associated with short-term use of central venous catheters. Compared with adult patients, children are more susceptible to nosocomial infection, and catheter-related BSI is considered the most common nosocomial infection in pediatric intensive care units (PICUs).…”

Description of a new non‐injectable connector to reduce the complications of arterial blood sampling

“…Major complications occur in < 1% of cases, therefore arterial lines are deemed to be a safe procedure [4]. However, there are many cases reported of accidental injection into arterial lines with significant complications, with patients developing necrosis and requiring debridement of ischaemic areas [1][2][3].…”

“…Blood spillage, exsanguination and bacterial contamination are other potential complications when using the standard three-way tap [3]. It is not commonly appreciated that arterial cannulae are prone to colonisation and infection at a similar rate to central venous catheters [4]. No real solutions have been proposed to these problems.…”