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Sample records for catheter related bloodstream

  1. Bacillus Cereus Catheter Related Bloodstream Infection in a Patient with Acute Lymphoblastic Leukemia

    OpenAIRE

    N Gurler; Oksuz, L; M Muftuoglu; Sargin, FD; Besisik, SK

    2012-01-01

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related bloodstream infections. Significant catheter-related bloodstream infections (CRBSI) caused by Bacillus spp. are mainly due to B. cereus and have been predominantly reported in immunocompromised hosts. Catheter removal is generally advised for management of infection. In t...

  2. Bacillus cereus catheter related bloodstream infection in a patient with acute lymphoblastic leukemia.

    Science.gov (United States)

    Gurler, N; Oksuz, L; Muftuoglu, M; Sargin, Fd; Besisik, Sk

    2012-01-01

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related bloodstream infections. Significant catheter-related bloodstream infections (CRBSI) caused by Bacillus spp. are mainly due to B. cereus and have been predominantly reported in immunocompromised hosts. Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B. cereus in a patient with acute lymphoblast c leukemia (ALL) in Istanbul Medical Faculty was presented.

  3. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit

    OpenAIRE

    Wall, R; Ely, E; Elasy, T; Dittus, R; Foss, J.; Wilkerson, K; Speroff, T

    2005-01-01

    

Problem: Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices.

  4. Tsukamurella catheter-related bloodstream infection in a pediatric patient with pulmonary hypertension

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    Kristen A. Wendorf

    2010-03-01

    Full Text Available Catheter-related bloodstream infections (CR-BSI are important complications in patients with long-term indwelling central venous catheters. In this report, we present the case of a 14-year-old male with pulmonary hypertension treated with continuous treprostinil infusion, who presented with a CR-BSI caused by a Tsukamurella species. This case highlights the potential for this unusual organism to cause infection in immunocompetent patients.

  5. Taurolidine lock is superior to heparin lock in the prevention of catheter related bloodstream infections and occlusions.

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    Evelyn D Olthof

    Full Text Available BACKGROUND AND AIMS: Patients on home parenteral nutrition (HPN are at risk for catheter-related complications; mainly infections and occlusions. We have previously shown in HPN patients presenting with catheter sepsis that catheter locking with taurolidine dramatically reduced re-infections when compared with heparin. Our HPN population therefore switched from heparin to taurolidine in 2008. The aim of the present study was to compare long-term effects of this catheter lock strategy on the occurrence of catheter-related bloodstream infections and occlusions in HPN patients. METHODS: Data of catheter-related complications were retrospectively collected from 212 patients who received HPN between January 2000 and November 2011, comprising 545 and 200 catheters during catheter lock therapy with heparin and taurolidine, respectively. We evaluated catheter-related bloodstream infection and occlusion incidence rates using Poisson-normal regression analysis. Incidence rate ratios were calculated by dividing incidence rates of heparin by those of taurolidine, adjusting for underlying disease, use of anticoagulants or immune suppressives, frequency of HPN/fluid administration, composition of infusion fluids, and duration of HPN/fluid use before catheter creation. RESULTS: Bloodstream infection incidence rates were 1.1/year for heparin and 0.2/year for taurolidine locked catheters. Occlusion incidence rates were 0.2/year for heparin and 0.1/year for taurolidine locked catheters. Adjusted incidence ratios of heparin compared to taurolidine were 5.9 (95% confidence interval, 3.9-8.7 for bloodstream infections and 1.9 (95% confidence interval, 1.1-3.1 for occlusions. CONCLUSIONS: Given that no other procedural changes than the catheter lock strategy were implemented during the observation period, these data strongly suggest that taurolidine decreases catheter-related bloodstream infections and occlusions in HPN patients compared with heparin.

  6. Bacillus Cereus catheter related bloodstream infection in a patient in a patient with acute lymphblastic leukemia

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    Lütfiye Öksüz

    2012-01-01

    Full Text Available Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related blood stream infections. Significant catheter-related bloodstream infections (CRBSI caused by Bacillus spp. are mainly due to B.cereus and have been predominantly reported in immunocompromised hosts1 . Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B.cereus in a patient with acute lymphoblastıc leukemia (ALL in Istanbul Medical Faculty was presented.A 44-year old man presented with fatigue, weight loss, epistaxis and high fever. A double-lumen Hickman–catheter (Bard 12.0 Fr, Round Dual Lumen was inserted by surgical cut-down to access the right subclavian vein which would be necessary for allogeneic stem cell transplantation. Three weeks later the patient presented with high fever and headache. Bacillus spp. was isolated from the cathether while blood culture obtained from the peripheral vein remained negative. The bacterial identification was confirmed as B.cereus using VITEK identification system It has been reported Bacillus cereus septicemia may be fatal in immunocompromised hosts despite broad-spectrum appropriate treatment10. Catheter removal is essential for prevention of recurrent bacteremia. Long-term cathater salvage should be reserved for appropriate patient group.

  7. Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

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    Geraldo Sadoyma

    2006-04-01

    Full Text Available Although central vascular catheters (CVC are indispensable in modern medicine, they are an important risk factor for primary bacteremias. We examined the incidence and risk factors associated with catheter-related bloodstream infection (CR-BSI caused by Staphylococcus aureus in surgical patients. A prospective study was carried out in the Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU from September 2000 to December 2002. The skin insertion site, catheter tip, and blood were microbiologically analyzed. Demographics and risk factors were recorded for each patient, and cultures were identified phenotypically. Staphylococcus aureus was the most frequent pathogen, with an incidence rate of 4.9 episodes of CR-BSIs per 1,000 catheter/days. Based on logistic regression, the independent risk factors were: colonization on the insertion site =200 colony forming units (CFU/20 cm² (p=0.03; odds ratio (OR =6.89 and catheter tip (p=0.01; OR=7.95. The CR-BSI rate was high; it was mainly associated with S. aureus, and skin colonization at the insertion site and on the catheter tip were important risk factors for CR-BSI.

  8. Bacillus Cereus catheter related bloodstream infection in a patient in a patient with acute lymphblastic leukemia

    Directory of Open Access Journals (Sweden)

    Lütfiye Öksüz

    2012-01-01

    Full Text Available

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related blood stream infections. Significant catheter-related bloodstream infections (CRBSI caused by Bacillus spp. are mainly due to B.cereus and have been predominantly reported in immunocompromised hosts1 . Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B.cereus in a patient with acute lymphoblastıc leukemia (ALL in Istanbul Medical Faculty was presented.A 44-year old man presented with fatigue, weight loss, epistaxis and high fever. A double-lumen Hickman–catheter (Bard 12.0 Fr, Round Dual Lumen was inserted by surgical cut-down to access the right subclavian vein which would be necessary for allogeneic stem cell transplantation. Three weeks later the patient presented with high fever and headache. Bacillus spp. was isolated from the cathether while blood culture obtained from the peripheral vein remained negative. The bacterial identification was confirmed as B.cereus using VITEK identification system

    It has been reported Bacillus cereus septicemia may be fatal in immunocompromised hosts despite broad-spectrum appropriate treatment10. Catheter removal is essential for prevention of recurrent bacteremia. Long-term cathater salvage should be reserved for appropriate patient group.

  9. Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients.

    Science.gov (United States)

    Koldehoff, M; Zakrzewski, J L

    2004-11-01

    Taurolidine is an antimicrobial agent that was originally used in the local treatment of peritonitis and was shown to be effective in the prevention of catheter-related bloodstream infections (CR-BSI). In this pilot study, we used taurolidine solution as an intravenous (i.v.) lock into the totally implantable intravascular devices of 11 consecutive oncological patients with catheter-related bloodstream infections not responding to systemic antimicrobial chemotherapy. All patients recovered completely from the infection. No adverse drug effects were seen. Three patients were successfully retreated for a recurrent infection. Our data suggest a beneficial role of taurolidine i.v. lock for the therapy of catheter-related bloodstream infections in oncological patients. Taurolidine i.v. lock application is feasible and could especially be useful in infections resistant to antibiotic chemotherapy.

  10. [Assessment of diagnostic methods for the catheter-related bloodstream infections in intensive care units].

    Science.gov (United States)

    Ataman Hatipoğlu, Ciğdem; Ipekkan, Korhan; Oral, Behiç; Onde, Ufuk; Bulut, Cemal; Demiröz, Ali Pekcan

    2011-01-01

    The majority of catheter-related bloodstream infections (CR-BSI) are associated with central venous catheters (CVCs) and most of them develop in patients staying at intensive care units (ICUs). The aim of this study was to assess the performance of different methods for the diagnosis of CR-BSI in neurology and neurosurgery ICUs of our hospital. This prospective study was carried out between January 2007 and January 2008 and all of the patients were followed daily for CR-BSI after the insertion of CVCs. Blood cultures were taken simultaneously from the catheter lumen and from at least one peripheral vein when there was a suspicion of CR-BSI. Additionally, from patients whose CVCs were removed, catheter tip cultures were taken and from patients with exit site infection, cultures of the skin surrounding the catheter entrance were taken. Catheter tip cultures were done by using quantitative and semiquantitative culture methods. Blood cultures taken from the catheter lumen and peripheral vein were incubated in the BACTEC 9050 (Becton Dickinson, USA) automated blood culture system. Gram and acridine orange (AO) staining were used for the smears prepared from the catheter tips and blood cultures. To evaluate the value of culture and staining methods in the diagnosis of CR-BSI; sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of each method were determined. A total of 148 patients (66 male, 82 female; age range: 1-94 years, mean age: 58.7 ± 21.8 years) were included in the study, of whom 67 (45.3%) were from neurology and 81 (54.7%) were from neurosurgery ICUs. One hundred ninety-nine CVC application performed in 148 patients were evaluated. Mean duration of catheterization was 8.5 ± 5.2 days. Thirty-two episodes of CR-BSI among 199 catheterizations (16%) in 29 patients among a total of 148 patients (19.6%) were determined. The most frequently isolated microorganisms were methicillin-resistant coagulase-negative staphylococci

  11. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit

    Science.gov (United States)

    Wall, R; Ely, E; Elasy, T; Dittus, R; Foss, J; Wilkerson, K; Speroff, T

    2005-01-01

    

Problem: Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices. Design: A system was developed for measuring the process of CVC care in real time. We used these new process measurements to continuously monitor the system, guide CQI activities, and deliver performance feedback to providers. Setting: Adult medical intensive care unit (MICU). Key measures for improvement: Measured process of CVC care in real time; CR-BSI rate and time between CR-BSI events; and performance feedback to staff. Strategies for change: An interdisciplinary team developed a standardized, user friendly nursing checklist for CVC insertion. Infection control practitioners scanned the completed checklists into a computerized database, thereby generating real time measurements for the process of CVC insertion. Armed with these new process measurements, the team optimized the impact of a multifaceted intervention aimed at reducing CR-BSIs. Effects of change: The new checklist immediately provided real time measurements for the process of CVC insertion. These process measures allowed the team to directly monitor adherence to evidence-based guidelines. Through continuous process measurement, the team successfully overcame barriers to change, reduced the CR-BSI rate, and improved patient safety. Two years after the introduction of the checklist the CR-BSI rate remained at a historic low. Lessons learnt: Measuring the process of CVC care in real time is feasible in the ICU. When trying to improve care, real time process measurements are an excellent tool for overcoming barriers to change and enhancing the sustainability of efforts. To continually improve patient safety, healthcare organizations should continually measure their key clinical processes in real

  12. Haemodialysis catheter-related bloodstream infections: current treatment options and strategies for prevention.

    Science.gov (United States)

    Saxena, Anil K; Panhotra, Bodh R

    2005-03-05

    Regardless of the repeated reservations raised by countless researchers with reference to the use of catheters as vascular access for haemodialysis (HD), central venous catheters (CVCs) remain irreplaceable tools of the modern dialysis delivery system as a reliable option for the clinical situations requiring instant access to circulation, for various reasons. Patients on long-term haemodialysis are therefore at a significantly high risk for catheterrelated bloodstream infections (CRBSI) and ensuing serious complications. Although early systemic antibiotic treatment should include the coverage for Staphylococcus aureus, the pathogen with most devastating consequences including bacterial endocarditis; optimal treatment of CRBSI while preserving the catheter site, remains contentious. Nonetheless, catheter exchange over a guide wire and antimicrobial-anticoagulant "locks" have shown promising results as novel access salvage techniques. Despite the fact that a number of novel potentially useful strategies for the prevention of CRBSI are in the pipeline; equally essential however, remains the role of rigorous implementation of standard infection control measures for hygiene and aseptic handling of CVCs in long-term HD patients. The policy of increasing the AVF (arteriovenous fistula) prevalence beyond 50% while minimising the use of CVCs, dependent largely upon the timely referrals and prudently implemented pre-ESRD program - ought to have a positive impact on long-term HD outcomes.

  13. Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin-controlled prospective trial.

    NARCIS (Netherlands)

    Bisseling, T.M.; Willems, M.C.M.; Versleijen, M.W.J.; Hendriks, J.C.M.; Vissers, R.K.; Wanten, G.J.A.

    2010-01-01

    BACKGROUND & AIMS: Catheter-related bloodstream infections remain the major threat for Home Parenteral Nutrition programs. Taurolidine, a potent antimicrobial agent, holds promise as an effective catheter lock to prevent such infections. Aim of the present study was to compare taurolidine with hepar

  14. Absence of microbial adaptation to taurolidine in patients on home parenteral nutrition who develop catheter related bloodstream infections and use taurolidine locks

    NARCIS (Netherlands)

    Olthof, E.D.; Rentenaar, R.J.; Rijs, A.J.M.M.; Wanten, G.J.A.

    2013-01-01

    BACKGROUND & AIMS: Some home parenteral nutrition (HPN) patients develop catheter related bloodstream infections (CRBSI) despite using an anti-microbial catheter lock solution taurolidine. The aim of this study was to assess whether long-term use of taurolidine leads to selective growth of microorga

  15. Risk factors for catheter-related bloodstream infection: a prospective multicenter study in Brazilian intensive care units

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    Daniela Bicudo

    2011-08-01

    Full Text Available INTRODUCTION: Central venous catheters (CVC are devices of great importance in health care. The advantages gained from the use of catheters outweigh the complications that might result from their use, among which bloodstream infections (BSI. In spite of its importance, few national studies have addressed this issue. OBJECTIVE: The aim this study was to determine the incidence of BSI in patients with CVC, hospitalized in ICU, as well as the variables associated with this complication. METHODS: Multicentric cohort study carried out at ICUs of three hospitals at Universidade Federal de São Paulo complex. RESULTS: A total of 118 cases of BSI in 11.546 catheters day were observed: 10.22 BSI per 1,000 catheters day. On average, BSI was associated to seven additional days of hospital stay in our study (p < 0.001, with a significant difference between types of catheters. Concerning the place of insertion, there was no statistical difference in BSI rates. CONCLUSION: We concluded that a patient who uses a catheter for longer than 13 days presents a progressive risk for infection of approximately three times higher in relation to a patient who uses the catheter for less than 13 days (p < 0.001. The median duration of catheter use was 14 days among patients with BSI and 9 days in patients without infection (p < 0.001. There was higher prevalence of Gram-negative infections. The risk factors for BSI were utilization of multiple-lumen catheters, duration of catheterization and ICU length of stay.

  16. Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia

    Science.gov (United States)

    Kawai, Eichiro; Yaoita, Hisao; Ichinoi, Natsuko; Sakamoto, Osamu; Kure, Shigeo

    2017-01-01

    Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens. PMID:28194286

  17. Etiology and epidemiology of catheter related bloodstream infections in patients receiving home parenteral nutrition in a gastromedical center at a tertiary hospital in denmark

    DEFF Research Database (Denmark)

    Nielsen, Xiaohui Chen; Chen, Ming; Hellesøe, Anne-Marie Blok

    2012-01-01

    We conducted a retrospective epidemiologic study of catheter related bloodstream infections (CRBSI) in patients receiving long-term home parenteral nutrition (HPN) from January 2002 to December 2005. Our results showed that coagulase negative staphylococci (CoNS) were the most prevalent pathogens...

  18. Catheter related bloodstream infection (CR-BSI in ICU patients: making the decision to remove or not to remove the central venous catheter.

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    Rodrigo Octávio Deliberato

    Full Text Available BACKGROUND: Approximately 150 million central venous catheters (CVC are used each year in the United States. Catheter-related bloodstream infections (CR-BSI are one of the most important complications of the central venous catheters (CVCs. Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI. METHODS: We reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi quantitative (>15 CFU culture of a catheter segment from where the same organism was isolated. The conservative method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and one of the following: (1 differential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or (2 simultaneous quantitative blood culture with ≥ 5:1 ratio (CVC versus peripheral. RESULTS: 53 CR-BSI (37 diagnosed by the standard method and 16 by the conservative method were diagnosed during the study period. There was a no statistically significant difference in the in-hospital mortality for the standard versus the conservative method (57% vs. 75%, p = 0.208 in ICU patients. CONCLUSION: In our study there was a no statistically significant difference between the standard and conservative methods in-hospital mortality.

  19. Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.

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    Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

    2015-01-01

    The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

  20. 抗感染中心静脉导管预防导管相关性血流感染的效果%Effect in prevention of catheter-related bloodstream infection using antiseptic impregnated central venous catheter

    Institute of Scientific and Technical Information of China (English)

    罗蕾; 秦英; 向亚娟

    2011-01-01

    Objective To evaluate the clinical effect in prevention of catheter-related bloodstream infection(CRBSI) using antiseptic impregnated central venous catheter. Methods The incidence of catheterrelated bloodstream infection was compared between 420 cases performed with antiseptic impregnated central venous catheter ( experimental group ) and 430 cases performed with general central venous catheter (control).Besides, the categories and characteristics of pathogenic bacteria which resulted in catheter-related bloodstream infection were analyzed. Results There were 66 cases of CRBSI in 850 cases, 25 cases were inserted antiseptic impregnated central venous catheter and 41 cases inserted general central venous catheter. No significant difference in the incidence between the two groups was found during 7 days(χ2 = 0. 06 ,P > 0. 05), however, the incidence of CRBSI was lower in the experimental group than of the control group after 7 days( χ2 = 3.91,4.30 ;P 0.05),7 d后实验组CRBSI感染率较对照组低,差异有统计学意义(χ2分别为3.91,4.30,P<0.05).实验组减少导管相关性血流感染的病原体主要为革兰阳性菌.结论 抗感染中心静脉导管可明显减少导管相关性血流感染的发生,有很大的临床价值.

  1. FACTORS ASSOCIATED WITH MORTALITY AMONG PATIENTS WITH CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION IN AN INTENSIVE CARE UNIT

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    Priscilla Roberta Silva Rocha

    2012-01-01

    Full Text Available Central venous catheterization is a common practice in the management of critically ill patients and is associated with various complications, such as Bloodstream Infections (BSI, which are major determinants of increased morbidity, mortality and healthcare expenses. Few studies have addressed factors that predict mortality in patients with this complication. The aim of this study was to investigate factors associated with mortality in patients with Central Venous Catheter (CVC-related BSI in an intensive care unit of a tertiary care hospital in the Federal District, Brazil. This was a retrospective and observational study, in which all CVC-related BSI that occurred between January 2008 and December 2010 were reviewed. We obtained demographic, clinical, biochemical and microbiological data from medical records and investigated its association with mortality during ICU stay. There were 4,504 ICU admissions during the study period and 68 were complicated by CVC-related BSI (4.09 per 1000 catheter-days, most due to gram-negative organisms (45.6%. Overall mortality was 59.7%. Death risk was significantly associated with mechanical ventilation (OR 27.8, 95% CI 3.28-250, p-1 in survivors vs. 73.9 mg dL-1 in non-survivors, p = 0.001. Mortality was not associated with other clinical or biochemical features, neither with microbiological variables, although lethality was high among patients with gram-positive infections (77% Vs 58.33% for fungi and 54.83% for gram-negative. CVC-related BSI was associated with high absolute mortality, which was predicted by mechanical ventilation and a higher number of invasive devices other than the CVC. Knowledge of local factors predictive of mortality is critical for planning strategies to reduce death risk associated with this complication.

  2. High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

    Science.gov (United States)

    Viedma, Esther; Chaves, Fernando; Lalueza, Antonio; Fortún, Jesús; Loza, Elena; Pujol, Miquel; Ardanuy, Carmen; Morales, Isabel; de Cueto, Marina; Resino-Foz, Elena; Morales-Cartagena, Alejandra; Rico, Alicia; Romero, María P.; Orellana, María Ángeles; López-Medrano, Francisco; Fernández-Ruiz, Mario; Aguado, José María

    2016-01-01

    We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications. PMID:27192097

  3. Taurolidine lock is superior to heparin lock in the prevention of catheter related bloodstream infections and occlusions

    NARCIS (Netherlands)

    Olthof, E.D.; Versleijen, M.W.J.; Huisman-de Waal, G.J.; Feuth, T.; Kievit, W.; Wanten, G.J.A.

    2014-01-01

    BACKGROUND AND AIMS: Patients on home parenteral nutrition (HPN) are at risk for catheter-related complications; mainly infections and occlusions. We have previously shown in HPN patients presenting with catheter sepsis that catheter locking with taurolidine dramatically reduced re-infections when c

  4. Taurolidine lock is superior to heparin lock in the prevention of catheter related bloodstream infections and occlusions

    OpenAIRE

    Olthof, Evelyn D.; Versleijen, Michelle W.; Getty Huisman-de Waal; Ton Feuth; Wietske Kievit; Geert J A Wanten

    2014-01-01

    BACKGROUND AND AIMS: Patients on home parenteral nutrition (HPN) are at risk for catheter-related complications; mainly infections and occlusions. We have previously shown in HPN patients presenting with catheter sepsis that catheter locking with taurolidine dramatically reduced re-infections when compared with heparin. Our HPN population therefore switched from heparin to taurolidine in 2008. The aim of the present study was to compare long-term effects of this catheter lock strategy on the ...

  5. The current understanding of arterial-catheter related bloodstream infection%当前对动脉导管相关性血流感染的认识

    Institute of Scientific and Technical Information of China (English)

    王斌; 安友仲

    2016-01-01

    导管相关性血流感染(CRBSI)是重症加强治疗病房(ICU)中常见的严重感染之一,可增加患者的病死率,延长住院时间,增加住院费用.在CRBSI中,动脉导管相关性血流感染(AC-BSI)常被忽视或低估,目前的报道显示,AC-BSI的发生率接近甚至不低于中心静脉导管相关性血流感染(CVC-BSI).一旦怀疑AC-BSI,应在留取相关培养物培养后立即拔出动脉导管,并根据患者的情况实施抗感染治疗;预防是减少AC-BSI的关键.本文作者从AC-BSI的流行病学、病原学及发病机制、危险因素、诊断、治疗和预防等方面的进展进行综述,以期为临床处理提供帮助.%Catheter-related bloodstream infection (CRBSI) is one of the common severe infections in intensive care unit (ICU),which tends to increase the mortality of patients,the length of hospital stay and the cost of hospitalization.Arterial catheter-related bloodstream infection (AC-BSI) is often overlooked or underestimated.Some studies pointed out that the incidence of AC-BSI is close to or even higher than central venous catheter related bloodstream infection (CVC-BSI),which plays an important role in catheter-related infections.Once AC-BSI is suspected,arterial catheter should be removed immediately after bacterial culture and antibiotics should be prescribed according to severities of patients.Prevention is the key to reduce AC-BSI.The research progress of epidemiology,etiology,pathogenesis,risk factors,diagnosis,treatment and prevention of AC-BSI was reviewed to facilitate the clinical decision.

  6. To reduce catheter-related bloodstream infections: is the subclavian route better than the jugular route for central venous catheterization?

    Science.gov (United States)

    Nagashima, Goro; Kikuchi, Toshiki; Tsuyuzaki, Hitomi; Kawano, Rumiko; Tanaka, Hiroyuki; Nemoto, Hiroshi; Taguchi, Kazumi; Ugajin, Kazuhisa

    2006-12-01

    The most important targets of hospital-acquired infection control are to reduce the incidence of surgical-site, catheter-related, and ventilator-associated infections. In this report, we address previously presented infection-control strategies for central venous (CV) line catheterization, using a CV catheter-related infection surveillance system. Data concerning CV catheter insertion were collected from all facilities in our 650-bed hospital, excluding the operating and hemodialysis wards. Collected data included the insertion method, purpose, length of catheter inserted, duration of catheterization, infection rate, and complication rate. Catheter-related infection was diagnosed based on bacteriological examinations from blood cultures. The total number of catheterizations was 806 a year, and average duration of catheterization was 9.8 days. The purpose of catheterization was nutritional support in 210 cases, hemodialysis in 96 cases, cardiac support in 174 cases, and other treatments in 260 cases. In 66 cases, the purpose of CV catheter was not specified. The rate of positive cultures was 7.1%, and complications other than infection occurred in 0.5%. The main causative organisms were methicillin-resistant Staphylococcus aureus (MRSA) in 38.6%, coagulase-negative Staphylococcus epidermidis (CNS) in 33.3%, and S. aureus in 12.3% of infections. Infection rates were 3.8 per 1000 catheter-days in subclavian, 6.1 in jugular, and 15.7 in femoral vein catheterization. In high-risk departments (intensive care unit [ICU] and emergency departments) the infection rate was 5.4 for subclavian and 10.2 for jugular catheterization, whereas it was 3.6 for subclavian and 4.6 for jugular catheterization in noncritical-care departments. Considering complications such as pneumothorax, CV catheterization of the jugular vein is recommended in certain situations.

