The CVC and CRBSI: don’t use it and lose it!

Laupland, Kevin B.; Koulenti, D.; Schwebel, Carole

doi:10.1007/s00134-017-5033-4

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…However, CVC insertion may increase the risk of related complications, especially under emergent conditions. Moreover, to reduce the incidence of CVC-associated bloodstream infections, shortening the indwelling time is recommended ( 11 ); hence, vasopressor infusion through a PIC has been recommended ( 12 , 13 ). It is extremely rare for patients with a PIC to develop thrombosis, and PIC-related bloodstream infections occur 40 times less often than CVC-related bloodstream infections ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of peripheral metaraminol infusion in patients with neurological conditions: a single-center retrospective observational study

Han,

Zhou

2024

Front. Neurol.

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IntroductionMetaraminol is a sympathomimetic amine vasopressor that can be administrated through a peripheral venous access. However, limited evidence restricts its application in critically ill patients. This study aimed to investigate the safety and efficacy of peripheral metaraminol infusion in patients with neurological conditions.MethodsPatients who received peripheral metaraminol infusion between May 2019 and April 2022 were recruited. Data on baseline characteristics, clinical parameters, and infusion-related complications were retrospectively collected and analyzed.Results273 patients who received metaraminol were enrolled. Of these, 35 (12.8%) patients required central venous catheter insertion due to inability in achieving hemodynamic stability following peripheral metaraminol monotherapy. In 29,574.2 hours of vasopressor infusion, metaraminol infusion resulted achievement of the target blood pressure 73.4% of the time. Meanwhile, adverse events occurred in 5 patients and resolved after local tissue treatment.DiscussionMetaraminol could provide hemodynamic support and avoid complications associated with a central venous catheter and delay in vasopressor administration. Through careful and close monitoring, peripheral metaraminol infusion is safe and feasible for patients with neurological conditions. Future large-scale, prospective, multicenter studies are needed to evaluate the safety and efficacy of metaraminol infusion through a peripheral intravenous catheter.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of peripheral metaraminol infusion in patients with neurological conditions: a single-center retrospective observational study

Han,

Zhou

2024

Front. Neurol.

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“…It is clinically relevant and quantifies the magnitude of risk of infection as a complication of obesity. Accordingly, overweight patients should be targeted for interventions aimed at minimizing exposure risk to intravascular catheters [3]. In addition, emphasis on maintenance of dressing integrity in this patient population must be placed [4].…”

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confidence: 99%

“…2 Queensland University of Technology (QUT), Brisbane, QLD, Australia. 3 Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland. 4 National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College of London, London, UK.…”

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confidence: 99%

More is not better: the complicated relationship between obesity, critical illness, and infection

Laupland

Zingg

2021

Intensive Care Med

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Management and Prevention of Central Venous Catheter-Related Infections in the ICU

Buetti

Timsit

2019

Semin Respir Crit Care Med

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Central venous catheter-related bloodstream infections (CR-BSI) are a frequent event in the intensive care unit (ICU) setting. In contrast to other nosocomial infections, most risk factors for CR-BSI are linked to the device and can be prevented efficiently. Rates of CR-BSI higher than 1 per 1,000 catheter days are no longer acceptable. A continuous quality improvement program is effective to reduce them. Key elements of prevention of CR-BSI are hand hygiene, avoidance of insertion of unnecessary catheters, full sterile barrier precautions at insertion, preferential use of subclavian venous insertion site, cutaneous antisepsis with 2% chlorhexidine alcoholic preparation, use of chlorhexidine-impregnated dressings, immediate replacement of moistened or detached catheter dressings, and removal of catheters as soon as possible. Audit and feedback of the process of care, infection rates, and periodic re-education of health care providers are other instrumental tools in the prevention of CR-BSI. Catheter removal is the main therapeutic intervention, especially recommended in the case of sepsis or shock. While awaiting culture results, an empiric antimicrobial treatment of CR-BSI should target gram-positive microorganism (i.e., Staphylococcus aureus) and gram-negative coverage should be based on clinical variables, patients' risk factors, and previous colonization status. While a short course of antimicrobials (7 days) is sufficient for noncomplicated CR-BSI, a longer course of 14 days should be preferred for uncomplicated S. aureus and Candida CR-BSI. In case of persisting fever or positive blood culture after 3 days despite adequate antimicrobial therapy and catheter removal, catheter-related complications (e.g., endocarditis, thrombophlebitis, septic metastasis) should be ruled out.

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The CVC and CRBSI: don’t use it and lose it!

Cited by 4 publications

References 17 publications

Safety and efficacy of peripheral metaraminol infusion in patients with neurological conditions: a single-center retrospective observational study

Safety and efficacy of peripheral metaraminol infusion in patients with neurological conditions: a single-center retrospective observational study

More is not better: the complicated relationship between obesity, critical illness, and infection

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

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