Reduced catheter sepsis and prolonged catheter life using a tunnelled silicone rubber catheter for total parenteral nutrition

Mitchell, Andrew R.J.; Atkins, Susan; Royle, G. T.; Kettlewell, M. G. W.

doi:10.1002/bjs.1800690722

Cited by 30 publications

(4 citation statements)

References 8 publications

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“…Strikingly, the incidence of local and systemic catheter-related infection was very low, although the catheters were not equipped with a Dacron cuff and subcutaneously tunneled. As outlined by different authors, this special design reduces the risk of infection by inhibiting bacterial ascension from the skin (14,151. This low rate of infection in this series is mainly due to the short duration of the catheters, which correlates with the effective collection of the PBSC.…”

Section: Discussionmentioning

confidence: 99%

Large‐bore central venous catheters for the collection of peripheral blood stem cells

Hahn

Goldschmidt

Salwender

et al. 1995

J of Clinical Apheresis

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In order to establish a peripheral blood stem cell graft, repeated apheresis are necessary in the majority of patients. Each apheresis requires withdrawal and reinfusion of blood with high flow rates. To guarantee these flow rates, large-bore catheters are needed for central venous access. Subcutaneously tunneled silicone catheters (Hickman) caused venous thrombosis in 10-40% of the patients. We therefore used polyurethane large-bore catheters only for the time of peripheral blood stem cells (PBSC) collection. Via a Seldinger guidewire following delineation of the right (160 patients) or left (23 patients) internal jugular vein by ultrasound, 183 apheresis catheters have been inserted when the white blood cell count was > 1.0 x 10(9)/L and a measurable population of CD34+ cells was detected by fluorescence-activated cell sorter analysis. The median flow rate was 70 ml/min (range 50-80 ml/min). We observed the following complications: puncture of the carotid artery in 2%, pneumothorax in 0.5%, local infection in 3%, and catheter-related septicemia in only 2% of the patients. At the time of the removal of the catheters, we detected thrombosis of the internal jugular vein in 5% of the patients by ultrasound. The collection of PBSC with short-term, large-bore catheters is effective and is associated with a low incidence of infection and thrombosis.

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Section: Discussionmentioning

confidence: 99%

Large‐bore central venous catheters for the collection of peripheral blood stem cells

Hahn

Goldschmidt

Salwender

et al. 1995

J of Clinical Apheresis

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“…They have been successfully applied in short-and long-dwelling catheters, dialysis machines and blood oxygenators [118]. Polysiloxane-based catheters used for parenteral nutrition have been shown to cause significantly less sepsis compared to alternative materials [119]. Patient compliance improved in comparison to that found with PVC catheters, due to the extended working life of the polysiloxane materials.…”

Section: Polysiloxanesmentioning

confidence: 99%

Perspectives on alternatives to phthalate plasticized poly(vinyl chloride) in medical devices applications

Chiellini

Ferri

Morelli

et al. 2013

Progress in Polymer Science

294

256

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Poly(vinyl chloride) (PVC) is one of the most important polymeric materials available today and is used to manufacture many items, ranging from packaging and toys to healthcare devices. PVC is per se a rigid material but it is made softer by compounding with plasticizers, particularly phthalate esters such as di-(2-ethylhexyl) phthalate (DEHP). In flexible plasticizer PVC (P-PVC), phthalates are not chemically bound to PVC and they are released into the external environment. In particular, prolonged contact of P-PVC based medical devices with body fluids or tissues has been shown to be associated with severe health risks. Major concerns regarding the safety of P-PVC in medical plastic items have been raised, and several alternatives to phthalates and to P-PVC itself as well as chemical/physical treatments of P-PVC to reduce DEHP migration have been proposed. This review outlines recent scientific approaches for preventing DEHP contamination of humans by P-PVC medical devices, highlighting the impact of the proposed alternative materials on human health and strategies for implementing them

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“…Other factors that need to be considered when reviewing studies reporting rates of CVC-associated BSIs (18) include different patient populations, the intent of catheter use (22) and the duration of use (14,23). Before the study, we predicted that rates calculated in the present study would be higher than those reported by the NNIS (14) because the NNIS uses all CVCs in the denominator data, regardless of duration.…”

Section: Central Venous Catheter Infectionsmentioning

confidence: 97%

Central Venous Catheter‐Associated Blood Stream Infections Occurring in Canadian Intensive Care Units: A Six‐Month Cohort Study

Holton

Paton²,

Conly³

et al. 2006

Canadian Journal of Infectious Diseases and Medical Microbiolog

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METHODS: Data were collected using a standardized format on all CVCs and patients when a CVC was inserted for more than 48 h. Results of microbiological studies and therapeutic interventions were recorded when a BSI occurred. RESULTS: There were 182 BSIs from 3696 CVC insertions in 2531 patients. Coagulase-negative staphylococci were responsible for 73% of the BSIs. Mean rates of CVC-associated BSIs per 1000 CVC days were 6.9, 6.8 and 5.0 in adult, neonatal and pediatric ICUs, respectively. Significant factors associated with BSI included duration of CVC insertion (OR=1.2, 95% CI 1.1 to 1.3), receiving total parenteral nutrition (OR=4.1, 95% CI 1.2 to 14.3) and having one or more CVCs (OR=3.1, 95% CI 1.5 to 6.5). In the case-control study, 80% of the variance in a backward elimination logistic regression analysis was explained by duration of CVC insertion (OR=1.2 per day), receiving chemotherapy (OR=6.1), more than one CVC insertion during the study (OR=3.5), insertion of a CVC with two or more lumens (OR=2.3), using the CVC to administer total parenteral nutrition (OR=1.6) and having a surgical wound other than a clean wound (OR=1.6). CONCLUSION: The present study identified risk factors explaining 80% of the variance associated with BSIs and is one of the largest reports on the rate of CVC-associated BSIs occurring in the ICU setting.

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Reduced catheter sepsis and prolonged catheter life using a tunnelled silicone rubber catheter for total parenteral nutrition

Cited by 30 publications

References 8 publications

Large‐bore central venous catheters for the collection of peripheral blood stem cells

Large‐bore central venous catheters for the collection of peripheral blood stem cells

Perspectives on alternatives to phthalate plasticized poly(vinyl chloride) in medical devices applications

Central Venous Catheter‐Associated Blood Stream Infections Occurring in Canadian Intensive Care Units: A Six‐Month Cohort Study

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