  7. Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Yong Liu

    Full Text Available BACKGROUND: Catheter-related bloodstream infections (CRBSIs are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS are beneficial for the prevention of CRBSIs remains controversial. In this meta-analysis, we aim to assess the efficacy of TLS for preventing CRBSIs. METHODS: We conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity. RESULTS: Six randomized controlled trials (RCTs conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21-0.55. Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G- bacteria (P = 0.004; RR, 0.27; CI, 0.11-0.65, and was associated with a non-significant decrease in gram-positive (G+ bacterial infections (P = 0.07; RR, 0.41; CI, 0.15-1.09. No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75-5.28. CONCLUSIONS: The use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies

  8. Ethanol lock therapy (E-Lock in the prevention of catheter-related bloodstream infections (CR-BSI after major heart surgery (MHS: a randomized clinical trial.

    Directory of Open Access Journals (Sweden)

    María Jesús Pérez-Granda

    Full Text Available Lock-therapy with antimicrobials has been used for the treatment and prevention of catheter-related bloodstream infections (CR-BSI. Experiences with Ethanol-Locks (E-locks have included therapeutic interventions with variable results. Patients undergoing Major Heart Surgery (MHS are a high-risk population for CR-BSI.The aim of this study was to assess the efficacy and tolerance to E-Locks in the prevention of CR-BSI of patients undergoing MHS.This is an academic, prospective, randomized, non-blinded and controlled clinical trial assessing the incidence of CR-BSI of patients with E-locks (E-lock and the tolerance to the procedure in comparison with patients receiving conventional catheter-care (CCC. Patients undergoing MHS with intravascular catheters for more than 48 hours were randomly assigned into treatment or control group by a computer-generated list of randomly assigned numbers. In the treatment group, all their catheter lumens were locked with an ethanol solution at 70% for two hours, every three days (E-Locks. The control group received conventional catheter-care (CCC. Overall, 200 patients with 323 catheters were included in the study, which was stopped after 10 months due to adverse events. Of them, 179 catheters (113 patients had E-Locks and 144 catheters (87 patients were CCC. Euroscore Surgical Risk in both groups was 4.04 vs 4.07 p = 0.94 respectively. The results for the E-Locks and CCC were as follows: Incidence of CR-BSI/1000 days of exposure 2.1 vs 5.2 (p = 0.33, catheter tip colonization 14 (7.8% vs 6 (4.2% patients (p = 0.17, median length of hospital stay, 15 vs 16 days (p = 0.77. Seven patients (6.19%, all in the ethanol branch, had to discontinue the trial due to intolerance or adverse events.We do not recommend prophylaxis of CR-BSI with ethanol-lock on a routine basis in patients undergoing Major Heart Surgery.Clinical Trials.gov NCT01229592.

  9. Prevention of Catheter-related Bloodstream Infection in ICU%ICU患者中心静脉导管相关性血流感染的预防

    Institute of Scientific and Technical Information of China (English)

    徐文

    2011-01-01

    Central venous catheter( CVC )is one of the most common technique for monitoring and treatment in ICU. But There is a risk of catheter-related bloodstream infection causing prolonged hospital stay and increased mortality. Positioning the CVC through the subclavian vein and using a antibiotic catheter can help to reduce the incidence of CRBSI. A bundle stratige is of a crucial role in CRBSI provention.It should include strict hand hygiene, sterilizing with mixture of 70% ethano and 2% chlorhexidine, maximal sterile barrier and regular dressing change. The efficiency of regular CVC replacement and of antibiotic based catheter lock solution are not clear, and are not recommended as a routine.%留置中心静脉导管是ICU中最常用的监测和治疗措施,但其同时存在发生导管相关性血流感染(CRBSI)的风险,从而导致患者住院时间延长和病死率升高.选择锁骨下穿刺径路、使用抗生素导管可减少CRBSI的发生.应用集束化预防措施进行置管及日常护理是预防CRBSI发生的重要措施,包括严格的手卫生、应用2%氯己定和70%乙醇混合液消毒皮肤、最大消毒屏障以及定期更换辅料.定期更换导管及使用抗生素封管对预防CRBSI效果不明确,不作为常规推荐.

  10. Clinical-epidemiological characteristics and outcome of patients with catheter-related bloodstream infections in Europe (ESGNI-006 Study)

    DEFF Research Database (Denmark)

    Muñoz, P; Bouza, E; San Juan, R

    2004-01-01

    (1.55 vs. 0.33/1,000 admissions). Most (67%) catheters were non-tunneled central venous catheters, were in the jugular vein (44%), had been implanted for > 7 days (70%), were made of polyurethane (61%) and were multi-lumen (67%). In 36% of cases, catheters were implanted by physicians other than...

  11. Hemodialysis Tunneled Catheter-Related Infections

    Science.gov (United States)

    Miller, Lisa M.; Clark, Edward; Dipchand, Christine; Hiremath, Swapnil; Kappel, Joanne; Kiaii, Mercedeh; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; MacRae, Jennifer

    2016-01-01

    Catheter-related bloodstream infections, exit-site infections, and tunnel infections are common complications related to hemodialysis central venous catheter use. The various definitions of catheter-related infections are reviewed, and various preventive strategies are discussed. Treatment options, for both empiric and definitive infections, including antibiotic locks and systemic antibiotics, are reviewed.

  12. Catheter Removal versus Retention in the Management of Catheter-Associated Enterococcal Bloodstream Infections

    Directory of Open Access Journals (Sweden)

    Jonas Marschall

    2013-01-01

    Full Text Available BACKGROUND: Enterococci are an important cause of central venous catheter (CVC-associated bloodstream infections (CA-BSI. It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI.

  13. Clinical Analysis of Catheter-Related Bloodstream Infection in ICU%ICU中心静脉置管患者血性感染的临床分析

    Institute of Scientific and Technical Information of China (English)

    吴敏

    2013-01-01

    目的 对ICU中心静脉导管患者发生医院血性感染的相关情况进行分析,探讨发生特点和危险因素.方法 对785例ICU中心静脉置管患者的一般情况和临床资料进行回顾性分析,包括患者的年龄、性别、自理能力、自身免疫性疾病、置管时间、置管部位和免疫抑制剂的使用等相关性感染因素.结果 785例患者相关血性感染共发生34例,发生率4.3%.34例病原菌共检出29株,阳性率85.3%.检出以革兰氏阴性菌为主,占总检出的48.3%,其次为革兰氏阳性菌,占41.4%,再次为真菌,占10.3%.ICU中心静脉导管患者发生医院血性感染与年龄、自理能力、自身免疫性疾病、置管时间和免疫抑制剂的使用相关.结论 积极治疗患者自身免疫性疾病,对置管时间进行控制,并减少免疫抑制剂的使用,是减少ICU中心静脉导管相关血性感染的重要措施.%Objective To investigate the bloodstream infection in patients with central venous catheter in ICU,explore the risk factors.Methods Totally 785 patients with central venous catheter were chosen and studied to analyze the risk factors which might cause bloodstream infection.The correlation factors were gender,age,self-help skills,autosomal disease,insertion time,catheter site,and application of immunosuppressive.Results 34 cases catheter-related bloodstream infection cases were detected in ICU(4.3%).29 cases were detected in 34 cases of pathogens,with the positive rate of 85.3%.The most common bacteria were Gram-negative bacteria,accounting for 48.3%,followed by Gram-positive bacteria which accounting for 41.4%,and Fungi which accounting for 10.3%.The analysis of 785 cases showed that the infection rate was closely related to age,self-help skills,autosomal disease,insertion time,and application of immunosuppressive.Conclusion It was effective to reduce the infection by treating the autosomal disease positively,controlling insertion time and using

  14. Second-Generation central venous catheter in the prevention of bloodstream infection: a systematic review 1

    Science.gov (United States)

    Stocco, Janislei Gislei Dorociaki; Hoers, Hellen; Pott, Franciele Soares; Crozeta, Karla; Barbosa, Dulce Aparecida; Meier, Marineli Joaquim

    2016-01-01

    Abstract Objective: to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention. Method: systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; search in Congress Proceedings and records from Clinical Trials. Results: 1.235 studies were identified, 97 were pre-selected and 4 were included. In catheter-related bloodstream infection, there was no statistical significance between second-generation impregnated catheter compared with the non-impregnated ones, absolute relative risk 1,5% confidence interval 95% (3%-1%), relative risk 0,68 (confidence interval 95%, 0,40-1,15) and number needed to treat 66. In the sensitivity analysis, there was less bloodstream infection in impregnated catheters (relative risk 0,50, confidence interval 95%, 0,26-0,96). Lower colonization, absolute relative risk 9,6% (confidence interval 95%, 10% to 4%), relative risk 0,51 (confidence interval 95% from 0,38-0,85) and number needed to treat 5. Conclusion: the use of second-generation catheters was effective in reducing the catheter colonization and infection when a sensitivity analysis is performed. Future clinical trials are suggested to evaluate sepsis rates, mortality and adverse effects. PMID:27508901

  15. Investigation of catheter-related bloodstream infections in ICU%ICU导管相关性血流感染调查研究

    Institute of Scientific and Technical Information of China (English)

    曾翠; 陈玉华; 贾会学; 李六亿; 吴安华

    2014-01-01

    OBJECTIVE To understand the utilization rate of central venous catheters in ICU and analyze the daily incidence of central venous catheter-related bloodstream infections so as to provide guidance for control of the central venous catheter-related bloodstream infections .METHODS The new definition of Central Line Associated Blood Stream Infection which was promulgated by the United States Centers for Disease Control in 2013 was viewed as the diagnostic criteria ,the patients who underwent central venous catheterization in 55 ICUs of 41 hospitals from Oct 1 , 2013 to Mar 31 , 2014 were monitored , and the baseline data , catheterization , and information of infections of the monitoring objects were completed ,and the statistical analysis was performed with the use of SPSS 10 .0 software .RESULTS A total of 4 256 patients were monitored ,with 51159 days of central venous catheter indwelling involved ;the infections occurred in 133 cases with the daily infection rate of 2 .60‰ , the daily infection rate was lowest in the ICUs of the cardiology department and the pediatric department .The daily infection rate was lowest in Guizhou province (0 .69‰) ,highest in general ICUs ( 2 .81‰) and Guangdong province (14 .22‰) .The average utilization rate of central venous catheter was 44 .12% ;the utilization rates was lowest in the ICUs of pediatric department (5 .91% ) and was lowest in Shandong province (26 .77% );the utilization rate was highest in the ICUs of surgery department (63 .21% ) and was highest in Guizhou province (90 .75% ) . CONCLUSION The average daily infection rate of central venous catheter-related bloodstream infections is slightly higher in those investigated hospitals than abroad and the rest parts of China .It is necessary to strengthen the operation training of the health care workers and pay attention to the maintenance of the catheters so as to ensure the safety of catheterization nursing of the patients .%目的:了解医院IC U中心静脉

  16. Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol.

    Science.gov (United States)

    Raad, Issam; Chaftari, Anne-Marie; Zakhour, Ramia; Jordan, Mary; Al Hamal, Zanaib; Jiang, Ying; Yousif, Ammar; Garoge, Kumait; Mulanovich, Victor; Viola, George M; Kanj, Soha; Pravinkumar, Egbert; Rosenblatt, Joel; Hachem, Ray

    2016-06-01

    In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively; P < 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.).

  17. Prediction of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified Infection Probability Score (mIPS).

    Science.gov (United States)

    Schalk, Enrico; Hanus, Lynn; Färber, Jacqueline; Fischer, Thomas; Heidel, Florian H

    2015-09-01

    The aim of this study was to predict the probability of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified version of the Infection Probability Score (mIPS). In order to perform a prospective, mono-centric surveillance of complications in clinical routine due to short-term central venous catheters (CVCs) in consecutive patients receiving chemotherapy from March 2013 to September 2014, IPS was calculated at CVC insertion and removal (mIPSin and mIPSex, respectively). We used the 2012 Infectious Diseases Working Party of the German Society of Haematology and Medical Oncology (AGIHO/DGHO) criteria to define CRBSI. In total, 143 patients (mean 59.5 years, 61.4 % male) with 267 triple-lumen CVCs (4044 CVC days; mean 15.1 days, range 1-60 days) were analysed. CVCs were inserted for therapy of acute leukaemia (53.2 %), multiple myeloma (24.3 %) or lymphoma (11.2 %), and 93.6 % were inserted in the jugular vein. A total of 66 CRBSI cases (24.7 %) were documented (12 definite/13 probable/41 possible). The incidence was 16.3/1000 CVC days (2.9/3.1/10.1 per 1000 CVC days for definite/probable/possible CRBSI, respectively). In CRBSI cases, the mIPSex was higher as compared to cases without CRBSI (13.1 vs. 7.1; p < 0.001). The best mIPSex cutoff for CRBSI prediction was 8 points (area under the curve (AUC) = 0.77; sensitivity = 84.9 %, specificity = 60.7 %, negative predictive value = 92.4 %). For patients with an mIPSex ≥8, the risk for a CRBSI was high (odds ratio [OR] = 5.9; p < 0.001) and even increased if, additionally, CVC had been in use for about 10 days (OR = 9.8; p < 0.001). In case other causes of infection are excluded, a mIPSex ≥8 and duration of CVC use of about 10 days predict a very high risk of CRBSI. Patients with a mIPSex <8 have a low risk of CRBSI of 8 %.

  18. ICU 导管相关性血流感染危险因素分析%Influential factors of central venous catheter-related bloodstream infections in ICU patients. Zong Zhihua

    Institute of Scientific and Technical Information of China (English)

    宗志华

    2013-01-01

      目的探讨 ICU 导管相关性血流感染(catheter-related blood stream infections, CRBSI)的风险因素,及其预防对策。方法回顾性分析2008年5月至2012年5月我院实 ICU 实施中心静脉置管的患者803例,其中发生 CRBSI 46例,分析发生的原因并制订相应的对策。结果46例患者发生 CRBSI 的原因与操作不当、导管的类型和材料、置管部位、时间及患者因素等有关;其中4例患者更换导管,7例拔除了导管,其余35例感染得到控制。结论患者、导管及置管因素均影响 CRBSI 的发生,通过纠正诱发因素,降低 CRBSI 发生率,有助于改善患者预后。%Objective To investigate the influential factors of central venous catheter-related bloodstream infections (CRBSI) in ICU, so as to develop appropriate countermeasures. Methods The clinical date of 803 ICU patients from May 2008 to May 2012 treated with central venous catheter were retrospectively reviewed to find 46 cases of catheter-related bloodstream infections. The influential factors were analyzed and the countermeasures were worked out. Results 46 cases of CRBSI were related with improper operation, tube type and materials, catheter site, time and patients and other relevant factors. 4 cases were treated with catheter replacement. 7 cases were removed of the catheter and 35 cases were controled stably. Conclusion it’s possible way to reduce the incidence of CRBSI and help to improve the prognosis of patients, from correcting factors, including patients, catheter and catheter factors, which influence the occurrence of CRBSI.

  19. 氯己定醇皮肤消毒液在预防导管相关血流感染中的效果研究%Effect of chlorhexidine skin disinfectant on prevention of catheter-related bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    吴晓琴; 李兰云; 郭晶; 何金; 李琳; 徐莉; 杜永川

    2014-01-01

    目的:探讨2%葡萄糖酸氯己定(CHG)醇皮肤消毒液对预防经外周静脉导入中心静脉置管(PICC)导管相关血流感染(CRBSI)的消毒效果。方法对2013年1-12月行PICC置管的肿瘤患者进行前瞻性随机对照研究,将64例PICC置管的患者进行随机分组,观察组34例使用2% CHG醇进行皮肤消毒,对照组30例使用5%聚维酮碘进行皮肤消毒,分别于各组患者进行PICC置管前及置管后48 h对置管周围部位的皮肤采样,进行细菌监测并比较两组间的差异。结果观察组在 PICC置管前和置管后较对照组48h皮肤菌落数低、干燥时间短(P<0.05),观察组总置管日2356 d ,无CRBSI发生;对照组总置管日1970 d ,CRBSI 4例,2% CHG醇消毒液能降低CRBSI的发生率(P<0.05)。结论2% CHG醇皮肤消毒液可降低PICC导管相关血流感染的发生率,并可减少皮肤表面的暂居菌,抑制其生长从而降低CRBSI风险。%OBJECTIVE To explore the effect of 2% chlorhexidine gluconate (CHG) on prevention of peripherally inserted central venous catheter-related bloodstream infections .METHODS The prospective randomized control study was conducted for the tumor patients who underwent PICC from Jan 2013 to Dec 2013;the 64 PICC patients were randomly divided into the observation group with 34 cases and the control group with 30 cases , the observation group was treated with 2% CHG for skin disinfection ,while the control group was given 5% povidone iodine for skin disinfection .The skins around the catheter insertion sites were respectively sampled before the PICC catheterization and at 48 hours after the PICC catheterization ;the bacterial species were monitored and compared between the two groups .RESULTS The bacterial colony counts in the skin were less in the observation group than in the control group before and after the PICC catheterization ,and the drying time of the observation group was shorter

  20. Analysis of Risk Factors of Central Venous Catheter-related Bloodstream Infection%中心静脉导管相关血流感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    吴庆华; 傅小云

    2012-01-01

    [Objective]To explore the risk factors and prevention points of central venous catheter(CVC)-related bloodstream infections(CVC-RBI). [Methods] Clinical data of 25 patients with catheter-related infection caused by central venipuncture in critical care medicine department of affiliated hospital of Zunyi medical college were analyzed retrospectively. The types and characteristics of pathogens of patients were analyzed by the culture at distal end of the catheter and blood culture or the secretion culture at outlet of the catheter. [Results ] Among 25 patients with catheter-related infection, 4 cases were infection at the tip of the catheter, 3 cases were infection at the outlet and 18 cases were catheter-related bloodstream infection. The patient's age and sex had no relation with the infection rate( P >0. 05). Catheter time was positively correlated to infection(R = 0. 32). When catheter time was less than one week, the infection rate was 0. When catheter time was less than or equal to one week and less than one month, the infection rate was 24%. When catheter time was less than or equal to one month, the infection rate was 76%. There were significant differences among groups( P <0. 05). [Conclusion]The incidence of CVC-BSI increases with the increasing of catheter time, and is related with various of operations and the patient's status.%[目的]探讨中心静脉导管(CVC)引发的导管相关性血流感染(CVC-RBI)的危险因素及预防要点.[方法]回顾性分析遵义医学院附属医院重症医学科25例中心静脉穿刺患者发生导管性感染的资料,并通过导管末端培养与血培养,或通过导管出口部位分泌物培养,分析患者病原菌种类和特点.[结果]25例导管相关性感染患者中,导管尖端部位感染4例,出口部位感染3例,导管相关性血流感染18例.患者的年龄和性别与感染率无关( P >0.05).置管时间与感染发生率呈正相关(R=0.32 ).置管时间<1周,感染发生率为0;≤1

  1. The value of bedside ultrasound-guided puncturing and individualized heparin catheter sealing management in the prevention of catheter-related bloodstream infection of patients with tumors%床旁B超引导穿刺及个体化的肝素封管在肿瘤患者中心静脉导管感染中的预防价值

    Institute of Scientific and Technical Information of China (English)

    达春丽; 许华; 吴莉; 于湘友

    2016-01-01

    目的:比较不同穿刺置管方式及不同封管方式对ICU中导管相关性血源性感染(catheter-related blood stream infection,CRBSI)的发生及预后的影响,指导临床选择更佳的置管及封管方式。方法选择2012年6月至12月收住我院ICU需中心静脉置管且置管时间大于7天的患者80例,按置管及封管方式的不同分为四组,分别为低剂量肝素封管组(125u/ml),高剂量肝素封管组(250u/ml),低剂量肝素封管+B超引导穿刺组,高剂量肝素封管+B超引导穿刺组,比较四组病人最终发生导管堵塞及CRBSI的差异性。结果高剂量肝素封管+ B超引导穿刺组堵管率及CRBSI的发生率明显低于低剂量肝素封管+B超引导穿刺组及高剂量肝素封管组,相同剂量肝素组间比较,联合B超引导穿刺组的导管管理方式优于单纯肝素封管组。结论高剂量肝素封管+ B超引导穿刺的导管管理方式较其他穿刺、封管方式能明显减少中心静脉导管的堵管率,降低CRBSI的发生率,在临床工作中值得推广应用。%ObjectiveTo compare the incidence of CRBSI (catheter-related bloodstream infection) and difference on patients' prognosis among different central-venous-catheter puncture and catheter sealing methods, to direct a better selection in central venous catheter puncturing and sealing methods.Methods80 patients with tumor who kept central-venous-catheter indwelled for more than 7 days were selected. These patients were divided into four groups according to central-venous-catheter puncturing method and catheter sealing methods: low-dose heparin catheter sealing group (125u/ml), high-dose heparin catheter sealing group (250u/ml), low-dose heparin catheter sealing with B ultrasound-guided biopsy group and high dose heparin catheter sealing with B ultrasound-guided biopsy group. Catheter blockage and incidence rate of CRBSI in four groups were observed.ResultsThe catheter blockage and CRBSI

  2. Impact of Cluster of Intervention Strategies on CRRT Central Venous Catheter-related Bloodstream Infections%集束化干预策略对CRRT中心静脉导管相关性血行感染的影响

    Institute of Scientific and Technical Information of China (English)

    陈刚; 黄晓铭; 陈鑫鑫

    2014-01-01

    Objective To explore the cluster intervention strategies for CRRT central venous catheter related bloodstream infections (hereinafter referred to as CRBIS). Methods Retrospective analysis of our department in August 2012-February 2013 lines of central venous catheter and conventional CRRT infection intervention measures of patients 150 cases (control group) and March 2013-September 2013 lines of central venous catheter and CRRT in 196 patients with cluster intervention strategies (observation group), compared two groups of patients the incidence of CRBIS, ICU hospitalization days and hospitalization expenses, etc. Results Cluster intervention strategies significantly reduce the rate of catheter-related bloodstream infection, which reduces the patients in ICU time, reduced the cost of patients. Conclusion Cluster intervention strategy can decrease the CRRT CRBIS rate of femoral vein, but need to improve the clinical compliance.%目的:探讨集束化干预策略对CRRT中心静脉导管相关性血流感染(以下简称 CRBIS)的影响。方法回顾性对比分析我科2012年8月~2013年2月行CRRT中心静脉导管并按常规实施感染干预措施的患者150例(对照组)与2013年3月~9月行CRRT中心静脉导管并按集束化干预策略患者196例(观察组),比较两组患者的CRBIS发生率、ICU 住院天数、住院费用等。结果集束化干预策略明显降低导管相关性血行感染,从而降低了患者入住 ICU时间,减少了患者费用。结论集束化干预策略可降低CRRT股静脉的CRBIS率,但需提高临床的依从性。

  3. Central venous catheters and catheter locks in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2013-01-01

    To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).......To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC)....

  4. 中心静脉导管相关性血流感染危险因素分析%Risk factors of central venous catheter-related bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    杨大运; 齐战; 高少伟

    2013-01-01

    目的 研究分析中心静脉导管相关性血流感染(CLABSI)的临床特征,为预防与控制CLABSI提供临床依据.方法 采用回顾性调查方法对2009-2011年CLABSI资料汇总进行统计分析.结果 600例住院患者发生CLABSI53例,发病率为7.1‰;在分离出的53株病原菌中以革兰阳性球菌为主,共27株占50.94%,真菌14株占26.42%,革兰阴性杆菌12株占22.64%;CLABSI发病率与插管时间、插管部位、导管腔数、全胃肠外营养(TPN)有关,差异有统计学意义(P<0.05),CLABSI发病率与最大无菌屏障及灌注抗菌药物无关(P>0.05).结论 插管时间、插管部位、导管腔数、全胃肠外营养是CLABSI的主要因素,应针对上述因素制定相应的干预措施,以降低CLABSI的发生.%OBJECTIVE To investigate and analyze the clinic features of central venous catheter-related infections so as to provide basis for the prevention and control of catheter-related bloodstream infections.METHODS By means of the retrospective survey,the data of the patients with central venous catheter-related infections who were hospitalized during 2009-2011 were statistically analyzed.RESULTS Of totally 600 cases of hospitalized patients,the central venous catheter-related infections occurred in 53 cases with the incidence rate of 7.1%.There were totally 53 strains of pathogens isolated,including 27 (50.94%) strains of gram-positive bacteria,14 (26.42%) strains of fungi,and 12 (22.64%) strains of gram-negative bacilli.The incidence of central venous catheterrelated infections was related to the catheterization duration,intubation site,number of catheter lumen,and total parenteral nutrition (TPN),and the difference was significant (P<0.05);the incidence of central venous catheter-related infections was not related to the maximum sterile barrier or the perfusion of antibiotics (P>0.05).CONCLUSION The catheterization duration,intubation site,number of catheter lumen,and TPN are the main

  5. Cluster of Central Venous Catheter Related Bloodstream Infections Intervention Study%集束化干预中心静脉导管相关性血流感染的研究

    Institute of Scientific and Technical Information of China (English)

    黄彩云; 庞杰媚

    2014-01-01

    目的:探讨集束化护理方案在预防中心静脉导管相关性血流感染(C RBS I )的效果。方法:对2012年8月-2014年1月收住IC U的466例中心静脉置管患者制定及实施集束化护理策略。选择集束化干预前2011年3月-2012年8月同科室置中心静脉导管的403例患者作为对照。结果:采取集束化干预后导管的使用率从63.6%升到71.6%,导管的感染率从8.61‰降低到1.49‰,下降了82.7%,干预前、后感染率差异有统计学意义。结论:集束化护理能减少中心静脉导管感染的机会。%Objective :Discusses cluster care solutions in central venous catheter related bloodstream infection (CRBSI) prevention effect. Methods :In August 2012 to January 2014 of 466 patients with central venous catheter admitted to the ICU nursing strategy formulation and implementation of cluster. Before choosing cluster change intervention in March 2011 to August 2012 of 403 patients as control of central venous catheter. Results:Take the cluster is changed after the intervention catheter utilization rose from 63. 6% to 71. 6% ,catheter infection rate reduced from 8. 61‰ to 1. 49‰ ,de‐creased by 82. 7% ,infection rate difference was statistically significant before and after intervention. Conclusion:Cluster of central venous catheter infection nursing can reduce the opportunity.

  6. ICU中心静脉导管相关性血流感染持续质量改进的成效分析%Assessment of effect of continuous quality improvement on catheter-related bloodstream infections in ICU

    Institute of Scientific and Technical Information of China (English)

    林娟; 钟既宁; 陈丽; 胡才宝; 蔡国龙

    2013-01-01

    OBJECTIVE To explore the effect of targeted surveillance and interventions on prevention and control of the catheter-related bloodstream infections in the intensive care unit (ICU) so as to reduce the incidence of infections.METHODS The patients with the central venous catheter-related infections,who were hospitalized the ICU from Jan 2009 to Dec 2010,were enrolled in the study,then the incidence of the central venous catheter-related infections was investigated by using the targeted monitoring method,the causes were analyzed,the continuous quality improvement was performed,the education and supervision of the medical staff was intensified,and the quality of maintenance of the catheter was improved after the catheterization.RESULTS Totally 147 patients with indwelling central venous catheters were included before the continuous quality improvement in 2009,with the mean catheterization duration of(33.84±30.89) days,4569 days in total,23 cases were diagnosed as the infections with the mean infection rate of 5.03 per 1000 catheter-days; totally 141 cases of patients underwent central venous catheterization after the continuous quality improvement in 2010,ith the mean catheterization duration of (36.78 ±43.54) days,5014 days in total,and 13 cases were diagnosed as infections with the mean infection rate of 2.59 per 1000 catheter-days.The mean catheterization duration of the patients with bloodstream infections was (47.23 ± 37.61) days,the incidence of catheter-related infections was 8.88 % in the patients with the catheterization duration no more than 7 days,58.3% in the patients with the catheterization duration more than 90 days,with the mean incidence rate of the central venous catheter-related blood stream infections dropping from 5.03‰ in 2009 to 2.59‰ in 2010.CONCLUSION The targeted monitoring combined with continuous quality improvement can effectively reduce the incidence of central venous catheter-related bloodstream infections in the ICU patients

  7. Closed Catheter Access System Implementation in Reducing Bloodstream Infection Rate in Low Birth Weight Preterm Infants

    Directory of Open Access Journals (Sweden)

    Lily eRundjan

    2015-03-01

    Full Text Available Background Bloodstream infection (BSI is one of the significant causes of morbidity and mortality encountered in a neonatal intensive care unit (NICU, especially in developing countries. Despite the implementation of infection control practices, such as strict hand hygiene, the BSI rate in our hospital is still high. The use of a closed catheter access system to reduce BSI related to intravascular catheter has hitherto never been evaluated in our hospital. Objective To determine the effects of closed catheter access system implementation in reducing the BSI rate in preterm neonates with low birth weight.Methods Randomized clinical trial was conducted on 60 low birth weight preterm infants hospitalized in the neonatal unit at Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to September, 2013. Randomized subjects either received a closed or non-closed catheter access system. Subjects were monitored for 2 weeks for the development of BSI based on clinical signs, abnormal infection parameters, and blood culture. Results Closed catheter access system implementation gave a protective effect towards the occurrence of culture-proven BSI (relative risk 0.095, 95% CI 0.011 to 0.85, p=0.026. Risk of culture-proven BSI in the control group was 10.545 (95% CI 1.227 to 90.662, p=0.026. BSI occurred in 75% of neonates without risk factors of infection in the control group compared to none in the study group.Conclusions The use of a closed catheter access system reduced the BSI in low birth weight preterm infants. Choosing the right device design, proper disinfection of device and appropriate frequency of connector change should be done simultaneously.

  8. Seasonal trend and clinical presentation of Bacillus cereus bloodstream infection: association with summer and indwelling catheter.

    Science.gov (United States)

    Kato, K; Matsumura, Y; Yamamoto, M; Nagao, M; Ito, Y; Takakura, S; Ichiyama, S

    2014-08-01

    Bacillus cereus, an opportunistic pathogen, can cause fatal infection. However, B. cereus bloodstream infections (BSIs) have not been well characterised. From 2008 to 2013, B. cereus isolates from all of the specimens and patients with B. cereus BSIs were identified. Environmental samples were collected to detect B. cereus contamination. We also characterised the clinical presentation of B. cereus BSI through analyses of risk factors for BSI and mortality. A total of 217 clinical B. cereus isolates was detected. Fifty-one patients with nosocomial infections were diagnosed as B. cereus BSI, and 37 had contaminated blood cultures. The number of B. cereus isolates and BSI patients was significantly greater from June to September than from January to April (4.9 vs. 1.5 per month and 1.2 vs. 0.2, respectively). All BSIs were nosocomial and related to central or peripheral vascular catheter. Urinary catheter [odds ratio (OR) 6.93, 95% confidence interval (CI) 2.40-20.0] was the independent risk factor associated with BSI patients when compared to patients regarded as contaminated. In-hospital mortality among BSI patients was 20% and was associated with urinary catheter (OR 34.7, 95 % CI 1.89-63.6) and higher Charlson index (OR 1.99, 95 % CI 1.26-3.12). The number of B. cereus isolates and BSI increased during summer. Inpatients with indwelling vascular or urinary catheters should be carefully monitored for potential B. cereus BSIs.

  9. Equipe interdisciplinar reduz infecção sanguínea relacionada ao cateter venoso central em Unidade de Terapia Intensiva Pediátrica Interdisciplinary task-force reduces catheter-related bloodstream infection in a Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ricardo Vilela

    2010-12-01

    Full Text Available OBJETIVO: Avaliar o impacto de intervenções interdisciplinares nos indicadores de infecção de corrente sanguínea relacionada ao cateter venoso central e microrganismos isolados, em uma Unidade de Terapia Intensiva Pediátrica. MÉTODOS: Estudo de intervenção do tipo antes e depois. Foi criado um programa educativo e constituída uma equipe interdisciplinar de intervenção composta por médicos e enfermeiros da unidade e do Serviço de Controle de Infecção Hospitalar. As intervenções foram compostas por medidas diretas e indiretas educativas e processuais. O período pré-intervenção (Fase 1, de junho de 2003 a maio de 2004, foi comparado ao período pós-intervenção nas Fases 2 (junho de 2004 a maio de 2005 e 3 (junho de 2005 a maio de 2006. As taxas de infecção foram comparadas por ANOVA, sendo significante pOBJECTIVE: To determine the impact of interdisciplinary interventions on central venous catheter-related bloodstream infections rates in a Pediatric Intensive Care Unit (PICU and on the bloodstream infection organisms. METHODS: Interventional study type before-and-after. An educational program was performed and an interdisciplinary team of interventions was created. This team was formed by nurses and doctors of the PICU and of the Infection Control Committee. The interventions were composed by direct and indirect educational and procedural measures. Task-force interventions were developed from Jun/2003 to May/2004. This pre-intervention period (Phase 1 was compared with two post-intervention periods: Phases 2 (Jun/2004 to May/2005 and 3 (Jun/2005 to May/2006. Central venous catheter-related bloodstream infection rates during the three periods were compared by ANOVA, being significant p<0.05. RESULTS: 1,234 patients were studied from June 1st 2003 to May 31, 2006. The number of central venous catheter-related bloodstream infections was 22.72 per 1,000 catheter-days in Phase 1, and 6.81 and 5.87 in Phases 2 and 3

  10. Application of cluster care in the catheter-related bloodstream infections%集束化护理在导管相关性血流感染中的应用

    Institute of Scientific and Technical Information of China (English)

    陈萍燕

    2016-01-01

    目的:探讨集束化护理在预防中心静脉导管相关性血流感染中的应用价值。方法从 ICU 收治的留置中心静脉导管的患者中选取200例为研究对象,采用随机数字表法分为研究组和对照组,每组各100例,对照组患者行常规护理,研究组患者行集束化护理。比较两组置管部位、置管时间、感染发生率。结果研究组中颈内静脉置管、锁下静脉置管、股静脉置管分别为82.00%(82/100)、14.00%(14/100)、4.00%(4/100),与对照组的79.00%(79/100)、15.00%(15/100)、6.00%(6/100)比较,差异均无统计学意义(均 P >0.05);研究组置管时间为(10.36±4.67)d,与对照组的(11.28±4.58)d 相当,组间差异无统计学意义(χ2=1.406,P >0.05)。研究组导管相关性血流感染发生率为1.00%(1/100),明显低于对照组的9.00%(9/100)(χ2=6.736,P =0.009)。结论集束化护理在留置中心静脉导管患者中的应用,较常规护理模式而言,可以显著降低中心静脉导管相关性血流感染发生率,是一种有效的护理干预模式。%Objective To explore the application value of cluster nursing care in preventing central venous catheter -related bloodstream infections.Methods 200 patients with indwelling central venous catheter in ICU were selected as the research subjects.They were randomly divided into study group and control group by digital table, 100 cases in each group.The patients in the control group received routine nursing.The patients in the study group was given cluster based nursing.The catheter site,catheterization time,infection rate were compared between two groups.Results In the study group,the rates of internal jugular vein set pipe and lock venous catheter and femoral vein set tube were 82.00%(82 /100),14.00%(14 /100),4.00%(4 /100),which in the control group were 79

  11. 综合ICU导管相关性血流感染的危险因素分析%Research on risk factors for central venous catheter-related bloodstream infections in general ICU

    Institute of Scientific and Technical Information of China (English)

    许燕卿; 周立新; 罗盛鸿; 李杏崧; 李轶男; 莫韶妹; 吕春梅; 邵劲松

    2012-01-01

    目的 探讨ICU导管相关性血流感染(CRBSI)的感染率及危险因素.方法 采用前瞻性监测,对2009年7月-2010年11月入住ICU> 24 h、年龄>1月龄的置管患者进行监测,并对发生CRBSI的病例进行危险因素分析.结果 监测患者共1145例,其中接受血管内置管的患者890例,血管内导管使用率为77.7%,置管日为9189 d,发生CRBSI 26例,CRBSI感染率为2.9%,平均日感染率为2.8/千日;CRBSI感染率与置管时间、置管次数均呈正相关(x2=40.71,P=0.000;x2=28.6,P=0.000);留置天数(OR=2.415)与置管次数(OR=1.531)是综合ICU的CRBSI独立危险因素.结论 严格执行手卫生、无菌技术置管和维护、尽早拔除导管是预防CRBSI发生的关键.%OBJECTIVE To determine the incidence rate and risk factors for catheter-related bloodstream infections (CRBSI ) in general ICU. METHODS Prospective monitoring was carried out on patients aged over one month whose ICU length of stay was over 24 hours from Jul 2009 to Nov 2010. The risk factors for CRBSI were analyzed. RESULTS Among the 1145 cases surveyed,890 cases were under intravenous catheterization. The rate of intravenous catheterization was 77. 7% while the overall duration was 9189 days. A total of 26 cases of CRBSI were observed with the incidence rate of 2. 9% and the mean daily incidence rate of 2. 8 per 1,000 catheter-day; the incidence rate of CRBSI was positively correlated with the duration of catheterization (x2 =40. 71,P = 0. 000) and frequency of catheterization (x2 =28. 6, P=0. 000), respectively. The duration (OR=2. 415) and frequency (OR=l. 531) of the catheterization were the independent risk factors for CRBSI in general ICU patients with central intravenous catheter. CONCLUSION The incidence rate of CRBSI can be reduced by performing strict hand hygiene procedures, aseptic technique for insertion, care for intravascular catheters and the removal of catheters in a timely manner.

  12. 探讨ICU患者中心静脉导管相关性血流感染的集束化预防策略%Increase the bundle prevention strategies of central venous catheter-related bloodstream infection in patients of ICU

    Institute of Scientific and Technical Information of China (English)

    王艳菊; 陈奕文; 姜爱丽

    2014-01-01

    ICU收治急危重症患者,大多数患者需要使用中心静脉导管测压、输液等,但其同时存在发生导管相关性血流感染(CRBSI)的风险,从而导致患者住院时间延长和病死率升高等。选择最优的穿刺途径、严格的手卫生、消毒皮肤、最大消毒屏障以及定期更换辅料等,应用集束化预防措施进行置管及日常护理是预防导管相关性血流感染发生的重要措施。%In ICU,there are critically ill patients,and most patients require the use of central venous catheter manometer,infusion and so on.But at the same time,the occurrence of catheter-related bloodstream infection(CRBSI) risk,result in patients with prolonged hospitalization and mortality rate higher.The application of bundle preventive measures of catheter and daily care, including the selection of optimal puncture,strict hand hygiene,disinfection, the biggest disinfection and barrier regular replacement of accessories and so on,is an important measure to prevent occurrence of catheter-related bloodstream infection,.

  13. 中心静脉导管留置时间与血行性感染的相关性分析%The Correlation Analysis of Central Venous Catheter Retention Time and Catheter Related Bloodstream Infection

    Institute of Scientific and Technical Information of China (English)

    徐艳; 常勇杰; 徐红炜; 张振; 胡波

    2015-01-01

    目的:探讨中心静脉导管(CVC)留置时间与导管相关性血行感染(CRBSI)的相关性。方法:收集2010年2月-2014年2月本院1086例使用过CVC的患者资料,分析CVC留置1~7 d、7~14 d、14~21 d、21~28 d和≥28 d几个不同时间段CRBSI的发病率,并对CRBSI患者不同年龄段、性别、CVC留置时间和CVC置管处皮肤细菌数做统计学分析。结果:1086例使用过CVC的患者中共发生了352例CRBSI,CVC留置1~7 d、7~14 d、14~21 d、21~28 d和≥28 d CRBSI的发病数分别为65例(5.98%)、69例(8.84%)、143例(13.17%)、198例(18.23%)和352例(32.41%)。CVC留置≤3 d比3~7 d CRBSI发病率有显著性升高,差异有统计学意义(P<0.01),≥28 d比3~28 d CRBSI发病率也有显著性升高,差异有统计学意义(P=0.04)。另外患者年龄≥60岁、CVC经皮穿刺置管和CVC置管处皮肤细菌数≥100 CFU/10 cm2也是导致CRBSI的重要因素。结论:CVC留置的前3天和后28天是CRBSI发生的高峰时间,CRBSI的发生与患者年龄大和置管处皮肤细菌数多有关。%Objective: To investigate the correlation of central venous catheter (CVC) retention time and catheter related b1oodstream infection (CRBSI).Method: A total of 1086 patients who were treated with CVC in our hospital were selected from February 2010 to February 2014,the CRBSI incidence of 1086 patients in different time periods of indwelling CVC 1-7 d, 7-14 d, 14-21 d, 21-28 d and ≥28 d were analysed,the CRBSI of different ages,gender, CVC retention time and the number of skin bacteria of indwelling CVC were statistical analysed.Result: There were 352 cases of CRBSI in 1086 patients who used CVC, CRBSI incidence were respectively 65 cases (5.98%), 69 cases (8.84%), 143 cases (13.17%), 198 cases (18.23%) and 352 cases (32.41%) in indwelling CVC 1-7 d, 7-14 d, 14-21 d, 21-28 d and≥28 d.The CRBSI incidence of indwelling CVC ≤3 days has increased significantly than 3 to

  14. Erratum to: Seasonal trend and clinical presentation of Bacillus cereus bloodstream infection: association with summer and indwelling catheter.

    Science.gov (United States)

    Kato, K; Matsumura, Y; Yamamoto, M; Nagao, M; Ito, Y; Takakura, S; Ichiyama, S

    2016-05-01

    Bacillus cereus, an opportunistic pathogen, can cause fatal infection. However, B. cereus bloodstream infections (BSIs) have not been well characterised. From 2008 to 2013, B. cereus isolates from all of the specimens and patients with B. cereus BSIs were identified. Environmental samples were collected to detect B. cereus contamination. We also characterised the clinical presentation of B. cereus BSI through analyses of risk factors for BSI and mortality. A total of 143 clinical B. cereus isolates was detected. Fifty-one patients with nosocomial infections were diagnosed as B. cereus BSI, and 37 had contaminated blood cultures. The number of B. cereus isolates and BSI patients was significantly greater from June to September than from January to April (3.4 vs. 1.0 per month and 1.4 vs. 0.2, respectively). All BSIs were nosocomial and related to central or peripheral vascular catheter. Urinary catheter [odds ratio (OR) 6.93, 95 % confidence interval (CI) 2.40-20.0] was the independent risk factor associated with BSI patients when compared to patients regarded as contaminated. In-hospital mortality among BSI patients was 20 % and was associated with urinary catheter (OR 12.3, 95 % CI 0.67-225, p=0.045) and higher Charlson index (OR 1.99, 95 % CI 1.26-3.12). The number of B. cereus isolates and BSI increased during summer. Inpatients with indwelling vascular or urinary catheters should be carefully monitored for potential B. cereus BSIs.

  15. Risk factors for catheter-related bloodstream infection in an intensive care unit%ICU 导管相关血流感染危险因素分析

    Institute of Scientific and Technical Information of China (English)

    刘银梅; 余红; 杨惠英

    2014-01-01

    目的:了解重症监护室(ICU)导管相关血流感染(CRBSI)的危险因素,为其预防控制提供科学依据。方法选取2008年1月-2012年12月某院 ICU 行中心静脉置管(CVC)且时间>48 h 的住院患者1677例,分为CRBSI 组和非 CRBSI 组,对其进行危险因素分析。结果 CVC 使用率为92.88%(21041 d);发生 CRBSI 86例, CRBSI 发生率为5.13%,千导管日 CRBSI 发生率为4.02/1000,CRBSI 组患者病死率为58.14%(50/86),显著高于非CRBSI 组的36.83%(586/1591),差异有统计学意义(χ2=15.74,P <0.01)。多因素 logistic 回归分析结果显示,入住ICU 时间>5 d、CVC 时间>5 d、CVC 次数>1次是 CRBSI 的危险因素(均 P <0.01)。结论了解 ICU 住院患者CRBSI 状况及其危险因素,可为进一步开展目标性监测,实现 CRBSI“零宽容”的奋斗目标提供参考。%Objective To study the risk factors for catheter-related bloodstream infection (CRBSI)in an intensive care unit (ICU),and provide scientific evidence for CRBSI prevention and control.Methods 1 677 ICU patients with central venous catheterization (CVC)for>48 hours between January 2008 and December 2012 were divided in-to CRBSI group and non-CRBSI group,risk factors for CRBSI were analyzed.Results The utilization rate of CVC was 92.88% (21 041 d);86 (5.13%)patients developed CRBSI,the incidence of CRBSI per 1 000 catheterization-day was 4.02,the mortality of CRBSI group was significantly higher than non-CRBSI group (58.14% [50/86]vs 36.83%[586/1 591])(χ2 =15.74,P 5 days,CVC>5 days,the episode of CVC>1 (P <0.01).Conclusion Realizing the occur-rence status and risk factors of CRBSI in ICU patients can provide reference for further targeted monitor and implementation of zero tolerance goal of the CRBSI.

  16. 综合重症监护病房中心静脉导管相关性血流感染监测与控制效果分析%Monitor and control of central venous catheter-related bloodstream infections in general intensive care unit

    Institute of Scientific and Technical Information of China (English)

    张淑敏; 刘香玲; 冯丽媛; 宋雪苹; 张豫生

    2011-01-01

    目的 降低重症监护病房导管相关性血流感染(CRBSI)的发生率.方法 A组采取回顾性调查方法,查阅出院病历,逐项填写记录表;B组采取目标性监测方法,由两名深静脉导管专职护理护士负责具体操作,采取一系列感染控制措施,将两组资料分别进行汇总统计、分析判断、计算感染率并做比较.结果 A组导管相关性血流感染率为20.9‰,B组实行目标性监测落实感染控制各项措施后,导管相关性血流感染率下降至5.4‰,差异有统计学意义(P<0.05).结论 在综合控制措施中,提高医护人员在医疗活动中的技术水平和执行力,设专业导管护理小组进行中心静脉置管全过程质量管理,是降低导管相关性血流感染非常有效的措施.%OBJECTIVE To reduce the incidence of catheter-related bloodstream infections.METHODS A retrospective survey was performed to Group A by searching for discharged patients and completing a record sheet item by item.A targeted surveillance to Group B was performed, There were two full-time care nurses in charge of specific operations on central venous catheter by adopting a series of infection control measures, the data of the two groups were aggregated statistics, analyzed and judged, the infection rates were calculated and compared.RESULTS The catheter-related bloodstream infection rate of group A was 20.9‰, Group B took the method of targeted survey and implemented measures of infection control, the catheter-related bloodstream infection rate fell to 5.4 ‰, it was significantly different(P<0.05).CONCLUSION In the comprehensive control measures, it is a very effective measure of setting professional nursing team on the whole process of quality management on central venous catheter tube and improving the technical level and execution of the doctors and nurses in the medical activities to reduce the catheter-related bloodstream infections.

  17. Incidence, risk factors, microbiology of venous catheter associated bloodstream infections - A prospective study from a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    M Kaur

    2015-01-01

    Full Text Available Purpose : Central venous catheters (CVCs though indispensable in current medical and intensive care treatment, also puts patients at risk of catheter related infection (CRI resulting in increased morbidity and mortality. We analysed the incidence, risk factors, bacteriological profile and antimicrobial susceptibility pattern of the isolates in central venous catheter associated bloodstream infection (CVC-BSI in the intensive care unit (ICU patients and studied the formation of biofilm in CVCs. Materials and Methods: The following case control study included 115 patients with CVC in situ. Quantitative blood cultures (QBC and catheter tip cultures were performed for the diagnoses. Direct catheter staining was done for an early diagnosis by acridine orange (AO and Gram staining methods. Biofilm production in catheters was detected by ′tissue culture plate′ (TCP method. The results were analysed using the computer-based program statistical package for the social sciences (SPSS. Results : In 25/115 patients, definite diagnosis of CVC-BSI was made. The mean age was 48.44 ± 17.34 years (cases vs 40.10 ± 18.24 years (controls and the mean duration of catheterisation was 25.72 ± 8.73 days (cases vs 11.89 ± 6.38 days (controls. Local signs of infection (erythema, tenderness and oozing were found more significantly in CVC-BSI cases. The AO staining was more sensitive and Gram staining of catheters showed higher specificity. Staphylococcus aureus followed by Pseudomonas aeruginosa and non-albicans Candida were common CVC-BSI pathogens. Multidrug-resistant (MDR strains were isolated in bacterial agents of CVC-BSI. Non-albicans Candida and Enterococcus faecalis showed strong biofilm production. Conclusion : The incidence of CVC-BSI was 21.73% and the rate was 14.59 per 1000 catheter days. Prolonged ICU stay and longer catheterisation were major risk factors. S. aureus was isolated most commonly in CVC-BSI cases. The menace of multidrug resistance and

  18. Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.

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    Walter Zingg

    Full Text Available Central line-associated bloodstream infection (CLABSI is the major complication of central venous catheters (CVC. The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001 after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22. Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI.

  19. Exchange of peripherally inserted central catheters is associated with an increased risk for bloodstream infection.

    Science.gov (United States)

    McCoy, Michael; Bedwell, Susan; Noori, Shahab

    2011-06-01

    It is not uncommon that the peripherally inserted central catheter (PICC) needs to be replaced either due to blockage or migration to a peripheral position. In such circumstances, there are two methods of PICC placement: new-site insertion and exchange by using the old PICC as a guide wire. Our objective was to investigate risk of infection associated with the exchange method. In this retrospective study, data on all PICC insertions in the neonatal intensive care unit in 2004 to 2008 were obtained. In the population who needed removal of existing PICC and insertion of a new one, we compared central line-associated bloodstream infection (CLABSI) within 1 week of insertion between the two insertion methods. Of 1148 PICC insertions reviewed, 164 (103 new-site and 61 exchange insertions) were performed after removal of a blocked/malpositioned PICC and therefore comprised the study population. The rate of CLABSI was higher in the exchange method (9.8% versus 1%, P exchange method (odds ratio 25.2, 95% confidence interval: 2.17 to 292.98; P = 0.01). In infants, insertion of PICCs using the exchange method carries an increased risk of bloodstream infection.

  20. Port central venous catheters-associated bloodstream infection during outpatient-based chemotherapy.

    Science.gov (United States)

    Mauri, Davide; Roumbkou, Sofia; Michalopoulou, Stella; Tsali, Lamprini; Spiliopoulou, Anastasia; Panou, Charalampos; Valachis, Antonis; Panagopoulos, Angelos; Polyzos, Nikolaos P

    2010-12-01

    Central venous catheters (CVCs) are commonly used for the administration of intravenous chemotherapy in outpatient setting. Nevertheless, outbreaks of catheter-associated bloodstream infections had been reported from oncology centers. We describe a large outbreak of CVCs-associated Klebsiella oxytoca bloodstream infection, occurring in an oncology chemotherapy outpatient unit of northern Greece between October 2006 and May 2007. The outbreak involved approximately 10% of the patients with CVCs who were receiving home-based chemotherapy, and it represents the second larger outbreak of CVCs-associated BSIs due to Klebsiella oxytoca in oncology outpatient centers. We retrospectively analyzed the chain of investigations and prophylactic/diagnostic measures taken to eradicate the infection: (1) patients' chart audit, (2) estimation of the infection among asymptomatic patients, (3) implementation of the level of awareness of medical and paramedical personnel, (4) collection of samples from environment, medications and infusion materials, (5) critical appraisal of chemotherapeutical schemes and (6) cooperation with peripheral institutions. The isolation of Klebsiella oxytoca in a chemotherapy solution (infusional 5-FU in dextrose 5% solution within a 48 h pump) from a peripheral General Hospital and the prompt transmission of the data to the chemotherapy center played a key role for the management of the infection cluster. This is the first report that evidenced the detection of Klebsiella oxytoca within a chemotherapeutical preparation. Data transmission from peripheral hospitals to the central institution resulted in an important feedback that allowed a better estimation of the infection cluster and more tailored actions for the eradication of the infection.

  1. [A retrospective study of the relationship between bacterial numbers from central venous catheter tip cultures and blood cultures for evaluating central line-associated bloodstream infections].

    Science.gov (United States)

    Ohtaki, Hirofumi; Ohkusu, Kiyofumi; Nakayama, Asami; Yonetamari, Jun; Ando, Kohei; Miyazaki, Takashi; Ohta, Hirotoshi; Furuta, Nobuyuki; Watanabe, Tamayo; Ito, Hiroyasu; Murakami, Nobuo; Seishima, Mitsuru

    2014-01-01

    Catheter-related bloodstream infection (CRBSI) is an infectious disease requiring special attention. It is a common cause of nosocomial infections; catheter insertion into the central veins particularly increases the risk of infection (CLA-BSI: central line-associated bloodstream infection). We examined the relationship between the number of bacterial colonies cultured from shredded central venous catheter (CVC) tips and from blood cultures in our hospital from 2011 to 2012. Coagulase-negative staphylococci topped the list of microbe isolated from the CVC tip culture, followed by Pseudomonas aeruginosa, Staphylococcus aureus, and Candida spp. S. aureus and Candida spp., with growth of over 15 colony-forming units in the CVC tip culture, were also detected at high rates in the blood culture. However, gramnegative bacilli (Enterobacteriaceae and P. aeruginosa) did not show a similar increase in colony number in the CVC tip culture. Because microbes adhering to shredded catheter tips are readily detected by culture, this method is useful as a routine diagnostic test. In addition, prompt clinical reporting of the bacterial number of serious CLA-BSI-causing S. aureus and Candida spp. isolated from CVC tips could contribute to earlier CLA-BSI diagnosis.

  2. Effectiveness analysis of cluster nursing to reduce ICU central venous catheter-related bloodstream infection rates%集束化护理对降低ICU中心静脉导管相关性血流感染率的效果分析

    Institute of Scientific and Technical Information of China (English)

    郑贞; 严继承; 黄鑫; 杨帆

    2014-01-01

    目的:探讨集束化护理对于减少IC U中心静脉导管相关性血流感染率效果的影响。方法选取2011年6月-2012年3月行常规护理的289例中心静脉导管患者作为对照组,并选取2012年4月-2013年3月行集束化护理的327例中心静脉导管患者为试验组,对两组患者的治疗结果进行对比分析。结果试验组实施集束化护理后的中心静脉导管相关性血流感染感染率为3.36‰、对照组为6.57‰,两组比较差异有统计学意义( P<0.05);试验组患者住院天数为(6.71±0.77)d、对照组为(8.47±0.79)d ,两组比较差异有统计学意义( P<0.05);试验组患者插管天数为(9.36±0.82)d、对照组为(6.29±0.63)d ,两组比较差异有统计学意义( P<0.05)。结论集束化护理对降低IC U中心静脉导管相关性血流感染率有显著效果,同时集束化护理措施的依从性也对治疗效果有明显影响。%OBJECTIVE To study the effect of cluster nursing on reducing the ICU central venous catheter-related bloodstream infection rate .METHODS Totally 289 patients with central venous catheters receiving routine care from June 2011 to Mar .2012 were selected as the control group ,meanwhile ,327 patients with central venous catheters receiving cluster nursing during Apr .2012 to Mar 2013 were selected as the experimental group .The two groups were compared for treatment outcomes .RESULTS After the implementation of cluster nursing ,the central venous catheter-related bloodstream infection rate was 3 .36‰ in the experimental group ,significantly low-er than 6 .57‰ in the control group (P<0 .05) .The hospitalization days were approximately (6 .71 ± 0 .77)d in the experimental group ,significantly lower than (8 .47 ± 0 .79) d in the control group(P<0 .05) .The catheteriza-tion days were (9 .36 ± 0 .82) d in the experimental group and (6 .29 ± 0 .63) d in the control group ,the

  3. 集束化干预管理预防肝移植患者外周中心静脉导管相关性血流感染的效果研究%Effect of bundle care on prevention of peripherally inserted central venous catheter-related bloodstream infections in liver transplantation patients

    Institute of Scientific and Technical Information of China (English)

    王丽芹; 陈东方; 李丽

    2014-01-01

    OBJECTIVE To explore the effect of bundle care on prevention of peripherally inserted central venous catheter (PICC)‐related bloodstream infections in the liver transplantation patients so as to provide guidance for clinical prevention of the PICC‐related bloodstream infections and the standardized nursing .METHODS Totally 32 liver transplantation patients who underwent PICC from Nov 2011 to Oct 2012 and did not receive the bundle care were assigned as the control group ,and 29 liver transplantation patients who underwent PICC from Nov 2012 to Oct 2013 and received the bundle care were set as the experimental group ;the incidence of catheter‐related blood‐stream infections was observed and compared between the two groups .RESULTS The catheter indwelling time of the control group was 3 840 days ,the experimental group 4 524 days;the catheter‐related bloodstream infections occurred in 7 cases of the control group with the infection rate of 1 .82‰ and occurred in 3 cases of the experimen‐tal group with the infection rate of 0 .66‰ ,there was statistically significant difference in the incidence of catheter‐related bloodstream infections between the two groups (P<0 .05) .CONCLUSION The bundle care can effectively prevent the catheter‐related bloodstream infections in the liver transplantation patients .%目的:探讨集束化干预管理预防肝移植患者外周中心静脉导管(PICC)相关性血流感染(CRBSI)的效果,为临床预防PICC导管相关性血流感染及规范化护理提供参考依据。方法将2011年11月-2012年10月32例肝移植患者行PICC术未采取集束化干预管理的患者作为对照组,将2012年11月-2013年10月29例肝移植患者行PICC术采取集束化干预管理的患者作为试验组,比较两组CRBSI的发生率。结果对照组患者导管留置时间3840 d ,发生CRBSI 7例,CRBSI发生率1.82‰;试验组29例,导管留置时间4524 d ,发生CRBSI 3例,C RBS I

  4. Investigation and analysis of postoperative cardiac venous catheter-related bloodstream infections in children with congenital heart disease%先天性心脏病患儿术后中心静脉导管相关性血流感染的调查分析

    Institute of Scientific and Technical Information of China (English)

    贾鹏; 黄睿; 李刚; 刘斌

    2015-01-01

    OBJECTIVE To investigate postoperative central venous catheter‐related bloodstream infections in children with congenital heart disease as well as the distribution of pathogenic bacteria ,so as to provide the basis for reducing infection rates .METHODS A total of 617 children with congenital heart disease who underwent surgical treatment in the cardiology center during May 2011 to Mar .2013 were enrolled .The targeted monitoring of central venous catheter‐related bloodstream infections was performed , and the infection incidence and the pathogen distribution were investigated .RESULTS Among the 617 children who underwent cardiac surgery and had indwelling central venous catheters ,12 cases of related bloodstream infections occurred ,the incidence was 1 .94% .Three cases (25 .00% ) had related bloodstream infections occurring in 7 days ,7 cases (58 .33% ) in 8 - 15 days and 2 cases (16 .67% ) after 15 days .Totally 21 pathogens were detected ,including 12 gram‐negative bacteria accounting for 57 .14% and 9 gram‐positive bacteria accounting for 42 .86% ,among which Acinetobacter baumannii ,Pseudomonas aeruginosa ,Staphylococcus aureus accounted for the top three .CONCLUSION The rate of postoperative central venous catheter‐related bloodstream infections in children with congenital heart disease is relatively high .In the course of treatment ,health care workers should be strictly in accordance with the instruc‐tion manual ,implement proactive measures to prevent infection in children ,reduce central venous catheter‐related bloodstream infections ,shorten hospital stay in children and reduce mortality .%目的:探讨先天性心脏病患儿术后中心静脉导管(CVC)相关性血流感染以及病原菌分布,为临床降低其感染率提供依据。方法选取2011年5月-2013年3月心脏病治疗中心收治的617例实施手术治疗的先天性心脏病患儿,进行中心静脉导管相关血流感染目标性监测,调查研究感

  5. Incidencia de bacteriemia asociada a catéter en niños hospitalizados que reciben nutrición parenteral Blood-stream catheter related infection in inpatient children receiving parenteral nutrition

    Directory of Open Access Journals (Sweden)

    E. Vaquero Sosa

    2011-02-01

    Full Text Available Las infecciones relacionadas con el catéter son la complicación más grave en los pacientes portadores de un catéter venoso central. Se considera que la nutrición parenteral (NP constituye un factor de riesgo de desarrollar una infección relacionada con el catéter (IRCat. Material y métodos: para conocer la tasa de infección y poder establecer estrategias de prevención de la infección nosocomial, se revisaron todas las historias de los 120 pacientes que recibieron NP a lo largo de 2008. Todas las historias de los pacientes con un episodio fiebre y hemocultivo positivo fueron consideradas. La tasa de infección se definió como número de episodios por cada 1000 días de NP. Resultados: Se obtuvieron 48 hemocultivos positivos. La tasa global de bacteriemia asociada a catéter fue de 37,8/1000 días de NP. La incidencia fue significativamente mayor en lactantes menores de 2 años de edad. Los gérmenes que se encontraron con mayor frecuencia fueron Estafilococo coagulasa negativo (56,8%, seguidos de bacilos Gram (20,8%, Staph aureus (12,5% y los hongos (12,5%. No encontramos diferencias en la tasa de infección cuando ajustamos por la enfermedad de base o la duración de la NP. Conclusiones: La tasa de infección en niños con NP en el hospital es considerablemente elevada. La NP parece constituir un factor de riesgo de desarrollar IRCat. Es necesario establecer políticas adecuadas y continuadas para conseguir disminuir la tasa de infección nosocomial.Blood-stream catheter related infection is the most severe complication in patients carrying a central venous catheter. Parenteral nutrition (PN use seems to be a risk factor for developing a catheter-related infection (CRI. Material & methods: In order to know the incidence of CRI in children to further implement policies to reduce nosocomial infection, we review all charts of children (1 month to 17 years who received parenteral nutrition while in hospital. All episodes of fever

  6. Improved method for the detection of catheter colonization and catheter-related bacteremia in newborns.

    Science.gov (United States)

    Martín-Rabadán, P; Pérez-García, F; Zamora Flores, E; Nisa, E S; Guembe, M; Bouza, E

    2017-04-01

    Accurate diagnosis of catheter-related bloodstream infection (CRBSI) is mandatory for hospital infection control. Peripherally inserted central venous catheters (PICCs) are widely used in intensive care units, but studies about procedures for detection of colonization are scarce in neonates. We sequentially processed 372 PICCs by 2 methods, first by the standard roll-plate (RP) technique and then by rubbing catheters on a blood agar plate after being longitudinally split (LS). With both techniques, we detected 133 colonized PICCs. Ninety-four events of CRBSI were diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value for detection of CRBSI were 58.5%, 92.8%, 73.3%, and 86.9%, respectively, for RP technique and 96.8%, 88.5%, 74.0%, and 98.8%, respectively, for LS technique. The LS technique increased the proportion of detected CRBSI by 38.3%. Neonatal PICC tips should be cultured after cutting them open. This technique is simple and sensitive to detect catheter colonization and also to diagnose CRBSI.

  7. Prevention of catheter-related bacteremia with a daily ethanol lock in patients with tunnelled catheters: A randomized, placebo-controlled trial

    NARCIS (Netherlands)

    L. Slobbe (Lennert); J.K. Doorduijn (Jeanette); P.J. Lugtenburg (Pieternella); A.E. Barzouhi (Abdelilah); H. Boersma (Eric); W.B. van Leeuwen (Willem); B.J.A. Rijnders (Bart)

    2010-01-01

    textabstractBackground: Catheter-related bloodstream infection (CRBSI) results in significant attributable morbidity and mortality. In this randomized, double-blind, placebo-controlled trial, we studied the efficacy and safety of a daily ethanol lock for the prevention of CRBSI in patients with a tu

  8. 系统评价抗生素在预防新生儿深静脉置管相关感染中的价值%Systematic review of prophylactic antibiotics in the prevention of catheter-related bloodstream infection in newborn infants

    Institute of Scientific and Technical Information of China (English)

    余章斌; 韩树萍; 沙莉; 陈玉林; 邱玉芳

    2013-01-01

    Objective To assess the effect of prophylactic antibiotics in the prevention of catheter-related bloodstream infection ( CRBSI ) in newborn infants. Methods We searched the randomizedcontroller( RCT ) studies on prophylactic antibiotics to prevent catheter-related bloodstream infection ( CRBSI )in neonates from 1 January, 1990 to 30 April, 2012,and performed meta-analysis with results from homogenous studies using Rev Man 5. 0 software to assess the odds ratio ( OR ) and 95% confidence intervals (95% Cl). Results Six studies were included. A total of 270 cases were in the group of prophylactic antibiotics ( observation group ), and 272 cases were in the group without antibiotics ( control group ). Meta-analysis showed that the observation group had decreased incidence of CRBSI (OR=0.14, 95% CI: 0. 07 - 0. 29 ), and catheter colonization (OR =0.41, 95% CI: 0. 23 - 0. 71 ). Overall mortality rate, the incidence of intraventricular hemorrhage, necrotizing enterocolitis and antibiotic resistance were similar between the two groups. Subgroup analysis based on the different routes of prophylactic antibiotics showed that there were no statistically significant difference between intravenous antibiotics and antibiotics-heparin lock solution on the outcome. Conclusions Prophylactic intravenous antibiotics in neonates reduced the rate of CRBSI and catheter colonization. However, the overall mortality rate was unaffectd. So, the routine use of prophylactic intravenous antibiotics in neonates with deep venous catheters cannot be recommended. Prophylactic antibiotics-heparin lock solutions in neonates with a deep venous catheter reduced the incidence of CRBSI and catheter colonization. But the small sample size of the included studies and the lack of data on antibiotic resistance mandate further clinical trials with higher quality and larger scale to evaluate its effectiveness and safety.%目的 系统评价抗生素预防新生儿深静脉置管相关感染的价值.方法

  9. IMPLEMENTATION OF CENTRAL VENOUS CATHETER - RELATED BLOODSTREAM INFECTIONS WITH KEY ASPECTS OF COMPLIANCE MONITORING ON ITS INCIDENCE%中心静脉导管相关血流感染重点环节依从性监测对其发生率的影响

    Institute of Scientific and Technical Information of China (English)

    杨洪艳; 范玲; 于晓江

    2015-01-01

    目的:探讨对预防中心静脉导管相关血流感染(catheter related blood stream infection,CRBSI)重点环节依从性监测,能否降低 CRBSI 的发生率。方法选择2013年1—10月56例中心静脉置管患者(A组),对预防 CRBSI 实施重点环节依从性监测,包括:使用抗菌药物包被导管、尽量使用锁骨下静脉置管、留置导管术时无菌屏障最大化、使用洗必泰乙醇溶液皮肤消毒、每天评估是否需要继续留置导管、严格执行定期更换穿刺点敷料要求、执行手卫生规范、使用生理盐水或肝素盐水常规冲管。观察 CRBSI 发生率,与2012年3—12月49例中心静脉患者(B 组,常规处置,无监测)的 CRBSI 发生率进行比较。结果A 组的 CRBSI 发生率0.6‰,明显低于 B 组的发生率4.9‰,差异有统计学意义。结论自2013年我院开展的预防 CRBSI 重点环节依从性监测,可进一步规范中心静脉导管置管要求,操作流程,以及护理方法等,监督医生,护士严格按要求完成中心静脉导管治疗及护理,提高留置中心静脉导管的管理水平,有效降低CRBSI 的发生率。%Objective To investigate the prevention of central venous catheter-related bloodstream infec-tions (catheter related blood stream infection CRBSI)for key aspects of compliance monitoring,the ability to reduce the incidence of CRBSI.Methods From January-October 2013,56 cases of patients with cen-tral venous catheter were enrolled at group A on the prevention of CRBSI implementation of key aspects of compliance monitoring,including:the use of catheters coated with antimicrobial drugs,to make use of the subclavian vein catheterization,indwelling catheters when sterile barrier technique to maximize the use of chlorhexidine for skin disinfection ethanol solution,assessing the need to continue daily indwelling cathe-ter,strict implementation of the puncture site dressings require periodic replacement,perform hand hygiene standards,the use of

  10. Prevenção de infecções de corrente sanguínea relacionadas a cateter em pacientes em hemodiálise Prevención de infecciones del torrente sanguíneo relacionadas al catéter de pacientes en hemodiálisis Prevention of Catheter-Related Bloodstream Infections in Patients on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Dayana Souza Fram

    2009-01-01

    Full Text Available OBJETIVO: Realizar uma revisão sistemática sobre medidas padronizadas para prevenção de infecções relacionadas a cateter em pacientes em hemodiálise. MÉTODOS: Foi realizada uma revisão sobre a prevenção de infecções em hemodiálise nas bases de dados Medline, Embase, SciElo, Lilacs e Cochrane Library de estudos publicados entre os anos de 1990 e 2008. RESULTADOS: Foram encontrados 293 artigos e destes 12 foram incluídos no estudo. CONCLUSÃO: Foi evidenciada a importância da aplicação de um conjunto de medidas de controle de infecções pelos profissionais da saúde para prevenir a infecção nesta população de pacientes.OBJETIVO: Realizar una revisión sistemática sobre las medidas patronizadas para la prevención de infecciones relacionadas al catéter de pacientes en hemodiálisis. MÉTODOS: Fue realizada una revisión sobre la prevención de infecciones en hemodiálisis en las bases de datos Medline, Embase, SciElo, Lilacs y Cochrane Library de estudios publicados entre los años de 1990 al 2008. RESULTADOS: Fueron encontrados 293 artículos y de éstos 12 fueron incluidos en el estudio. CONCLUSIÓN: Se evidenció la importancia de la aplicación de un conjunto de medidas de control de infecciones por los profesionales de la salud para prevenir la infección en esta población de pacientes.OBJECTIVE: To conduct a systematic review of the literature on the prevention of catheter-related bloodstream infections in patients on hemodialysis. METHODS: A literature search was performed in Medline, Embase, Scielo, Lilacs, and Cochrane databases for articles published from 1990 to 2008. RESULTS: Two hundred ninety- three articles were retrieved. However, only 12 studies were included in this review. CONCLUSIONS: Findings suggest that health care providers use several infection control measures to prevent bloodstream infections in this patient population.

  11. Impact of bloodstream infections on catheter colonization during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Kim, Dong Wan; Yeo, Hye Ju; Yoon, Seong Hoon; Lee, Seung Eun; Lee, Su Jin; Cho, Woo Hyun; Jeon, Doo Soo; Kim, Yun Seong; Son, Bong Soo; Kim, Do Hyung

    2016-06-01

    There are concerns about secondary extracorporeal membrane oxygenation (ECMO) catheter infections in bacteremic patients. We investigated the association between blood stream infection (BSI) and ECMO catheter colonization. From January 2012 to August 2014, 47 adults who received ECMO support were enrolled. The ECMO catheter tip was cultured at the end of the ECMO procedure. The enrolled patients were classified into two groups according to the presence of BSI during ECMO support and analyzed with respect to ECMO catheter colonization. Of 47 cases, BSI during ECMO was identified in 13 patients (27.7 %). ECMO catheter colonization was identified in 6 (46.2 %) patients in the BSI group and 3 (8.8 %) in the non-BSI group. BSI during ECMO support was independently associated with ECMO catheter colonization [odds ratio (OR) 5.55; 95 % confidence interval (CI) 1.00-30.73; p = 0.049]. The organisms colonizing ECMO catheters in the setting of primary BSI were predominantly Gram-positive cocci and Candida species. Acinetobacter baumannii was the most common colonizing pathogen in the setting of secondary BSI. All the organisms colonizing ECMO catheters were multi-drug resistant organisms, including methicillin-resistant S. aureus, Candida glabrata, and carbapenem-resistant A. baumannii. ECMO catheters may become contaminated with multi-drug resistant pathogens in the presence of BSI. Therefore, ECMO should be applied cautiously in septic patients with bacteremia caused by multi-drug resistant pathogens.

  12. Microbiocidal effects of various taurolidine containing catheter lock solutions

    NARCIS (Netherlands)

    Olthof, E.D.; Nijland, R van; Gulich, A.F.; Wanten, G.J.A.

    2015-01-01

    BACKGROUND & AIMS: We have recently shown that a catheter lock solution containing taurolidine dramatically decreases catheter-related bloodstream infections (CRBSI) in patients on home parenteral nutrition (HPN) when compared to heparin. Since several taurolidine formulations are commercially avail

  13. Central Venous Catheter-Related Hydrothorax

    Directory of Open Access Journals (Sweden)

    Se Hun Kim

    2015-11-01

    Full Text Available This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right sub-clavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

  14. Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa Método bundle en la redución de infecciones relacionadas a catéteres centrales: una revisión integrativa Care bundle to reduce central venous catheter-related bloodstream infection: an integrative review

    Directory of Open Access Journals (Sweden)

    Juliana Dane Pereira Brachine

    2012-12-01

    éter con su retirada inmediata cuando posible. La mayoría de los estudios analizados mostraron una reducción significante de infección sanguínea relacionadas o asociadas con catéteres intravenosos centrales.This is an integrative review of literature aimed to identify evidence-based interventions which make up care bundles to reduce central venous catheter-related or associated bloodstream infections. To collect data in Brazilian and international databases were used the key word bundle and the descriptors catheter-related infection, infection control and central venous catheterization, resulting in fifteen articles, after inclusion criteria application. This work showed five interventions as those commonly employed in the bundles methods: hand hygiene, chlorhexidine gluconate for skin antisepsis, use of maximal sterile barrier precaution during the catheter insertion, avoid the femoral access and daily review of catheter necessity with prompt removal as no longer essential. The majority of the studies showed a significant reduction in bloodstream infection related to or associated with central venous catheters.

  15. Development of subsequent bloodstream infection in patients with positive Hickman catheter blood cultures and negative peripheral blood cultures.

    Science.gov (United States)

    Park, Ki-Ho; Cho, Oh-Hyun; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Yang Soo; Woo, Jun Hee; Kim, Mi-Na; Kim, Dae-Young; Lee, Jung-Hee; Lee, Je-Hwan; Lee, Kyoo-Hyung; Lee, Dae Ho; Suh, Cheolwon; Kim, Sung-Han

    2011-05-01

    There are limited data on the incidence of subsequent bloodstream infection (BSI) and the effect of systemic antibiotics in patients who had positive catheter-drawn blood cultures (CBC) and negative peripheral blood cultures (PBC). We retrospectively reviewed all paired blood cultures from patients with Hickman catheter in the hematology-oncology ward between January 1997 and December 2008. There were 112 episodes with positive CBC and negative PBC. Nine episodes (8.0%; 95% CI, 3.0-13.1%) led to subsequent BSI within 28 days. Subsequent BSI developed in 6 of 31 episodes (19%) where empiric antibiotics were inappropriate but in 3 of 81 episodes (4%) where empiric antibiotics were appropriate (P = 0.01). Subsequent candidemia (50%, 2 of 4) was more common than subsequent bacteremia (6%, 7 of 108) (P = 0.03). In conclusion, for patients with positive CBC and negative PBC, the overall incidence of subsequent BSI was 8.0%, and inappropriate empiric antibiotics was associated with subsequent BSI.

  16. First reported case of Staphylococcus condimenti infection associated with catheter-related bacteraemia

    Directory of Open Access Journals (Sweden)

    Y. Misawa

    2015-01-01

    Full Text Available We report a case of a patient who experienced a catheter-related bloodstream infection caused by Staphylococcus condimenti, which was first isolated from soy sauce mash. This is the first reported case of human infection. Although blood culture isolates and the catheter tip tube did not reveal coagulase or clumping factor, false-positive results were obtained from latex agglutination tests for clumping factor and protein A due to self-agglutination. Care is needed when performing only latex agglutination test without a coagulase test. Further studies are needed to determine the pathogenic potential of S. condimenti based on appropriate identification.

  17. 外科ICU中心静脉导管相关血流感染的回顾性病例对照研究%Central Venous Catheter Related-Bloodstream Infection in Surgical Intensive Care unit: a Retrospective, Case-Controlled Study

    Institute of Scientific and Technical Information of China (English)

    王惠芬; 孙运波; 徐振涛; 高秋芳

    2012-01-01

    目的:了解外科ICU中心静脉导管相关血流感染(CRBSI)的发病率、病原菌分布及相关危险因素,为临床预防和经验性治疗提供依据.方法:回顾性调查我院外科ICU 2010年1月~2011年8月的中心静脉导管置管病例,根据血培养和导管培养结果分为CRBSI组和非CRBSI组,统计CRBSI的发病率、致病菌;比较CRBSI组与非CRBSI的临床资料,应用多因素Logistic回归分析筛查相关危险因素.结果:共收集249例中心静脉置管病例,CRBSI发病率为8.41例次/千导管日,病原菌分布为G+菌4例,G-菌9例,真菌8例.Logistic回归分析显示导管留置时间(OR 3.298,95% CI 1.070~10.168,P=0.038)、APACHEII评分(OR1.137,95%CI 1.067~1.213,P=0.000)、完全胃肠外营养(OR 1.117,95% CI 1.023~1.219,P=0.014)是CRBSI的独立危险因素.结论:导管留置时、APACHEII评分、完全胃肠外营养是发生CRBSI的独立危险因素.%Objective: To analyze the incidence, pathogens distribution and risk factors of centra! venous catheter related-bloodstream infection in surgical intensive care unit. Methods: Patients admitted in surgical intensive care unit of our hospital from January 2010 -August 2011 with CVC were enrolled, and divided into CRBS1 group and non-CRBSI group, on the basis of the outcomes of germicultu-re of blood samples and hub tips. Then, the incidence and pathogens of CRBSI were analyzed retrospectively. The clinical dam of CRBSI group and non-CRBSI group were compared, and a multivariate analysis has been performed with logistic regression to investigate the risk factors. Results: 249 cases with CVC has been collected, and the incidence of CRBSI is 8.41 cases per 1000 catheter days. 21 pathogens were isolated, including 4 gram-positive bacterium, 9 gram-negative bacterium and 8 fungi, and some were antibiotic-resistance strains. Logistic regression analysis showed that duration of cathetenzation (OR 3.298, 95% CI 1.070-10.168, P=0.038), APACHEII score (OR

  18. 洋葱伯克霍尔德菌污染肝素钠封管液致血管导管相关血流感染暴发%Vascular catheter-related bloodstream infection outbreak due to the contamination of heparin sodium sealing solution by Burkholderia cepacia

    Institute of Scientific and Technical Information of China (English)

    李静

    2013-01-01

    目的 调查某院肿瘤病房一起由洋葱伯克霍尔德菌(BC)引起的血管导管相关血流感染(CRBSI)暴发的原因,为预防和控制医院感染提供依据.方法 采用临床资料调查和现场采样检测相结合的方法,对此次医院感染的暴发进行流行病学调查.结果 11例次BC引起的 CRBSI发生时间集中,分别为2008年2月18日(1例)、19日(1例)、20日(6例)、21日(1例)、22日(2例);均为股静脉置管患者,均从患者血液中培养出BC,均使用了同一袋肝素钠封管液.环境卫生学调查,患者所使用的液体、一次性注射器材、环境物品细菌学检测均合格,仅在1份剩余肝素钠封管液中(患者共用此封管液)培养出1株BC,其药敏结果与患者血液培养菌株一致.立即采取措施,拔除患者深静脉置管,并抗感染治疗.11例患者7 d后血培养均无细菌生长,该病区再无相同病例出现.结论 BC污染肝素钠封管液是此次CRBSI暴发的原因,经积极采取措施,感染得到有效控制.%Objective To investigate the causes of an outbreak of Burkholderia cepacia (B. cepacia) vascular catheter-related bloodstream infection(CRBSI) in an oncology department, and provide the basis for the prevention and control of health care-associated infection. Methods Epidemiological investigation was performed by combination of clinical data analysis and on-site sampling . Results The occurrence time of 11 B. cepacia CRBSf cases concentrated on February 18(1 case) , 19 (1 case) , 20 (6 cases) , 21 (1 case) , and 22 (2 cases) of 2008, respectively ; all patients were intubated in the femoral vein, isolated B. cepacia from blood cultures ,and used the same bag of heparin sodium sealing solution. Bacterial culture results of heparin sodium sealing solution , disposable syringes, and environmental samples were all qualified, only 1 tube of used heparin sodium sealing solution (all patients shared this tube) isolated B. cepacia, antimicrobial susceptibility

  19. 血培养阳性时间差法对重症患者导管相关性血流感染诊断的应用价值%The value of differential time to positivity of blood cultures in diagnosis of catheter-related bloodstream ;infection in patients with solid tumors in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    张青; 王东浩; 张文芳; 白长森; 郑珊; 刘坤彬; 李丁; 张鹏

    2015-01-01

    Objective To determine the value of differential time to positivity ( DTTP ) of blood culture for the diagnosis of catheter-related bloodstream infection ( CRBSI ) in patients with solid tumors in intensive care unit ( ICU ). Methods A retrospective study was conducted. 615 pairs of peripheral vein blood cultures and instantaneous catheter tip blood culture of 615 patients admitted to ICU of Tianjin Medical University Cancer Institute and Hospital were collected from August 2011 to March 2014. The DTTP method and ( or ) semi quantitative culture of catheter tip were compared. CRBSI was diagnosed when both cultures were positive for the same microorganism and DTTP ≥2 hours ( 120 minutes ). The result of this procedure was compared with that of organism obtained using the semi quantitative culture of blood at catheter tip with≥15 cfu. Based on the clinical diagnosis, the reliability of two kinds of laboratory examination was compared for the diagnosis of CRBSI by plotting receiver operator characteristic curve ( ROC curve ). Results The result of 615 cases suspected of having CRBSI were analyzed during the study period. Of these, 440 episodes were excluded because cultures were negative for blood obtained through peripheral vein and central vein. Eight episodes were excluded because only peripheral vein blood culture was positive and 57 episodes were excluded because of only central vein blood culture was positive, 68 pairs of blood cultures were excluded due to the presence of multiple catheters and repeated blood withdrawals. Two cases of polymicrobial cultures were excluded from the final analysis due to the difficulty in determining the time of positive result for each individual microorganism. Ten cases in 42 cases of suspected cases of CRBSI were excluded from analysis because catheter was not removed, therefore culture from catheter tip could not be obtained. Using the DTTP method, 14 out of 17 CRBSI cases were diagnosed with DTTP≥120 minutes, while 3

  20. Bloodstream infections among patients using central venous catheters in intensive care units Infección de corriente sanguínea en pacientes con catéter venosos central en unidades de cuidado intensivo Infecções da corrente sangüínea em pacientes em uso de cateter venoso central em unidades de terapia intensiva

    OpenAIRE

    2007-01-01

    Central Venous Catheters (CVC), widely used in Intensive Care Units (ICU) are important sources of bloodstream infections (BSI). This prospective cohort epidemiological analytical study, aimed to infer the incidence of BSI, the risk factors associated and evaluate the care actions related to the use of these catheters in seven ICU in the Federal District - Brasília, Brazil. From the 630 patients using CVC, 6.4% developed BSI (1.5% directly related to the catheter and 4.9% clinic BSI). The hos...

  1. Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis.

    Science.gov (United States)

    Wang, H; Huang, T; Jing, J; Jin, J; Wang, P; Yang, M; Cui, W; Zheng, Y; Shen, H

    2010-09-01

    We aimed to compare the effectiveness of various catheters for prevention of catheter-related infection and to evaluate whether specific catheters are superior to others for reducing catheter-related infections. We identified randomised, controlled trials that compared different types of central venous catheter (CVC), evaluating catheter-related infections in a systematic search of articles published from January 1996 to November 2009 via Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Network meta-analysis with a mixed treatment comparison method using Bayesian Markov Chain Monte Carlo simulation was used to combine direct within-trial, between-treatment comparisons with indirect trial evidence. Forty-eight clinical trials (12 828 CVCs) investigating 10 intervention catheters contributed to the analyses. For prevention of CVC colonisation, adjusted silver iontophoretic catheters (odds ratio: 0.58; 95% confidence interval: 0.33-0.95), chlorhexidine and silver sulfadiazine catheters (0.49; 0.36-0.64), chlorhexidine and silver sulfadiazine blue plus catheters (0.37; 0.17-0.69), minocycline-rifampicin catheters (0.28; 0.17-0.43) and miconazole-rifampicin catheters (0.11; 0.02-0.33) were associated with a significantly lower rate of catheter colonisation compared with standard catheters. For prevention of CRBSI, adjusted heparin-bonded catheters (0.20; 0.06-0.44) and minocycline-rifampicin catheters (0.18; 0.08-0.34) were associated with a significantly lower rate of CRBSI with standard catheters. Rifampicin-based impregnated catheters seem to be better for prevention of catheter-related infection compared with the other catheters.

  2. 重症患者中心静脉导管相关血流感染护理对策分析%Nursing countermeasures for bloodstream infection induced by central venous catheter in severe patients

    Institute of Scientific and Technical Information of China (English)

    兰艳萍; 葛凯杰

    2014-01-01

    Objective To analyze the nursing countermeasures for bloodstream infection induced by central venous catheter in severe patients, to provide reference for the control of infections in severe patients. Methods Divided 116 cases of central venous catheter in several patients randomly into group A, group B, 58 cases in each group, group A was given routine nursing care, group B was implemented the optimal nursing, observed nursing effect of the two groups.Results Catheter related bloodstream infection rates of group A and group B were 13.8% and 3.45%, indwelling catheter time was (12.5±3.4)d and (16.5±4.3)d, differences were statistically significant(P<0.05).Conclusion Optimal nursing for severe patients with central venous catheter can reduce catheter-related bloodstream infection, prolong indwelling time and improve the prognosis.%目的:分析重症患者中心静脉导管相关血流感染护理对策,为重症患者感染防止提供参考。方法将116例留置中心静脉导管的重症患者随机分为A、B两组,各58例, A组实施常规护理, B组实施优化护理,观察两组护理效果。结果A、B两组导管相关血流感染率分别为13.8%及3.45%,留置导管时间分别为(12.5±3.4)d及(16.5±4.3)d,差异均有统计学意义(P<0.05)。结论对留置中心静脉导管的重症患者进行优化护理后可减少导管相关血流感染、延长置管时间、改善预后。

  3. Cessation of In-line Filters in Central Venous Catheters Does Not Significantly Influence the Incidence of Bloodstream Infections and Mortality in a Hospital Hematological Ward.

    Science.gov (United States)

    Tanaka, Hiroaki; Ambiru, Satoshi; Kawaguchi, Takeharu; Sugita, Yasumasa; Kawajiri, Chika; Nagao, Yuhei; Shimura, Takenori

    2016-01-01

    Objective The use of intravenous in-line filters is effective for the mechanical removal of large particles, precipitates, bacteria, fungi, large lipid globules, and air. However, the routine use of in-line filters remains controversial. Many patients with hematological diseases frequently suffer from bloodstream infections (BSIs) with fatal outcomes. Methods The year before cessation of an in-line filter was defined as the "filter period" and the year after its cessation was defined as the "non-filter period." The number of central line-associated bloodstream infections (CLABSIs), which are defined through surveillance, the catheter utilization rate, the number of patient deaths within 7 days after removal of the central venous catheters (CVCs), and the overall survival rate following CVC insertion were measured. Results During both periods, 84 patients had a total of 140 CVCs with a total number of catheter days of 3,407. There were 10 CVCs with CLABSIs, and the overall CLABSI rate was 2.9/1,000 catheter days, including 4 CVCs with CLABSIs (2.5/1,000 catheter days) during the filter period and 6 CVCs with CLABSIs (3.3/1,000 catheter days) during the non-filter period. The CLABSI rate, catheter utilization rate, and mortality did not differ significantly between the two periods. The only independent variable that was found to be significantly associated with the development of CLABSIs was a neutrophil count of line filters from CVCs does not significantly influence the incidence of BSIs and mortality in patients with hematological disease. To confirm our results, however, a large-scale randomized controlled study is warranted.

  4. Risk factors and the outcomes of central venous catheter-related bloodstream infections in ICU wards%ICU病房中心静脉导管相关性血流感染的高危因素及预后分析

    Institute of Scientific and Technical Information of China (English)

    肖丽; 卢岩; 彭松林; 李国福; 于晓江; 安春丽

    2012-01-01

    目的 调查ICU住院患者中心静脉导管相关性血流感染(CRBSI)的发生情况、高危因素及预后,为制定合适的防治策略提供依据.方法 应用前瞻性研究方法,采用美国国家院内感染监测(NNIS)规定的统一标准系统,对2007年6月1日至2008年5月31日入住中国医科大学附属盛京医院综合性ICU的所有符合条件的病例进行调查.结果 CRBSI感染率为13.2%(23例次/174),感染密度为12.0/1000导管日.单因素分析结果,中心静脉置管的个数、CRBSI发生前抗生素应用个数、导管日差异具有统计学意义(P<0.05);多因素Logistic回归分析结果,CRBSI发生前抗生素应用个数≥3( OR=6.335)和中心静脉置管个数>1(OR=5.981)是CRBSI发生的独立危险因素(P<0.05);CRBSI组的病患粗死亡率、呼吸机日、住院总费用、药费、ICU内住院日、总住院日和平均日花费均高于非CRBSI的病患(P<0.05).结论 该院CRBSI发生率高,感染密度大,多个中心静脉置管以及抗生素应用频繁是CRBSI的高危因素.CRBSI者的预后及医疗费用的经济负担明显高于非CRBSI者.必须进一步加强有效的预防和控制措施.%Objective To identify the incidence rate, pathogenic characteristics, risk factors, and outcomes of catheter-related bloodstream infections ( CRBSI) in ICU wards. Method From June 2007 to May 2008, qualified cases in the ICU ward at the Affiliated Shengjing Hospital of China Medical University were prospectively surveyed. Result A total of 174 patients were included in the study. The duration of catheterization lasted 1,913 days. Twenty-one patients developed an infection, yielding an infection rate of 12.0/1,000, and the application rate of catheters was 72. 8% . Specifically, nine cases of infection involved G- bacteria, seven cases involved G+ bacteria, and seven cases involved fungi. After applying a single-factorial analysis, the number of catheter implantations, the number of pre-CRBS1

  5. Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections.

    Science.gov (United States)

    Salama, Mona F; Jamal, Wafaa; Al Mousa, Haifa; Rotimi, Vincent

    2016-01-01

    Central line-associated bloodstream infection (CLABSIs) is an important healthcare-associated infection in the critical care units. It causes substantial morbidity, mortality and incurs high costs. The use of central venous line (CVL) insertion bundle has been shown to decrease the incidence of CLABSIs. Our aim was to study the impact of CVL insertion bundle on incidence of CLABSI and study the causative microbial agents in an intensive care unit in Kuwait. Surveillance for CLABSI was conducted by trained infection control team using National Health Safety Network (NHSN) case definitions and device days measurement methods. During the intervention period, nursing staff used central line care bundle consisting of (1) hand hygiene by inserter (2) maximal barrier precautions upon insertion by the physician inserting the catheter and sterile drape from head to toe to the patient (3) use of a 2% chlorohexidine gluconate (CHG) in 70% ethanol scrub for the insertion site (4) optimum catheter site selection. (5) Examination of the daily necessity of the central line. During the pre-intervention period, there were 5367 documented catheter-days and 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56 CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The reduction in the CLABSI/1000 catheter days was not statistically significant (P=0.0859). This study demonstrates that implementation of a central venous catheter post-insertion care bundle was associated with a reduction in CLABSI in an intensive care area setting.

  6. Epidemiology and prevention of catheter-related thrombosis in patients with cancer

    NARCIS (Netherlands)

    Lee, A. Y. Y.; Kamphuisen, P. W.

    2012-01-01

    . Central venous catheters are extensively used in patients with cancer to secure delivery of chemotherapy and facilitate phlebotomy. Unfortunately, considerable morbidity can result from early complications or late sequelae, ranging from arterial puncture, pneumothorax and bloodstream infections to

  7. Bloodstream infection caused by nontoxigenic Corynebacterium diphtheriae in an immunocompromised host in the United States.

    Science.gov (United States)

    Wojewoda, Christina M; Koval, Christine E; Wilson, Deborah A; Chakos, Mary H; Harrington, Susan M

    2012-06-01

    Corynebacterium species are well-known causes of catheter-related bloodstream infections. Toxigenic strains of Corynebacterium diphtheriae cause respiratory diphtheria. We report a bloodstream infection caused by a nontoxigenic strain of C. diphtheriae and discuss the epidemiology, possible sources of the infection, and the implications of rapid species identification of corynebacteria.

  8. Corynebacterium striatum Bacteremia Associated with a Catheter-Related Blood Stream Infection

    Science.gov (United States)

    Oishi, Tomohiro; Yamane, Kunikazu; Terada, Kihei

    2017-01-01

    A 49-year-old woman visited our emergency department because of exertional dyspnea due to severe left ventricular functional failure. It progressed to disseminated intravascular coagulation and disturbance of consciousness on day 67 of admission. Gram-positive bacilli were detected from two different blood culture samples on day 67 of admission. An API-Coryne test and sequencing (1~615 bp) of the 16S rRNA gene were performed, and the strain was identified as Corynebacterium striatum. The bacterium was detected from the removed central venous catheter tip too, and the patient was diagnosed with catheter-related bloodstream infection by C. striatum. However, treatment was not effective, and the patient died on day 73 of admission. PMID:28197349

  9. Evaluation of mupirocin ointment in control of central venous catheter related infections: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Rezaei J

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Central venous catheter (CVC related infections are important complications of cathter application. This study assessed the usefulness of mupirocin in prevention and control of these infections."n"nMethods: In this randomized clinical trial, consecutive surgical patients requiring central venous catheter (for more than 2 days in Amir-Alam Hospital from 2006-2008 were enrolled. Patients were divided in two groups; in "case group" patients received topical mupirocin 2% every 48 hours at the time of insertion of catheter and dressing change and for "control group" mupirocin was not used. All of the patients received chlorhexidine and enoxoparin as complementary treatments. Two groups were comparable in regard of age, sex and risk factors."n"nResults: One hundred eighteen patients enrolled in the study (57 in case and 61 in control group completed the study. 84 catheters in case group and 88 catheters in control group were inserted. The catheters in 90% of patients were inserted in jugular vein. At the end of study 29(16.8% patients (16 in control versus 13 in case group had catheter colonization (p=NS. Catheter related bloodstream infection was observed in 16(9.3% patients (6 in

  10. Totally implantable catheter embolism: two related cases

    Directory of Open Access Journals (Sweden)

    Rodrigo Chaves Ribeiro

    Full Text Available CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath® are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

  11. Management of complications related to central venous catheters in cancer patients: an update.

    Science.gov (United States)

    Linnemann, Birgit

    2014-04-01

    Central venous catheters (CVCs) are important for the treatment of patients with cancer, especially in the perioperative and palliative care settings. These devices not only allow for the administration of chemotherapy, parenteral nutrition, and other intravenous therapies, but they may also improve the patients' quality of life by reducing the need for repeated peripheral venipunctures. Thrombotic and infectious complications are common, especially in the long-term use of CVCs. There are different types of thrombotic complications associated with CVCs, that is, a thrombotic occlusion of the catheter, a mural thrombus at the catheter tip and classical deep vein thrombosis, which occurs most frequently in the upper extremity where the majority of long-term catheters are inserted. Infections are common complications associated with CVCs. Patients with cancer who receive intensive chemotherapy and those patients who undergo hematopoietic stem cell transplantation have a markedly increased risk for insertion site and bloodstream infections. In this review, the epidemiology and risk factors that predispose patients to CVC-related thrombosis and infection are discussed. The diagnostic and therapeutic options according to the published data and the current guidelines are summarized and data for establishing primary and secondary preventative strategies are provided.

  12. Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil

    Directory of Open Access Journals (Sweden)

    Daiane Silva Resende

    2011-12-01

    Full Text Available INTRODUCTION: Catheter-associated bloodstream infection (CA-BSI is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: A total of sixty-seven (26.7% CA-BSIs were observed. There were 46 (32% episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]. Neonates in the group after implementation of the intervention had 21 (19.6% episodes of CA-BSI (14.9 per 1,000 CVC days. The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04. In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

  13. Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution.

    OpenAIRE

    Betjes, Michiel; Agteren, Madelon

    2004-01-01

    textabstractBACKGROUND: The use of haemodialysis catheters is complicated by catheter-related sepsis. Intraluminal colonization of the catheter with bacteria is important in the pathogenesis of catheter-related sepsis. The use of a catheter lock solution containing the antimicrobial taurolidine might prevent bacterial colonization, thereby reducing the incidence of catheter-related sepsis. METHODS: In a randomized prospective trial, patients receiving a dialysis catheter were included and cat...

  14. Peripherally Inserted Central Catheter-Related Infections in a Cohort of Hospitalized Adult Patients

    Energy Technology Data Exchange (ETDEWEB)

    Bouzad, Caroline, E-mail: caroline.bouzad@gmail.com [Percy Military Teaching Hospital, Radiology Department (France); Duron, Sandrine, E-mail: duronsandrine@yahoo.fr [GSBdD, Military Centre for Epidemiology and Public Health (CESPA) (France); Bousquet, Aurore, E-mail: aurorebousquet@yahoo.fr [Begin Military Teaching Hospital, Bacteriology Department (France); Arnaud, François-Xavier, E-mail: fxa0160@hotmail.com [Percy Military Teaching Hospital, Radiology Department (France); Valbousquet, Laura, E-mail: laura.valbousquet@gmail.com [Begin Military Teaching Hospital, Radiology Department (France); Weber-Donat, Gabrielle, E-mail: weberdonatgabrielle@yahoo.fr; Teriitehau, Christophe, E-mail: cteriitehau@me.com; Baccialone, Jacques, E-mail: jacques.baccialone@wanadoo.fr; Potet, Julien, E-mail: potet-julien@yahoo.fr [Percy Military Teaching Hospital, Radiology Department (France)

    2016-03-15

    PurposeTo determine the incidence and the risks factors of peripherally inserted central catheter (PICC)-related infectious complications.Materials and MethodsMedical charts of every in-patient that underwent a PICC insertion in our hospital between January 2010 and October 2013 were reviewed. All PICC-related infections were recorded and categorized as catheter-related bloodstream infections (CR-BSI), exit-site infections, and septic thrombophlebitis.ResultsNine hundred and twenty-three PICCs were placed in 644 unique patients, mostly male (68.3 %) with a median age of 58 years. 31 (3.4 %) PICC-related infections occurred during the study period corresponding to an infection rate of 1.64 per 1000 catheter-days. We observed 27 (87.1 %) CR-BSI, corresponding to a rate of 1.43 per 1000 catheter-days, 3 (9.7 %) septic thrombophlebitis, and 1 (3.2 %) exit-site infection. Multivariate logistic regression analysis showed a higher PICC-related infection rate with chemotherapy (odds ratio (OR) 7.2–confidence interval (CI) 95 % [1.77–29.5]), auto/allograft (OR 5.9–CI 95 % [1.2–29.2]), and anti-coagulant therapy (OR 2.2–95 % [1.4–12]).ConclusionChemotherapy, auto/allograft, and anti-coagulant therapy are associated with an increased risk of developing PICC-related infections.Clinical AdvanceChemotherapy, auto/allograft, and anti-coagulant therapy are important predictors of PICC-associated infections. A careful assessment of these risk factors may be important for future success in preventing PICC-related infections.

  15. Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution.

    NARCIS (Netherlands)

    M.G.H. Betjes (Michiel); M. Agteren (Madelon)

    2004-01-01

    textabstractBACKGROUND: The use of haemodialysis catheters is complicated by catheter-related sepsis. Intraluminal colonization of the catheter with bacteria is important in the pathogenesis of catheter-related sepsis. The use of a catheter lock solution containing the antimicrobia

  16. Cefotaxime-heparin lock prophylaxis against hemodialysis catheter-related sepsis among Staphylococcus aureus nasal carriers.

    Science.gov (United States)

    Saxena, Anil K; Panhotra, Bodh R; Al-hafiz, Abdul Aziz; Sundaram, Dasappan S; Abu-Oyun, Bassam; Al Mulhim, Khalifa

    2012-07-01

    Staphylococcus aureus nasal carriers undergoing hemodialysis (HD) through tunneled cuffed catheters (TCCs) form a high-risk group for the development of catheter-related bloodstream infections (CRBSI) and ensuing morbidity. The efficacy of antibiotic-locks on the outcomes of TCCs among S. aureus nasal carriers has not been studied earlier. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) S. aureus of five standardized nasal swabs taken from all the participants dialyzed at a large out-patient HD center affiliated to a tertiary care hospital. Of 218 participants, 82 S. aureus nasal carriers dialyzed through TCCs (n = 88) were identified through April 2005 to March 2006 and randomized to two groups. Group I comprised of 39 nasal carriers who had TCCs (n = 41) "locked" with cefotaxime/heparin while group II included 43 patients with TCCs (n = 47) filled with standard heparin. The CRBSI incidence and TCC survival at 365 days were statistically compared between the two groups. A significantly lower CRBSI incidence (1.47 vs. 3.44/1000 catheter-days, P cefotaxime group compared with the standard heparin group. However, no significant difference in MRSA-associated CRBSI incidence was observed between the two groups. Cefotaxime-heparin "locks" effectively reduced CRBSI-incidence associated with gram-positive cocci, including MSSA, among S. aureus nasal carriers. There remains a compelling requirement for antibiotic-locks effective against MRSA.

  17. Diagnosis of intra vascular catheter-related infection.

    Science.gov (United States)

    Cicalini, S; Palmieri, F; Noto, P; Boumis, E; Petrosillo, N

    2002-01-01

    The use of central vascular catheters (CVC) is associated with a substantial number of complications, amongst which infections predominate. A diagnosis of CVC-related infection usually requires catheter removal for culture. Semiquantitative (roll-plate method) and quantitative methods (flush, vortex, centrifugation or sonication methods) are the most reliable diagnostic methodologies requiring catheter removal, because of their greater specificity. The roll-plate method is the simplest and most commonly used technique. This method only samples the external surface of the catheter, and is particularly indicated for recently inserted catheters in which extraluminal colonisation is the primary mechanism of infection. Luminal culture techniques, such as the quantitative methods, may be more relevant for catheters that have been in place for a long period of time. However, in up to 85% of removed CVC the culture is negative, and other diagnostic techniques that do not require catheter removal have been proposed, including paired quantitative blood cultures, endoluminal brushing, and differential time to positivity (DTP) of paired blood cultures. DTP, that compares the time to positivity for qualitative cultures of blood samples simultaneously drawn from the CVC and a peripheral vein, appears to be the most reliable in the routine clinical practice since many hospitals use automatic devices for qualitative blood culture positivity detection. More recently catheter-sparing direct diagnostic methods, which include Gram stain and acridin-orange leucocyte cytospin (AOLC) test, appeared to be especially useful because of the rapidity of results and the ability to distinguish different microorganisms, allowing early targeted antimicrobial therapy.

  18. Surveillance and analysis of central venous catheter-associated bloodstream infections in children with congenital heart disease after cardiac surgery%小儿先天性心脏病手术后中心静脉导管相关性血流感染调查分析

    Institute of Scientific and Technical Information of China (English)

    胡梅英; 陈修文; 乐萍

    2013-01-01

    OBJECTIVE To investigate the incidence of the central venous catheter-associated bloodstream infections in the children with congenital heart disease (CHD) after cardiac surgery and observe the distribution of pathogens. METHODS The targeted surveillance was performed for 928 children with CHD who were treated in the cardiac ICU from Jan to Dec 2012, and the children with the indwelling catheter duration over 48 hours and the children with the extubation time less than 48 hours were selected as the study objects, then the incidence of the central venous catheter-related bloodstream infections and the isolation of pathogens were analyzed. RESULTS Totally 15 cases were diagnosed as the central venous catheter-related bloodstream infections with the incidence of 1. 62% and 3. 79/1. 000 catheter days; totally 23 strains of pathogens were isolated from peripheral vein blood and/or catheter tips, which were mainly the gram-egative bacteria, and the Acinetobacter baumannii, Pseudo-monas aeruginosa and Serratia marcescens were the top three species. CONCLUSION The children with CHD are at high risk of the central-venous catheter-related bloodstream infections, it is necessary to strengthen the surveillance of the central venous catheter-related bloodstream infections in the children after cardiac surgery and take interventions so as to reduce the incidence of nosocomial infections.%目的 探讨小儿先天性心脏病(先心病)患儿术后,中心静脉导管相关血流感染(CLA-BSI)发生水平及病原菌分布特点.方法 对2012年1-12月心脏病治疗中心手术治疗的928例先心病患儿进行CLA-BSI目标性监测,将中心静脉导管留置时间>48 h或拔除导管<48 h内的先心病术后患儿作为研究对象,对CLA-BSI发生水平和病原菌检出进行分析.结果 共诊断CLA-BSI病例15例,感染率为1.62%,每千个导管日感染为3.79%;经外周静脉血或(和)中心静脉导管尖端标本共检出病原菌23株,病原菌以革

  19. Prevention of catheter-related Pseudomonas aeruginosa infection by levofloxacin-impregnated catheters in vitro and in vivo

    Institute of Scientific and Technical Information of China (English)

    Yan Ping; Liu Wei; Kong Jinliang; Wu Hong; Chen Yiqiang

    2014-01-01

    Background Implanted medical catheter-related infections are increasing,hence a need for developing catheter polymers bonded to antimicrobials.We evaluated preventive effects of levofloxacin-impregnated catheters in catheterrelated Psuedomonas aeruginosa (strain PAO1) infection.Methods Drug release from levofloxacin-impregnated catheters was measured in vitro.Levofloxacin-impregnated catheters and polyvinyl chloride (PVC) catheters were immersed in 5 ml 50% Luria Bertani medium containing 108 CFU/ml Pseudomonas aeruginosa then incubated for 6,12,24 or 48 hours at 37℃ when bacteria adhering to the catheters and bacteria in the growth culture medium were determined.Impregnated and PVC catheters were singly implanted subcutaneously in mice,50 μl (107CFU) of PAO1 was injected into catheters.After the first and fifth days challenge,bacterial counts on implanted catheters and in surrounding tissues were determined microbiologically.Bacterial colonization and biofilm formation on implanted catheters were assessed by scanning electron microscopy.Results Drug release from levofloxacin-impregnated catheters was rapid.Levofloxacin-impregnated catheters had significantly fewer bacteria compared to PVC in vitro.After first and fifth day of challenge,no or significantly fewer bacteria adhered to impregnated catheters or in surrounding tissues compared to PVC.Scanning electron microscopical images after first day displayed from none to significantly fewer bacteria adhering to impregnated implanted catheters,compared to bacteria and microcolonies adhering to PVC catheters.After the fifth day,no bacteria were found on impregnated catheters,compared to clusters surrounding mucus-like substance and coral-shaped biofilms with polymorphonuclear leukocyte on PVC catheters.After the first day of challenge,secretion occurred in all implanted catheters with surrounding tissues mildly hyperaemic and swollen.After the fifth day,minute secretions inside impregnated catheters and no

  20. New tools in diagnosing catheter-related infections.

    Science.gov (United States)

    Blot, F; Nitenberg, G; Brun-Buisson, C

    2000-07-01

    Clinical criteria alone are insufficient to allow a diagnosis of intravascular catheter-related sepsis (CRS). A definite diagnosis of CRS usually requires removal of the catheter for quantitative catheter tip culture. However, only about 15-25% of central venous catheters (CVC) removed because infection is suspected actually prove to be infected, and the diagnosis is always retrospective. Other diagnostic tests, such as differential quantitative blood cultures from samples taken simultaneously from the catheter and a peripheral vein, have been proposed to avoid unjustified removal of the catheter and the potential risks associated with the placement of a new catheter at a new site: a central-to-peripheral blood culture colony count ratio of 5:1 to 10:1 is considered indicative of CRS. Despite its high specificity, the latter diagnostic technique is not routinely used in clinical practice because of its complexity and cost. The measurement of the differential time to positivity between hub blood (taken from the catheter port) and peripheral blood cultures might be a reliable tool facilitating the diagnosis of CRS in situ. In an in vitro study, we found a strong relationship between the inoculum size of various microorganisms and the time to positivity of cultures. When the times to positivity of cultures of blood taken simultaneously from central and peripheral veins in patients with and without CRS were examined, we found that earlier positivity of central vs peripheral vein blood cultures was highly correlated with CRS. Using a cut-off value of +120 min, the "differential time to positivity" of the paired blood samples, defined as time to positivity of the peripheral blood minus that of the hub blood culture, had 91% specificity and 94% sensitivity for the diagnosis of CRS. This method may be coupled with other techniques that have high negative predictive value, such as skin cultures at the catheter exit site. This diagnostic test can be proposed for routine

  1. Urinary catheter related nosocomial infections in paediatric intensive care unit.

    Directory of Open Access Journals (Sweden)

    Tullu M

    1998-04-01

    Full Text Available The present prospective study was carried out in the Paediatric Intensive Care Unit (PICU of a tertiary care teaching hospital in Mumbai. The objective was to determine the incidence, risk factors, mortality and organisms responsible for urinary catheter related infections (UCRI. Colonization and/or bacteriuria was labelled as urinary catheter related infection (UCRI. Forty-four patients with 51 urinary catheters were studied. Incidence of UCRI was 47.06%. Age, female sex and immunocompromised status did not increase the risk of UCRI. Duration of catheter in-situ and duration of stay in the PICU were associated with higher risk of UCRI. The mortality was not increased by UCRI. Commonest organism isolated in UCRI was E. coli, which had maximum susceptibility to nitrofurantoin and amikacin.

  2. Management Of Fever And Suspected Infection In Pediatric Patients With Central Venous Catheters.

    Science.gov (United States)

    Brennan, Courtney; Wang, Vincent J

    2015-12-01

    The use of indwelling central venous catheters is essential for pediatric patients who require hemodialysis, parenteral nutrition, chemotherapy, or other medications. Fever is a common chief complaint in the emergency department, and fever in a patient with a central venous catheter may be related to a common cause of fever, or it may be due to a catheter-associated bloodstream infection. Catheter-associated bloodstream infections may also lead to additional complications such as sepsis, septic shock, or septic complications including suppurative thrombophlebitis, endocarditis, osteomyelitis, septic emboli, and abscesses. Early resuscitation as well as timely and appropriate antibiotic therapy have been shown to improve outcomes. This issue focuses on the approach to fever in pediatric patients with central venous catheters and the management and disposition of patients with possible catheter-associated bloodstream infections.

  3. Catheter-related infection in gastrointestinal fistula patients

    Institute of Scientific and Technical Information of China (English)

    Ge-Fei Wang; Jian-An Ren; Jun Jiang; Cao-Gan Fan; Xin-Bo Wang; Jie-Shou Li

    2004-01-01

    AIM: To study the incidence, bacterial spectrum and drug sensitivity of catheter-related infection (CRI) in gastrointestinal fistula patients.METHODS: A total of 216 patients with gastrointestinal fistulae during January 1998 to April 2001 were studied retrospectively. Two hundred and sixteen catheters of the 358 central venous catheters used in 216 gastrointestinal fistula patients were sent for microbiology analysis.RESULTS: Ninety-five bacteria were cultivated in 88catheters (24.6%). There were 54 Gram-negative bacteria (56.8%), 35 Gram-positive bacteria (36.8%), and 6 fungi (6.4%). During the treatment of CRI, 20 patients changed to use antibiotics or antifungal, and all patients were cured.The mean time of catheters used was 16.9±13.0 d.CONCLUSION: CRI is still the common complication during total parenteral nutrition (TPN) treatment in patients with gastrointestinal fistulae, and Gram-negative bacteria are the main pathogens, and bacterial translocation is considered the common reason for CRI.

  4. Cefotaxime-heparin lock prophylaxis against hemodialysis catheter-related sepsis among Staphylococcus aureus nasal carriers

    Directory of Open Access Journals (Sweden)

    Anil K Saxena

    2012-01-01

    Full Text Available Staphylococcus aureus nasal carriers undergoing hemodialysis (HD through tunneled cuffed catheters (TCCs form a high-risk group for the development of catheter-related bloodstream infections (CRBSI and ensuing morbidity. The efficacy of antibiotic-locks on the outcomes of TCCs among S. aureus nasal carriers has not been studied earlier. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible (MSSA or methicillin-resistant (MRSA S. aureus of five standardized nasal swabs taken from all the participants dialyzed at a large out-patient HD center affiliated to a tertiary care hospital. Of 218 participants, 82 S. aureus nasal carriers dialyzed through TCCs (n = 88 were identified through April 2005 to March 2006 and randomized to two groups. Group I comprised of 39 nasal carriers who had TCCs (n = 41 "locked" with cefotaxime/heparin while group II included 43 patients with TCCs (n = 47 filled with standard heparin. The CRBSI incidence and TCC survival at 365 days were statistically compared between the two groups. A significantly lower CRBSI incidence (1.47 vs. 3.44/1000 catheter-days, P <0.001 and higher infection-free TCC survival rates at 365 days (80.5 vs. 40.4%, P <0.0001 were observed in the cefotaxime group compared with the stan-dard heparin group. However, no significant difference in MRSA-associated CRBSI incidence was observed between the two groups. Cefotaxime-heparin "locks" effectively reduced CRBSI-incidence associated with gram-positive cocci, including MSSA, among S. aureus nasal carriers. There remains a compelling requirement for antibiotic-locks effective against MRSA.

  5. A European perspective on intravascular catheter-related infections

    DEFF Research Database (Denmark)

    Bouza, E; San Juan, R; Muñoz, P;

    2004-01-01

    The laboratory workload, microbiological techniques and aetiology of catheter-related infections in European hospitals are mostly unknown. The present study (ESGNI-005) comprised a 1-day (22 October 2001), laboratory-based, point-prevalence survey based on a questionnaire completed by microbiology...... by these institutions was 121,363,800, and the estimated number of admissions during 2000 was 6,712,050. The total number of catheter tips processed during 2000 was 142,727, or 21/1,000 admissions, of which 23.7% were considered to be positive in the institutions using semiquantitative or quantitative techniques....... Overall, EU centres received significantly more catheter tip samples/1,000 admissions and had a significantly higher rate of 'positivity' (p...

  6. Rhodococcus bacteremia in cancer patients is mostly catheter related and associated with biofilm formation.

    Directory of Open Access Journals (Sweden)

    Fadi Al Akhrass

    Full Text Available Rhodococcus is an emerging cause of opportunistic infection in immunocompromised patients, most commonly causing cavitary pneumonia. It has rarely been reported as a cause of isolated bacteremia. However, the relationship between bacteremia and central venous catheter is unknown. Between 2002 and 2010, the characteristics and outcomes of seventeen cancer patients with Rhodococcus bacteremia and indwelling central venous catheters were evaluated. Rhodococcus bacteremias were for the most part (94% central line-associated bloodstream infection (CLABSI. Most of the bacteremia isolates were Rhodococcus equi (82%. Rhodococcus isolates formed heavy microbial biofilm on the surface of polyurethane catheters, which was reduced completely or partially by antimicrobial lock solution. All CLABSI patients had successful response to catheter removal and antimicrobial therapy. Rhodococcus species should be added to the list of biofilm forming organisms in immunocompromised hosts and most of the Rhodococcus bacteremias in cancer patients are central line associated.

  7. Catheter-related blood stream infection caused by Raoultella ornithinolytica

    OpenAIRE

    2015-01-01

    Raoultella spp. representatives are Gram-negative capsulated, nonmotile rods. These bacteria are found in the natural environment: plants, water, soil and insects. R. ornithinolytica is one of the three species of Raoultella. R. ornithinolytica is the only species within the genus which has the ability to produce ornithine decarboxylase. Human infections related to R. ornithinolytica are exceedingly rare. The present case report describes catheter-related blood stream infection caused by R. o...

  8. Catheter-related blood stream infection caused by Raoultella ornithinolytica.

    Science.gov (United States)

    Sękowska, Alicja; Dylewska, Katarzyna; Gospodarek, Eugenia; Bogiel, Tomasz

    2015-11-01

    Raoultella spp. representatives are Gram-negative capsulated, nonmotile rods. These bacteria are found in the natural environment: plants, water, soil and insects. R. ornithinolytica is one of the three species of Raoultella. R. ornithinolytica is the only species within the genus which has the ability to produce ornithine decarboxylase. Human infections related to R. ornithinolytica are exceedingly rare. The present case report describes catheter-related blood stream infection caused by R. ornithinolytica and successfully treated with antibiotic therapy.

  9. The impact of sodium citrate on dialysis catheter function and frequency of catheter-related bacteriemia and haemorrhage

    Directory of Open Access Journals (Sweden)

    Maciej Szymczak

    2009-10-01

    Full Text Available Vascular access is one of the most important problems of hemodialysis therapy. It is known that an arteriovenous fi sutla provides the best vascular access, but its creation is not always possible. Other solutions, such as the insertion of a central venous catheter, are then required. Adequate protection of such catheters by interdialytic fi ll with locking solution affects the frequency of hemodialysis-related complications. The most widespread catheter locking solution is heparin. Sodium citrate is being used more frequent recently. Available data indicate that hemorrhage is 11.9 times more frequent if the catheter locking solution is 5000 IU/ml heparin than if 4�0sodium citrate or 1000 IU/ml heparin is used. Other data indicate that the frequency of infection is statistically decreased when 30�0sodium citrate is used to fi ll the catheter instead of 5000 IU/ml heparin. Analogous data on 46.7�0sodium citrate are not consistent. It seems that the use of 4�0sodium citrate instead of 5000 IU/ml heparin does not decrease the frequency of infections. Numerous studies indicate that sodium citrate at various concentrations exerts a positive infl lence on catheter function. However, not all data are in accord. The spill of sodium citrate from the catheter to the systemic circulation is connected with a risk of adverse events. It may be dangerous if the citrate concentration is 46.7�20However, adequate fi lling of the catheter should prezent such events. Available data indicate that fi lling of the catheter with a solution of citrate of a concentration of no more than 30�0should be safe. Data on 46.7�0citrate are not conclusive, so precautions should be taken.

  10. Central venous catheter-related infections: Risk factors and effects of glycopeptide antibiotics

    Directory of Open Access Journals (Sweden)

    Arsenijević Ljubica

    2007-01-01

    Full Text Available INTRODUCTION Central venous catheters (CVC are used in the treatment of critically ill patients. Indications for placement of CVCs include hemodynamic monitoring, administration of intravenous fluids, medications and total parenteral nutrition. MATERIAL AND METHODS We investigated risk factors and effects of glycopeptide antibiotics on the development of central venous catheter-related infections in 300 patients treated in intensive care units. A semiquntitative culture technique was used. The investigation included: age, diagnosis on admission, catheter insertion site, catheter duration, the first or next catheter and using of glycopeptide drugs. RESULTS 91 catheters (30.3% were colonised, catheter-related infection was found in 50 catheters (16.7%. Infections were more frequent in catheters inserted through the internal jugular vein than in subclavian venous catheters; they were also more frequent if duration of catheterization was longer than seven days, but less frequent in patients who received glycopeptide antibiotics. The isolated microorganism was Staphylococcus aureus. DISCUSSION According to the literature, a number of catheter-related risk factors for infections include: insertion site, type of catheter, the number of manipulations, inadequat asepsis, lumen number, type of antiseptic. The relative importance of one risk factor over another is difficult to assess, given that studies have no priority report. CONCLUSION The duration of catheterization and the insertion site were the most frequent risk factors for infection. The use of glycopeptide antibiotics during catheterization has protective effects.

  11. 基层医院ICU中心静脉导管相关性血流感染的危险因素分析%Risk Factors of Catheter-Associated Bloodstream Infections in Intensive Care Unit of Primary Hospital

    Institute of Scientific and Technical Information of China (English)

    张细江

    2012-01-01

    Objective To explore the risk factors of catheter-associated bloodstream infections (CRBSI) in intensive care unit (ICU) of primary hospital. Methods A total of 623 patients with central venous catheters were recruited in the study. 60 of them suffered from CRBSI served as an observation group and other 563 cases without CRBSI served as control. Univariate analysis was used to scan possible risk factors. Then logistic regression analysis was used to exclude the confounding factors. Results The overall incidence rate of CRBSI was 9. 63% (60/623). There were significant differences in APACHE score, type of catheter,location of catheter,duration of central venous catheter,intravenous nutrition, use of steroid,times of intubation, urgent intubations, nutritional status, diabetes, and MODS between the two groups. Logistic regression analysis revealed that higher APACHE score, double-lumen catheter, femoral vein catheter, catheter indwelling more than two weeks, intravenous nutrition, intubation more than 2 times, and emergency intubation were risk factors of CRBSI. Conclusions Higher APACHE score,double-lumen catheter,femoral vein catheter,catheter indwelling more than two weeks,intravenous nutrition,intubation more than 2 times, and emergency intubation were major risk factors of CRBSI in ICU of primary hospital.%目的 探讨基层医院ICU中心静脉导管相关血流感染(CRBSI)的危险因素.方法 以台州市立医院ICU就诊的中心静脉导管留置患者为研究对象,根据是否发生CRBSI分成感染组(60例)和非感染组(563例),首先单因素分析初步筛查CRBSI的危险因素,然后以是否发生CRBSI(1=是,0=否)为因变量,以单因素分析有差别的危险因素为自变量,进行Logistic多因素回归分析,寻找CRBSI的危险因素.结果 CRBSI的发生率为9.63% (60/623);感染组与非感染组APACHE评分、导管类型、导管留置部位、留置时间、静脉营养、激素使用、插管次数、紧急插管、营

  12. Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

    Directory of Open Access Journals (Sweden)

    Eraksoy Haluk

    2003-02-01

    Full Text Available Abstract Backround We undertook a prospective study of all new central venous catheters inserted into patients in the intensive care units, in order to identify the risk factors and to determine the effect of glycopeptide antibiotics on catheterrelated infections. Methods During the study period 300 patients with central venous catheters were prospectively studied. The catheters used were nontunneled, noncuffed, triple lumen and made of polyurethane material. Catheters were cultured by semiquantitative method and blood cultures done when indicated. Data were obtained on patient age, gender, unit, primary diagnosis on admission, catheter insertion site, duration of catheterization, whether it was the first or a subsequent catheter and glycopeptide antibiotic usage. Results Ninety-one (30.3% of the catheters were colonized and infection was found with 50 (16.7% catheters. Infection was diagnosed with higher rate in catheters inserted via jugular vein in comparison with subclavian vein (95% CI: 1.32–4.81, p = 0.005. The incidence of infection was higher in catheters which were kept in place for more than seven days (95% CI 1.05–3.87, p = 0.03. The incidence of infection was lower in patients who were using glycopeptide antibiotic during catheterization (95% CI: 1.49–5.51, p = 0.005. The rate of infection with Gram positive cocci was significantly lower in glycopeptide antibiotic using patients (p = 0.01. The most commonly isolated organism was Staphylococcus aureus (n = 52, 37.1%. Conclusion Duration of catheterization and catheter insertion site were independent risk factors for catheter related infection. Use of glycopeptide antibiotic during catheterization seems to have protective effect against catheter related infection.

  13. Biofilm formation in long-term central venous catheters in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Fuursted, Kurt; Funch, Peter;

    2012-01-01

    Taurolidine has demonstrated inhibition of biofilm formation in vitro. The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters. Forty-eight children with cancer were randomized to catheter locking by heparin (n...... = 22) or taurolidine (n = 26), respectively. After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Biofilm was present if morphologically typical structures and bacterial cells were identified. Quantitative and semi......-quantitative cultures were also performed. Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group. A positive culture was made of six of the catheters locked with taurolidine and heparin, respectively (p = 0.78). The rate of catheter-related bloodstream...

  14. Medical-grade honey does not reduce skin colonization at central venous catheter-insertion sites of critically ill patients: A randomized controlled trial

    NARCIS (Netherlands)

    J. Kwakman (Jan); M.C. Müller (Marcella); J.M. Binnekade (Jan); J.P. van den Akker (Johannes); C.A. de Borgie (Corianne); M.J. Schultz (Marcus); S.A.J. Zaat (Sebastiaan)

    2012-01-01

    textabstractIntroduction: Catheter-related bloodstream infections (CRBSIs) associated with short-term central venous catheters (CVCs) in intensive care unit (ICU) patients are a major clinical problem. Bacterial colonization of the skin at the CVC insertion site is an important etiologic factor for

  15. Delayed Presentation of Catheter-Related Subclavian Artery Pseudoaneurysm

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    Hwa Rim Kang

    2015-08-01

    Full Text Available Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here we report the rare case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient was treated for aspiration pneumonia with respiratory failure in another hospital. The patient's chest wall swelling began two weeks after the initial catheterization in the other hospital, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery. Her condition improved, and she was discharged to her home.

  16. The economics of hemodialysis catheter-related infection prophylaxis.

    Science.gov (United States)

    Kosa, S Daisy; Lok, Charmaine E

    2013-01-01

    Hemodialysis central venous catheter (CVC) use is associated with the highest morbidity, mortality, and cost of all types of hemodialysis vascular access. CVC-related infection drives much of the cost associated with CVC use. The magnitude of the cost associated with CVC-related infection varies depending on the type and severity of that infection; however, estimates of the total direct and indirect costs associated with hospitalizations due to hemodialysis CVC-related infections range from 17,000 USD to 32,000 USD per episode. Thus, it is critically important, to not only have effective strategies to limit CVC-related infection but also evaluate whether these strategies are an efficient use of resources. Prophylactic strategies can be considered economically efficient only if the value of its implementation and the corresponding drop in infection rate offer greater value than standard care. The optimal CVC-related infection prophylaxis strategy should work to limit infection risk with minimal risk, inconvenience, and discomfort to the patient, and at minimal cost. The aim of this review was to examine the clinical and economic impact of some commonly described interventions used for CVC infection prophylaxis.

  17. Catheter-related Complications in Postoperative Intraperitoneal Chemotherapy for Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To analyze catheter-related complications during postoperative Intraperitoneal chemotherapy (IPCT) for gastric cancer. Methods: From December 2003 to April 2007, 80 patients with gastric cancer were treated with postoperative IPCT using central venous catheters (CVCs), during which the complications that occurred in association with CVCs were documented and analyzed. Results: Catheter-related complications were seen in 10 out of the 80 patients, yielding a total complication rate of 12.5%. Main complications included abdominal pain (3.8%), local infection (1.3%), catheter obstruction (2.5%), leakage (2.5%) and dislocation (2.5%). All patients successfully finished their IPCT, the success rate was 100%. There occurred no severe complications or treatment-related deaths. Conclusion: It is convenient and safe to carry out postoperative IPCT for gastric cancer using CVCs, which, with a low catheter-related complication rate, should be recommended for more clinic use.

  18. Dialysis catheter-related septicaemia--focus on Staphylococcus aureus septicaemia

    DEFF Research Database (Denmark)

    Nielsen, J; Ladefoged, S D; Kolmos, H J

    1998-01-01

    BACKGROUND: Dialysis catheters are a common cause of nosocomial septicaemia in haemodialysis units usually due to staphylococci, of which Staphylococcus aureus is the most pathogenic. In this study, the epidemiology and pathogenesis of dialysis catheter-related infections were studied, and methods...

  19. Bacterial profile and antimicrobial susceptibility pattern in catheter related nosocomial infections.

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    Tullu M

    1998-01-01

    Full Text Available This prospective study was carried out over a period of 6 months in the Paediatric Intensive Care Unit (PICU of a tertiary care teaching hospital. The aim of the study was to determine the organisms causing catheter related nosocomial infections in the PICU and to study their antimicrobial susceptibility pattern. Patients with endotracheal intubation, indwelling urinary catheters and central venous catheters (CVC/venous cutdown catheters were included in the study. Colonization of the endotracheal tube, urinary catheter related infections (UCRI and colonization of the CVC/venous cutdown catheters was studied. E. coli was the commonest organism colonizing the endotracheal tube tip with maximum susceptibility to cefotaxime and amikacin. E. coli was also was the commonest organism causing UCRI with maximum susceptibility to nitrofurantoin and amikacin. Acinetobacter was the commonest organism colonizing the CVC/venous cutdown catheters with maximum susceptibility to ciprofloxacin. All these sites of catheter related infections considered together, E. coli and Klebsiella were the commonest nosocomial organisms. Both had maximum susceptibility to amikacin. Methicillin resistant Staphylococcus aureus (MRSA was isolated only from one culture. All the organisms had a poor susceptibility to cefazolin and amoxycillin. A knowledge of the resident microbial flora and their antimicrobial susceptibility pattern is necessary for formulating a rational antibiotic policy in an ICU.

  20. Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip

    Energy Technology Data Exchange (ETDEWEB)

    Qanadli, S.D.; Mesurolle, B.; Sissakian, J.F.; Chagnon, S.; Lacombe, P. [Service de Radiologie, Hopital Ambroise Pare, 92 - Boulogne (France)

    2000-08-01

    We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip. (orig.)

  1. Hemodialysis Tunneled Catheter Noninfectious Complications

    Science.gov (United States)

    Miller, Lisa M.; MacRae, Jennifer M.; Kiaii, Mercedeh; Clark, Edward; Dipchand, Christine; Kappel, Joanne; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; Pike, Pamela; Hiremath, Swapnil

    2016-01-01

    Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.

  2. The Incidence of Peripheral Catheter-Related Thrombosis in Surgical Patients

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    Amy Leung

    2016-01-01

    Full Text Available Background. Central venous catheters and peripherally inserted central catheters are well established risk factors for upper limb deep vein thrombosis. There is limited literature on the thrombosis rates in patients with peripheral catheters. A prospective observational study was conducted to determine the incidence of peripheral catheter-related thrombosis in surgical patients. Methods. Patients deemed high risk for venous thrombosis with a peripheral catheter were considered eligible for the study. An ultrasound was performed on enrolment into the study and at discharge from hospital. Participants were reviewed twice a day for clinical features of upper limb deep vein thrombosis during their admission and followed up at 30 days. Results. 54 patients were included in the study. The incidence of deep vein thrombosis and superficial venous thrombosis was 1.8% and 9.2%, respectively. All cases of venous thrombosis were asymptomatic. Risk factor analysis was limited by the low incidence of thrombosis. Conclusion. This study revealed a low incidence of deep vein thrombosis in surgical patients with peripheral catheters (1.8%. The study was underpowered; therefore the association between peripheral catheters and thrombosis is unable to be established. Future studies with larger sample sizes are required to determine the association between peripheral catheters and thrombosis.

  3. Sonication for diagnosis of catheter-related infection is not better than traditional roll-plate culture: a prospective cohort study with 975 central venous catheters.

    Science.gov (United States)

    Erb, Stefan; Frei, Reno; Schregenberger, Katharina; Dangel, Marc; Nogarth, Danica; Widmer, Andreas F

    2014-08-15

    This prospective randomized controlled study with 975 nontunneled central venous catheters (CVCs) showed that the semiquantitative roll-plate culture technique (SQC) was as accurate as the sonication method for diagnosis of catheter-related infections. Sonication is difficult to standardize, whereas SQC is simpler, faster, and as reliable as the sonication method for culturing CVCs.

  4. Analysis of Central Venous Catheter-related Infections%中心静脉导管相关性感染的临床分析

    Institute of Scientific and Technical Information of China (English)

    黄业; 谢逢春; 刘凤鸣

    2015-01-01

    Objective:To analyze the central venous catheter-related infections prevention strategies.Method: 120 patients in our hospital to accept deep vein indwelling tube were selected,the prevention and control measures were analyzed.Result:Among 120 patients received the central venous catheterization,the infection of catheter export was found in 3 cases,accounting for 2.50%,5 cases of catheter-related bloodstream infection, accounting for 4.17%,both of which were recovery after the corresponding disposals.Conclusion:Strengthening education and training of medical personnel,strict aseptic can effective prevent central venous catheter-related infections.%目的:探讨中心静脉导管相关性感染预防策略。方法:抽取笔者所在医院的接受深静脉留置管的120例患者为研究对象,分析预防、控制措施。结果:在行中心静脉置管术的120例患者中,3例患者出现置管出口部位感染,占2.50%,5例患者发生导管相关血流感染,占4.17%,通过对患者进行相应的临床处理,均得到一定的改善。结论:需要加强医务人员的教育培训,严格进行无菌操作,有效预防中心静脉导管相关性感染的发生。

  5. A role for peripherally inserted central venous catheters in the prevention of catheter-related blood stream infections in patients with hematological malignancies.

    Science.gov (United States)

    Sakai, Toshiro; Kohda, Kyuhei; Konuma, Yuichi; Hiraoka, Yasuko; Ichikawa, Yukari; Ono, Kaoru; Horiguchi, Hiroto; Tatekoshi, Ayumi; Takada, Kouichi; Iyama, Satoshi; Kato, Junji

    2014-12-01

    Central venous catheter-related blood stream infections (CR-BSIs) are a serious complication in patients with hematological malignancies. However, it remains unclear whether there is a difference in the rate of CR-BSI associated with the conventional type of central venous catheters (cCVCs) and peripherally inserted CVCs (PICCs) in such patients. To address this question, we retrospectively investigated the incidence of CR-BSIs associated with PICCs versus cCVCs in patients with hematological malignancies. We used PICCs in all consecutive patients requiring CVC placement between February 2009 and February 2013. We compared the CR-BSI rate in patients with PICCs with that in patients with cCVCs treated between September 2006 and January 2009 (control group). Eighty-four patients received PICCs and 85 received cCVCs. The most common reason for removal due to catheter-related complications was CR-BSI. The CR-BSI rate in the PICC group was significantly lower than that in the cCVC group (PICCs: 1.23/1000 catheter days; cCVCs: 5.30/1000 catheter days; P Catheter-related complications other than CR-BSIs occurred at an extremely low rate in the PICC group. The median catheter-related complication-free survival duration was significantly longer in the PICC group than in the cCVC group. Our study shows that PICCs are useful in patients with hematological malignancies.

  6. Risk factors for central venous catheter-related thrombosis in children: a retrospective analysis.

    Science.gov (United States)

    Chen, Kai; Agarwal, Arnav; Tassone, Maria Cristina; Shahjahan, Nadia; Walton, Mark; Chan, Anthony; Mondal, Tapas

    2016-06-01

    Central venous catheter (CVC) placement is associated with increased risk of thrombosis in the paediatric population, particularly in relation to the type of catheter and the manner of its insertion. Here, we investigate risk factors associated with CVC-related thrombosis in children, with particular emphasis on positioning of the catheter tip. Patients aged 0-18 who underwent at least one CVC placement from 2008 to 2013 at a single centre with a subsequent follow-up echocardiogram were included for a total of 104 patients and 147 lines. Data on clinical and catheter-related risk factors were collected from patient charts. Statistical analysis using Pearson's χ tests, independent samples t-test, and odds ratios were used to assess potential risk factors for thrombosis. Neither insertion site (subclavian vein or otherwise), left- vs. right-sided insertion, nor catheter type were significant risk factors for thrombosis. There were no thrombotic events reported at the superior vena cava (SVC)-right atrium junction and no significant differences in thrombotic risk with initial tip placement in the SVC-right atrium junction vs. the SVC, right atrium, or inferior vena cava. Acute lymphoblastic leukaemia was a major clinical risk factor for thrombosis. Tip movement was common and may have been an important factor in the development of CVC-related thrombi. Prospective studies can yield insight into the role of follow-up imaging in the prevention of catheter-related thrombosis in children.

  7. A catheter related sepsis case caused by Pantoea agglomerans

    Directory of Open Access Journals (Sweden)

    Fadime Yılmaz

    2015-04-01

    microorganism was sensitive to piperacillin-tazobactam, so, patient's therapy was not changed. After treatment, when the general condition of the patient healed, he was discharged by ending antibiotics on the sixteenth day. This case report, is intended to call attention to the risk of the growth of catheter-associated sepsis and antibioterapi are lated to P. agglomerans which is rarely seen on immunocompromised patients.

  8. Biofilm formation in long-term central venous catheters in children with cancer: a randomized controlled open-labelled trial of taurolidine versus heparin

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Fuursted, Kurt; Funch, Peter;

    2012-01-01

    Taurolidine has demonstrated inhibition of biofilm formation in vitro. The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters. Forty-eight children with cancer were randomized to catheter locking by heparin (n...... = 22) or taurolidine (n = 26), respectively. After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Biofilm was present if morphologically typical structures and bacterial cells were identified. Quantitative and semi......-quantitative cultures were also performed. Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group. A positive culture was made of six of the catheters locked with taurolidine and heparin, respectively (p = 0.78). The rate of catheter-related bloodstream...

  9. Reducing bloodstream infection with a chlorhexidine gel IV dressing.

    Science.gov (United States)

    Jeanes, Annette; Bitmead, James

    The use of vascular access devices (VAD) is common in healthcare provision but there is a significant risk of acquiring an infection. Central venous catheters (CVC) are associated with the highest risk of intravenous catheter-related bloodstream infection (CRBSI). 3M™ Tegaderm™ CHG IV dressing is a semi-permeable transparent adhesive dressing with an integrated gel pad containing chlorhexidine gluconate 2%. This product was reviewed by the National Institute for Health and Care Excellence (NICE) in 2015, recommending that Tegaderm CHG could be used for CVC and arterial line dressings in high-dependency and intensive-care settings. This article discusses issues around CRBSI, interventions to reduce the risk of CRBSI, and the use of Tegaderm CHG dressing.

  10. Catheter-related candidemia caused by Candida lipolytica in a child with tubercular meningitis

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    Agarwal Santwana

    2008-04-01

    Full Text Available Candida lipolytica is weakly pathogenic yeast, which is rarely isolated from the blood. We recovered this species from repeated blood samples and in the central venous catheter in a debilitated pediatric patient of tubercular meningitis. Identity was established on the basis of colony morphology and sugar assimilation tests (ID 32C assimilation profile. The fungemia and associated fever subsided after the removal of catheter and amphotericin B therapy. The data suggest that though of low virulence and usually a contaminant, C. lipolytica is emerging yeast pathogen in cases of catheter-related candidemia. Pathogenicity is indicated by isolation from repeated samples as in our case. Intensive therapy is recommended in cases not resolving spontaneously or responding to removal of catheter alone.

  11. Infecção de corrente sanguínea relacionada a cateter venoso central (ICSRC em enfermarias: estudo prospectivo comparativo entre veia subclávia e veia jugular interna Catheter-associated bloodstream infections (CA-BSI in wards: a prospective comparative study between subclavian and jugular access

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    Gustavo Lopes Gomes Siqueira

    2011-09-01

    Full Text Available CONTEXTO: Hemocultura positiva associada a cateter venoso central tem sido estudada em unidades de terapia intensiva (UTI, mas ainda é controverso se o acesso jugular tem maior incidência de complicações infecciosas que o acesso na veia subclávia. OBJETIVO: Comparar índice de infecção entre os acessos na jugular interna e os na veia subclávia em pacientes internados nas enfermarias de cirurgia. MÉTODOS: Estudo prospectivo, descritivo e comparativo com 114 cateteres em 96 pacientes admitidos nas enfermarias de cirurgia de um Hospital Quaternário, tendo como variáveis o local de inserção, número de lumens, tempo de uso, comparando-os com o índice de complicações infecciosas. RESULTADOS: O índice de infecção foi de 9,64% (11 cateteres, sem significância estatística quando comparados o número de lumens (mono versus duplo e infecção (p=0,274; também sem significância estatística a comparação entre o tempo de uso (>14 dias e infecção (p=0,156. Comparando os acessos jugular e subclávia, encontramos significância estatística tendo infecção em 17,2% na subclávia e 1,8% na jugular, com p=0,005. Índice de Hemocultura positivo associado a cateter venoso central foi maior no acesso subclávia quando comparado com jugular interna, com OR 11,2, IC95% (1,4-90,9; p=0,023. CONCLUSÕES: O acesso venoso central na jugular interna tem menor risco de infecção se comparado com subclávia em enfermarias.BACKGROUND: Positive hemoculture associated with central venous catheters has been studied in intensive care units (ICU, but is still controversial if the internal jugular vein access has a higher incidence of infection than subclavian or femoral vein access. OBJECTIVE: To compare catheter-related bloodstream infection (CABSI rates between internal jugular and subclavian vein access in patients admitted to surgical wards. METHODS: This is a prospective, descriptive and comparative study of 114 central venous catheters placed in

  12. Culture Positivity of CVCs Used for TPN: Investigation of an Association with Catheter-Related Infection and Comparison of Causative Organisms between ICU and Non-ICU CVCs

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    Criona Walshe

    2012-01-01

    Full Text Available A relationship between central venous catheter (CVC tip colonisation and catheter-related blood-stream infection (CRBSI has been suggested. We examined culture positivity of CVC tips (colonised and infected CVCs in a total parenteral nutrition (TPN population. Our aims were to define the relationship between culture positivity and CRBSI, and to compare causative organisms between culture positive and CRBSI CVCS, and between ward and ICU CVCs. All patients receiving TPN via non-tunnelled CVCs during the study (1997–2009 were included. All CVC tips were analysed. Data were collated contemporaneously. A TPN audit committee determined whether CVC tip culture positivity reflected colonisation/CRBSI using CDC criteria. 1,392 patients received TPN via 2,565 CVCs over 15,397 CVC days. 25.4% of CVCs tips were culture positive, of these 32% developed CRBSI. There was a nonsignificant trend of higher Gram negative Bacilli isolation in ICU CVCs (=0.1, ward CVCs were associated with higher rates of staphylococcal isolation (=0.01. A similar pattern of organisms were cultured from CRBSI and culture positive CVCs. The consistent relationship between CRBSI and culture positive CVCs, and similar pattern of causative organisms further supports an aetiological relationship between culture positive CVC tips and CRBSI, supporting the contention that CVC culture-positivity may be a useful surrogate marker for CRBSI rates.

  13. Positive deviance as a strategy to prevent and control bloodstream infections in intensive care

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    Francimar Tinoco de Oliveira

    Full Text Available Abstract OBJECTIVE To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. METHOD An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. RESULTS In 90 days, 188 actions were observed, of these, 36.70% (n=69 were related to catheter dressing. In 81.15% (n=56 of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. CONCLUSION Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care.

  14. [Infections associated with the use of indwelling urinary catheters. Infections related to intrauterine devices].

    Science.gov (United States)

    Pigrau, Carlos; Rodríguez-Pardo, M Dolores

    2008-05-01

    Hospital-acquired urinary tract infections (UTI) are mainly associated with indwelling urinary catheter use. In this chapter, the pathogenesis of hospital-acquired UTI in catheterized patients, the mechanisms by which microorganisms reach the urinary tract and are able to adhere and form biofilms, and the influence of other risk factors, such as time since catheter insertion and catheter composition, are reviewed. A wide variety of infecting microorganisms can affect patients with urinary catheters, making the choice of an adequate empirical antimicrobial course complex, particularly in cases of suspected multiresistant microorganisms. Moreover, the clinical symptoms are less characteristic in catheter infection and the diagnosis may be difficult. Treatment should be stratified according to the clinical features, which can vary from asymptomatic bacteriuria that may not require treatment, to severe septic episodes that need wide antibiotic coverage. The prevention measures for UTI in permanently catheterized patients are reviewed. Infections of the female genital tract associated with foreign bodies are mainly related to the use of intrauterine devices (IUDs). The epidemiology, microbiology profile, antimicrobial treatment, and prophylaxis of pelvic inflammatory disease related to IUD use in women are also reviewed.

  15. Utilização de cateter central de inserção periférica e ocorrência da infecção da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal | Use of peripherally inserted central catheters and occurrence of bloodstream infections in a neonatal intensive care unit

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    Márcia Yumi Yonekura

    2015-02-01

    Full Text Available Objetivo: Analisar a prevalência de infecção hospitalar primária da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal. Métodos: Estudo retrospectivo, com análise de prontuários de uma Unidade de Terapia Intensiva Neonatal, no período de janeiro a dezembro de 2010. Foi calculada a densidade de incidência de infecção de corrente sanguínea associada ao cateter por 1000 cateteres-dia. Resultados: Dos 192 recém-nascidos, 16 (8,3% apresentaram infecção da corrente sanguínea e todos estes utilizaram o cateter central de inserção periférica. A densidade de infecção confirmada por hemocultura foi de 5,9 e a baseada em critérios clínicos foi de 3,5 por 1000 pacientes com cateter vascular central-dia. A distribuição por faixa de peso foi de: 30,9 (750-999g; 11 (1000-1499g; 8,5 (1500-2499g e 6,8 (> 2500g por 1000 pacientes com cateter vascular dia. A média do tempo de uso do cateter foi de 11 dias. O sítio de inserção mais comum foi o acesso jugular (37,5% e a mortalidade associada à infecção da corrente sanguínea foi de 31%. Conclusões: A utilização do cateter central de inserção periférica é uma prática não isenta de riscos, considerando que este é um dispositivo invasivo e pode predispor à ocorrência de infecção. ------------------------------------------------------------------------------------------ Objective: To analyze the prevalence of hospital primary bloodstream infections in a neonatal intensive care unit (NICU. Methods: A retrospective study involving analyses of records of patients admitted to the NICU from January to December 2010 was conducted. The incidence density of catheter-associated bloodstream infections per 1000 catheter-days was calculated. Results: Among 192 newborns, 16 (8.3% who used peripherally inserted central catheters had bloodstream infections. The infection density confirmed by blood culture reached 5.9, while the density based on clinical criteria accounted for

  16. Bloodstream infections among patients using central venous catheters in intensive care units Infección de corriente sanguínea en pacientes con catéter venosos central en unidades de cuidado intensivo Infecções da corrente sangüínea em pacientes em uso de cateter venoso central em unidades de terapia intensiva

    Directory of Open Access Journals (Sweden)

    Eni Rosa Aires Borba Mesiano

    2007-06-01

    Full Text Available Central Venous Catheters (CVC, widely used in Intensive Care Units (ICU are important sources of bloodstream infections (BSI. This prospective cohort epidemiological analytical study, aimed to infer the incidence of BSI, the risk factors associated and evaluate the care actions related to the use of these catheters in seven ICU in the Federal District - Brasília, Brazil. From the 630 patients using CVC, 6.4% developed BSI (1.5% directly related to the catheter and 4.9% clinic BSI. The hospitalization term was 3.5 times greater among these patients. Different modalities of catheter insertion and antiseptic substances use were observed. Time of CVC permanence was significantly associated to infection incidence (pLos catéteres venosos centrales (CVC utilizados principalmente en unidades de cuidados intensivos - UCIs, son importantes fuentes de infección de la corriente sanguínea (ICS. Este estudio epidemiológico analítico, de corte prospectivo, enfoca la incidencia de ICS, factores de riesgo asociados y medidas asistenciales relacionadas con el uso de estos catéteres en 7 UCIs del Distrito Federal. Del total de 630 pacientes con CVC, 6,4% presentaron ICS (1,5% relacionado al catéter y 4,9% ICS-Clínica. El tiempo de hospitalización fue 3,5 veces mayor para este grupo de pacientes. Fueron observadas diferentes conductas con relación a la inserción de catéteres y al uso de antisépticos. El tiempo de permanencia del CVC estuvo asociado a la incidencia de infección (pOs cateteres venosos centrais (CVC, utilizados, principalmente em unidades de terapia intensiva-UTIs, são importantes fontes de infecção da corrente sangüínea (ICS. Este estudo epidemiológico analítico, tipo coorte prospectiva, enfoca a incidência de ICS, fatores de risco associados e ações assistenciais relacionadas ao uso desses cateteres em 7 UTIs no Distrito Federal. Dos 630 pacientes com CVC, 6,4% apresentaram ICS (1,5% relacionadas ao cateter e 4,9% ICS

  17. [Risk factors for catheter-related bloodstream infection in non-critical patients with total parenteral nutrition].

    Science.gov (United States)

    Ocón Bretón, María Julia; Mañas Martínez, Ana Belén; Medrano Navarro, Ana Lidia; García García, Blanca; Gimeno Orna, José Antonio

    2013-01-01

    Introducción: La bacteriemia asociada al catéter (BAC) es una de las complicaciones más importantes en pacientes portadores de un catéter venoso central (CVC) debido a su asociación con un incremento en la mortalidad, morbilidad y gasto sanitario. La administración de nutrición parenteral total (NPT) aumenta el riesgo de aparición de BAC. El objetivo de nuestro estudio fue determinar la tasa de incidencia y los factores de riesgo de BAC en pacientes con NPT hospitalizados en plantas médico-quirúrgicas. Métodos: Estudio observacional, analítico, retrospectivo donde se analizaron a todos los pacientes adultos no críticos que precisaron NPT desde enero de 2010 hasta noviembre de 2011. El punto final clínico fue la BAC. La tasa de incidencia de BAC se calculó en forma de episodios por cada 1.000 pacientes-día de cateterización. Los factores predictivos independientes de BAC se determinaron mediante regresión logística. Resultados: Durante el periodo de estudio precisaron NPT un total de 331 pacientes. La duración media del CVC fue de 12,4 (DE 8,7) días y la NPT fue infundida durante un periodo medio de 10,4 (DE 8,3) días. 47 pacientes presentaron BAC, con una tasa de incidencia de 11,4/1.000 pacientes- día de CVC y de 13,7/1.000 pacientes-día de NPT. Los factores predictores univariantes de aparición de BAC fueron la permanencia del CVC superior a 20 días (OR = 2,48; IC 95%: 1,16-5,26), la duración de la NPT superior a 2 semanas (OR = 4,63; IC 95%: 2,16-9,90) y la presencia de fístulas (OR = 3,08; IC 95%: 1,24-7,63). En análisis multivariante, el único predictor independiente de BAC fue la duración de la NPT (OR para una duración superior a 14 días = 4,9; IC 95%: 2,2-10,9; p < 0,0001). Conclusiones: En pacientes adultos hospitalizados en plantas diferentes a UCI, hemos demostrado que la duración de la infusión de la NPT incrementa el riesgo de BAC. El incremento de riesgo es especialmente marcado, llegando a multiplicarse por 5, con duraciones superiores a las 2 semanas.

  18. Catheter-Related Bacteremia Due to Kocuria kristinae in a Patient with Ovarian Cancer

    Science.gov (United States)

    Basaglia, G.; Carretto, E.; Barbarini, D.; Moras, L.; Scalone, S.; Marone, P.; De Paoli, P.

    2002-01-01

    We report on the first case of a catheter-related recurrent bacteremia caused by Kocuria kristinae, a gram-positive microorganism belonging to the family Micrococcaceae, in a 51-year-old woman with ovarian cancer. This unusual pathogen may cause opportunistic infections in patients with severe underlying diseases. PMID:11773142

  19. We still go for the jugular: implications of the 3SITES central venous catheter study for nephrology.

    Science.gov (United States)

    Wyatt, Christina M; Vassalotti, Joseph A

    2016-03-01

    The 3SITES study randomly assigned a nontunneled central venous catheter site in over 3000 adults treated in intensive care units. The subclavian site was associated with a lower rate of short-term complications, including catheter-related bloodstream infection and deep venous thrombosis, compared to the femoral or internal jugular site. Nephrologists should be aware of this study and should continue to advocate for alternatives to subclavian vein catheter placement in patients with chronic kidney disease who are expected to require arteriovenous access for dialysis in the future.

  20. Implementation of a children's hospital-wide central venous catheter insertion and maintenance bundle

    NARCIS (Netherlands)

    K. Helder MScN (Onno); R.F. Kornelisse (René); C. van der Starre (Cynthia); D. Tibboel (Dick); C.W.N. Looman (Caspar); R.M.H. Wijnen (René); M.J. Poley (Marten); E. Ista (Erwin)

    2013-01-01

    textabstractBackground: Central venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requir

  1. Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients.

    Science.gov (United States)

    Patel, Priti R; Kallen, Alexander J; Arduino, Matthew J

    2010-09-01

    Infections cause significant morbidity and mortality in patients undergoing hemodialysis. Bloodstream infections (BSIs) are particularly problematic, accounting for a substantial number of hospitalizations in these patients. Hospitalizations for BSI and other vascular access infections appear to have increased dramatically in hemodialysis patients since 1993. These infections frequently are related to central venous catheter (CVC) use for dialysis access. Regional initiatives that have shown successful decreases in catheter-related BSIs in hospitalized patients have generated interest in replicating this success in outpatient hemodialysis populations. Several interventions have been effective in preventing BSIs in the hemodialysis setting. Avoiding the use of CVCs in favor of access types with lower associated BSI risk is among the most important. When CVCs are used, adherence to evidence-based catheter insertion and maintenance practices can positively influence BSI rates. In addition, facility-level surveillance to detect BSIs and stimulate examination of vascular access use and care practices is essential to a comprehensive approach to prevention. This article describes the current epidemiology of BSIs in hemodialysis patients and effective prevention strategies to decrease the incidence of these devastating infections.

  2. Incidence and risk factors for central venous catheter-related thrombosis in hematological patients.

    Science.gov (United States)

    Joks, Monika; Czyż, Anna; Popławski, Dariusz; Komarnicki, Mieczysław

    2014-01-01

    Catheter-related thrombosis (CRT) is a serious complication in hematological patients, but the risk factors for its occurrence are not well established. The study objectives were to estimate the incidence of CRT and to identify the risk factors for developing CRT in hematological patients. In a prospective setting, 104 consecutive patients with 200 insertions of central venous catheters were enrolled into the study. The patients were screened for CRT by compression Doppler ultrasound every 10-14 days. Additionally, ultrasonography was performed in the case of clinical symptoms suggesting CRT. Over the course of 6,098 catheter days of follow-up, the incidence of CRT was 13.5 %. In 18/27 cases (66.6 %), radiological evidence of CRT was preceded by clinical symptoms. However, in 9/27 (33.3 %), CRT was clinically asymptomatic. The median times to symptomatic and asymptomatic CRT were 17 (range 1-49) and 8 (range 1-16) catheter days, respectively. In univariate analysis, the risk factors for CRT were exit-site infection (ESI) (P risk of CRT. The results of our study provide information regarding the characteristic features of the patients who are at high risk of thrombosis, for whom Doppler ultrasound screening should be considered.

  3. Prospective monocentric study of non-tunnelled central venous catheter-related complications in hematological patients.

    Science.gov (United States)

    Nosari, Anna Maria; Nador, Guido; De Gasperi, Andrea; Ortisi, Giuseppe; Volonterio, Alberto; Cantoni, Silvia; Nichelatti, Michele; Marbello, Laura; Mazza, Ernestina; Mancini, Valentina; Ravelli, Erica; Ricci, Francesca; Ciapanna, Denis; Garrone, Federica; Gesu, Giovanni; Morra, Enrica

    2008-11-01

    Indwelling central venous catheters (CVCs) are used in the management of hematologic patients. However, insertion and maintenance of CVCs are susceptible to complications. Study design and methods data concerning 388 consecutive catheterisations, performed in oncohematologic patients between April 2003 and December 2004, were prospectively collected. At insertion thrombocytopenia was present in 109 cases (28.1%) and neutropenia in 67 (17.3%). Hemorrhage after CVC insertion occurred in five thrombocytopenic patients (1.3%). The median duration of catheterisation was 18.8 days (range 1-89), longer in the 7-French CVCs utilised in leukemic patients (24.3 days) and shorter in 12-French CVCs (11 days), used for PBSC harvesting. Deep venous thrombosis was diagnosed in 13 cases (3.3%). Ninety-two catheterisations (12.6/1000 days-catheter) were complicated by infections: 19 local infections (4.8%) and 73 (18.8%) bacteraemias of which 45 (11.6%) were catheter-related, mainly due to Gram positive germs (32/45, 71.1%). The frequency of catheter-related bacteraemia was 7.2 events/1000 days-catheter. Thirteen CVCs were removed due to thrombosis, 15 due to infections, 20 due to malfunction, the remaining 333 at patients discharge. At univariate analysis high-dose chemotherapy (p = 0.013), 7-Fr lumen (p = 0.023), acute myeloid leukemia (AML) (p = 0.001), duration of neutropenia >10 days and length of catheterisation were significantly correlated to infection. Multivariate analysis confirmed the duration of catheterisation, AML and high-dose chemotherapy as risk factors. Even though hematological in-patients are at increased risk for bleeding and infections, non-tunnelled CVCs offer a safe venous access also in patients affected by severe thrombocytopenia and prolonged neutropenia.

  4. Catheter-related bacteremia due to Roseomonas species in pediatric hematology/oncology patients.

    Science.gov (United States)

    McLean, Thomas W; Rouster-Stevens, Kelly; Woods, Charles R; Shetty, Avinash K

    2006-04-01

    Roseomonas is a newly described genus of pink-pigmented, gram-negative bacteria. Human infections caused by Roseomonas species are very rare. We report two cases of central venous catheter-related bacteremia associated with Roseomonas species (one case with R. gilardii and one with R. fauriae), and review the clinical spectrum of previously reported cases in the literature. Clinicals should be aware that Roseomonas species may cause serious infections in children.

  5. Chronic Complications After Femoral Central Venous Catheter-related Thrombosis in Critically Ill Children.

    Science.gov (United States)

    Sol, Jeanine J; Knoester, Hennie; de Neef, Marjorie; Smets, Anne M J B; Betlem, Aukje; van Ommen, C Heleen

    2015-08-01

    Prescription of thromboprophylaxis is not a common practice in pediatric intensive care units. Most thrombi are catheter-related and asymptomatic, without causing acute complications. However, chronic complications of these (a)symptomatic catheter-related thrombi, that is, postthrombotic syndrome (PTS) and residual thrombosis have not been studied. To investigate these complications, critically ill children of 1 tertiary center with percutaneous inserted femoral central venous catheters (FCVCs) were prospectively followed. Symptomatic FCVC-thrombosis occurred in 10 of the 134 children (7.5%; 95% confidence interval [CI], 2.4-9.5). Only FCVC-infection appeared to be independently associated (P=0.001) with FCVC-thrombosis. At follow-up 2 of the 5 survivors diagnosed with symptomatic thrombosis developed mild PTS; one of them had an occluded vein on ultrasonography. A survivor without PTS had a partial occluded vein at follow-up. Asymptomatic FCVC-thrombosis occurred in 3 of the 42 children (7.1%; 95% CI, 0.0-16.7) screened by ultrasonography within 72 hours after catheter removal. At follow-up, mild PTS was present in 6 of the 33 (18.2%; 95% CI, 6.1-30.3) screened children. Partial and total vein occlusion was present in 1 (3%) and 4 (12%) children, respectively. In conclusion, children on pediatric intensive care units are at risk for (a)symptomatic FCVC-thrombosis, especially children with FCVC-infection. Chronic complications of FCVC-thrombosis are common. Therefore, thromboprophylaxis guidelines are warranted in pediatric intensive care units to minimize morbidity as a result of FCVC-thrombosis.

  6. Catheter-related infection in Irish intensive care units diagnosed with HELICS criteria: a multi-centre surveillance study.

    LENUS (Irish Health Repository)

    Conrick-Martin, I

    2013-03-01

    Catheter-related infection (CRI) surveillance is advocated as a healthcare quality indicator. However, there is no national CRI surveillance programme or standardized CRI definitions in Irish intensive care units (ICUs).

  7. Biofilm formation in long-term central venous catheters in children with cancer: a randomized controlled open-labelled trial of taurolidine versus heparin.

    Science.gov (United States)

    Handrup, Mette Møller; Fuursted, Kurt; Funch, Peter; Møller, Jens Kjølseth; Schrøder, Henrik

    2012-10-01

    Taurolidine has demonstrated inhibition of biofilm formation in vitro. The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters. Forty-eight children with cancer were randomized to catheter locking by heparin (n = 22) or taurolidine (n = 26), respectively. After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Biofilm was present if morphologically typical structures and bacterial cells were identified. Quantitative and semi-quantitative cultures were also performed. Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group. A positive culture was made of six of the catheters locked with taurolidine and heparin, respectively (p = 0.78). The rate of catheter-related bloodstream infections (CRBSI) was 0.1 per 1000 catheter-days using taurolidine and 0.9 per 1000 catheter-days using heparin (p = 0.03). This randomized trial confirmed that the use of taurolidine as catheter-lock compared with heparin reduced the rate of CRBSIs; this reduction was not related to a reduction in the intraluminal biofilm formation and the rate of bacterial colonization detected by scanning electron microscopy in the two groups.

  8. Incidence of bloodstream infection among patients on hemodialysis by central venous catheter Incidencia de infección de la corriente sanguínea em los pacientes sometidos a hemodiálisis por catéter venoso central Incidência de infecção da corrente sanguínea nos pacientes submetidos à hemodiálise por cateter venoso central

    Directory of Open Access Journals (Sweden)

    Cibele Grothe

    2010-02-01

    Full Text Available This study evaluated the incidence and risk factors of bloodstream infection (BSI among patients with a double-lumen central venous catheter (CVC for hemodialysis (HD and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156 who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo - UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.El objetivo de este estudio fue evaluar la incidencia y los factores de riesgo de infección de la corriente sanguínea (ICS en pacientes con catéter venoso central (CVC doble lumen, para hemodiálisis (HD e identificar los microorganismos aislados en la corriente sanguínea. Como método, se uso el acompañamiento, realizado en el período de un año, incluyendo todos los 156 pacientes que estaban en tratamiento de HD por CVC doble lumen, en la Universidad Federal de Sao Paulo - UNIFESP. Los resultados mostraron que de los 156 pacientes estudiados, 94 presentaron ICS, de estos, 39 tuvieron culturas positivas en el local de inserción del catéter. De los 128 microorganismos aislados de la corriente sanguínea, 53 eran S.aureus, de los cuales 30 eran sensibles a la metilcilina y 23 resistentes. Entre las complicaciones relacionadas a la ICS, hubo 35 casos de septicemia y 27 casos de endocarditis, de los cuales 15 resultaron en muerte. La incidencia de ICS en este grupo de pacientes se mostr

  9. Real-Time Monitoring of Catheter-Related Biofilm Infection in Mice.

    Science.gov (United States)

    Liu, Xu; Yin, Hong; Xu, Xianxing; Cheng, Yuanguo; Cai, Yun; Wang, Rui

    2015-10-01

    This study was done to establish a mouse model for catheter-related biofilm infection suitable to bioluminescence imaging (BLI). Biofilm formation of Pseudomonas aeruginosa (P. aeruginosa) Xen5 grown on catheter disks in vitro and in an implanted mouse model was real-time monitored during a 7-day study period using BLI. The numbers of integrated brightness (IB) and viable bacterial count (VBC) in the biofilm disks in vitro were highest at 24 h after inoculation; the IB of biofilm in vivo was increased until 24 h after implantation. A statistical correlation was observed between IB and VBC in vitro by linear regression analysis. The actual VBC value in vivo can be estimated accurately by IB without sacrifice. In addition, we monitored the change in white blood cells (WBCs) during infection. The number of WBCs on day 7 was significantly higher in the infection group than in the control group. This study indicates that BLI is a simple, fast, and sensitive method to measure catheter biofilm infection in mice.

  10. 导管相关血流感染临床分析%Clinical analysis of cathetei-related bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    卓婕; 孙永昌; 李莉; 李然

    2011-01-01

    目的 分析我院2008年1月至2010年12月重症监护病房(ICU)和普通病房导管相关血流感染(CRBSI)的发生情况,为CRBSI的预防和治疗提供依据.方法 将我院131例CRBSI病例分为ICU组和普通病房组,对临床资料、病原菌、导管位置、预后等进行回顾性分析.结果 ICU组(88例)和普通病房组(43例)在年龄和性别构成上差异无统计学意义(P>0.05).ICU组患者APACHE Ⅱ评分高于普通病房组(P=0.039).CRBSI在股静脉置管的患者中发生率最高.两组患者共培养出致病菌株152株.ICU组106株,其中革兰阳性球菌43株(40.6%),革兰阴性杆菌41株(38.7%),真菌22株(20.7%);普通病房组46株,其中革兰阳性球菌29株(63.0%).革兰阴性杆菌13株(28.3%),真菌4株(8.7%).因CRBSI导致死亡病例ICU组16例(18.2%),普通病房组4例(9.3%)(P>0.05).混合感染患者死亡率显著高于单一菌株感染(P=0.004).死亡病例感染病原菌前三位分别为真菌(12株)、肠球菌(6株)、铜绿假单胞菌(3株).结论 CRBSI在ICU和普通病房患者中病原菌分布存在差异,是抗菌药物选择和预后判断中需要考虑的因素.%Objective To study the incidence and pathogenic etiology of catheter-related bloodstream infection (CRBSI) in intensive care unit (ICU) and general ward, and to provide basis for the prevention and therapy of CRBSI. Methods 131 cases of CRBSI were divided into ICU group and general ward group. The clinical data, pathogens, catheter location, and prognosis were analyzed retrospectively. Results There was no statistical significance on age and gender between ICU group (88 cases) and general ward group (43 cases) ( P >0. 05). APACHE Ⅱ score in ICU group was higher than that in general ward group ( P =0.039). The incidence of CRBSI in the femoral vein was the highest. There were 152 pathogenic strains isolated from the two groups. There were 106 strains in ICU group, in which 43 strains (40.6%) were gram-positive cocci, 41

  11. Home Nursing of Continuous Improvement Prevention and Controlling Role of Tumor Patient with PICC Related Bloodstream Infection%居家护理持续改进在防控PICC相关性血流感染中的作用

    Institute of Scientific and Technical Information of China (English)

    高群英; 刘建红; 张柳柳; 陈传英; 张容; 孟爱凤; 朱敏; 朱娟芳

    2012-01-01

    目的 探讨居家护理持续改进在防控PICC( Parenterally Insersted Central-Catheters)相关性血流感染中的作用.方法 回顾性分析1年内265例PICC置管肿瘤患者中PICC相关性血流感染(PICC-BSIs)病例,针对因居家护理不当引起的PICC-BSIs,提出居家护理改进措施,①出院前加强PICC居家护理相关知识宣教;②发放自行设计的居家PICC日常维护单;③寻求家庭、社会支持系统;④建立维护网络;⑤通过电话回访提高患者出院后导管维护依从性.结果 在回顾性265例PICC置管肿瘤患者中有3例居家护理不当引起的PICC-BSIs,进行居家护理措施持续改进的252例PICC置管肿瘤患者因居家护理不当引起的PICC-BSIs为0.结论 对PICC置管的肿瘤患者进行居家护理措施持续改进,能有效防控PICC-BSIs的发生.%Objective Explore home nursing of continuous improvement prevention and controlling role of tumor patients with PICC related bloodstream infection ( PICC-BSIs) . Methods 265 cases in home nursing patients with tumor caused by PICC-BSIs cases for one year were analyzed retrospectively, and intervention measures were taken to improve home nursing care into the way. ①before discharge PICC strengthen knowledge education related to home nursing;②increase instructions of daily maintenance of home PICC; ③search for family and social support system; ④operate a PICC intervention system such as establish a PICC maintenance network in residential communities; ⑤through the telephone patients a better return after discharge tube maintenance compliance. Results 265 cases were analyzed retrospectively, three cases of PICC-BSIs were caused by improper home nursing in one year. For the continuous improvement of 252 home nursing patients with tumor PICC tube, PICC-BSIs cases were zero. Conclusion The tumor patients with PICC catheter can control and prevent PICC-BSIs by improving home nursing continuously.

  12. Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Faisal A. Khasawneh

    2011-01-01

    Full Text Available Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guidewire-related complications are rare but potentially serious. We describe a case of a lost guidewire during central venous catheter insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.

  13. Central line-associated bloodstream infections: prevention and management.

    Science.gov (United States)

    Weber, David J; Rutala, William A

    2011-03-01

    Approximately 80,000 central venous line-associated bloodstream infections (CLA-BSI) occur in the United States each year. CLA-BSI is most commonly caused by coagulase-negative staphylococci, Staphylococcus aureus, Candida spp, and aerobic gram-negative bacilli. These organisms commonly gain entrance in into the bloodstream via the catheter-skin interface (insertion site) or via the catheter hub. Use of strict aseptic technique for insertion is the key method for the prevention of CLA-BSI. Various methods can be used to reduce unacceptably high rates of CLA-BSI, including use of an antiseptic- or antibiotic-impregnated catheter, daily chlorhexidine baths/washes, and placement of a chlorhexidine-impregnated sponge over the insertion site.

  14. Outbreak of long-term intravascular catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit.

    Science.gov (United States)

    Tena, D; Carranza, R; Barberá, J R; Valdezate, S; Garrancho, J M; Arranz, M; Sáez-Nieto, J A

    2005-11-01

    Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term intravascular catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under XbaI restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The catheter was removed in only one patient. The three patients in whom the catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous catheters and should be called into question. Patients with long-term intravascular catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without catheter removal.

  15. Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment.

    Science.gov (United States)

    Richardson, Ian P; Sturtevant, Rachael; Heung, Michael; Solomon, Michael J; Younger, John G; VanEpps, J Scott

    2016-01-01

    Central line-associated bloodstream infections (CLABSIs) are not easily treated, and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50°C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter, positioned with tip in the human vena cava as well as computational fluid dynamic simulations, we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature.

  16. Ethanol lock therapy for the treatment of catheter-related infections in haemophilia patients.

    Science.gov (United States)

    Rajpurkar, M; Boldt-Macdonald, K; McLenon, R; Callaghan, M U; Chitlur, M; Lusher, J M; Becker, C

    2009-11-01

    Central venous access devices (CVAD) are increasingly being used for optimal delivery of clotting factor concentrates in patients with haemophilia with poor peripheral venous access. The utility of CVAD is particularly well recognized in young patients starting factor prophylaxis and in patients with inhibitors undergoing immune tolerance induction (ITI). A catheter-related infection (CRI) remains the most common complication of CVAD in haemophilia patients and is the most frequent indication for its removal. Additionally, in some patients the infection results in significant morbidity and mortality and also contributes to failure of the ITI regimen. Ethanol-lock therapy (ELT) is a treatment modality that has been used to treat CRI in patients with indwelling catheters for home parenteral nutrition and chemotherapy. The aim of this study was to report the success in treating CRI in haemophilia patients using ELT. Three severe haemophilia A patients undergoing ITI regimen who developed CVAD infections resistant to conventional management with antibiotics were treated by ELT according to the institutional technique. All three patients responded well to ELT with clearance of the CVAD infection. There were no adverse side effects. To our knowledge, this is the first report of ELT in patients with haemophilia. The role of ELT needs to be investigated in larger studies for treatment of CRI in patients with bleeding disorders.

  17. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Aya Amer

    2016-01-01

    Full Text Available Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC, who then developed a supraventricular tachycardia (SVT. This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management.

  18. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

    Science.gov (United States)

    Amer, Aya; Broadbent, Roland S.; Edmonds, Liza

    2016-01-01

    Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC), who then developed a supraventricular tachycardia (SVT). This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management. PMID:28058050

  19. Radiofrequency catheter ablation of atrial tachycardias related to myocardial scar or incision

    Institute of Scientific and Technical Information of China (English)

    Jianqiang HU; Jiang CAO; Shengqiang WANG; Yongwen QIN; Bingyan ZHOU

    2006-01-01

    Intra-atrial re-entrant tachycardias (IARTs) are common late after heart surgery. Conventional mapping and ablation is relatively difficult because of the complicated anatomy and multiple potential re-entry loops. In this study we aimed to evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia (AT) induced by myocardial scar or incision. Methods In 6 patients (three male and three female, aged 33.3+ 11.8 years) who had AT related to myocardial scar or incision,electrophysiological study and radiofrequency catheter ablation (RFCA) were performed. Earliest activation combined with entrainment mapping was adopted to determine a critical isthmus. Results Re-entry related to the lateral atriotomy scar was inducible in 5 of6 patients. With entrainment mapping, the PPI (post-pacing interval)-TCL (tachycardia cycle length) difference was <30 ms when pacing at the inferior margins of the right lateral atriotomy scar. Among them, 3 patients had successful linear ablation between scar area to inferior vena cava, and 2 patients between scar area to tricuspid annulus. Re-entry involving an ASD patch was demonstrated in 1 of 6 patients. PPI-TCL differences <30 ms were observed when entraining tachycardia at sites near the septal patch. But linear ablation failed in terminating AT. There was no complication during procedure. No recurrence of AT related to incision was observed during follow-up except for the failed patient. Conclusion Under conventional electrophysiological mapping, adopting linear ablation from scar area to anatomic barrier, successful ablation can be obtained in patients with IRATs related to myocardial scar or incision.

  20. Computer algorithms to detect bloodstream infections.

    Science.gov (United States)

    Trick, William E; Zagorski, Brandon M; Tokars, Jerome I; Vernon, Michael O; Welbel, Sharon F; Wisniewski, Mary F; Richards, Chesley; Weinstein, Robert A

    2004-09-01

    We compared manual and computer-assisted bloodstream infection surveillance for adult inpatients at two hospitals. We identified hospital-acquired, primary, central-venous catheter (CVC)-associated bloodstream infections by using five methods: retrospective, manual record review by investigators; prospective, manual review by infection control professionals; positive blood culture plus manual CVC determination; computer algorithms; and computer algorithms and manual CVC determination. We calculated sensitivity, specificity, predictive values, plus the kappa statistic (kappa) between investigator review and other methods, and we correlated infection rates for seven units. The kappa value was 0.37 for infection control review, 0.48 for positive blood culture plus manual CVC determination, 0.49 for computer algorithm, and 0.73 for computer algorithm plus manual CVC determination. Unit-specific infection rates, per 1,000 patient days, were 1.0-12.5 by investigator review and 1.4-10.2 by computer algorithm (correlation r = 0.91, p = 0.004). Automated bloodstream infection surveillance with electronic data is an accurate alternative to surveillance with manually collected data.

  1. Reduction in catheter-related infections after switching from povidone-iodine to chlorhexidine for the exit-site care of tunneled central venous catheters in children on hemodialysis.

    Science.gov (United States)

    Paglialonga, Fabio; Consolo, Silvia; Biasuzzi, Antonietta; Assomou, Jolanda; Gattarello, Elisabetta; Patricelli, Maria Grazia; Giannini, Alberto; Chidini, Giovanna; Napolitano, Luisa; Edefonti, Alberto

    2014-10-01

    Only a few studies have investigated the optimal exit site management of tunneled central venous catheters (CVCs) in pediatric patients on chronic hemodialysis (HD). The aim of this study was to assess the efficacy of chlorhexidine solutions and a 5% povidone-iodine solution on the incidence of CVC-related infections in children on HD. The incidence of exit-site infection (ESI), tunnel infection (TI), and bloodstream infection (BSI) was assessed in two groups of tunneled CVCs. The iodopovidone group consisted of 14 CVCs used between 1 January 2011 and 30 June 2012 in 10 children, whose median age at the time of CVC placement was 11.8 years (range 1.2-19.2): 5% povidone-iodine was used for CVC exit-site care. From 1 August 2012 to 31 January 2014, 0.5% chlorhexidine gluconate/70% isopropyl alcohol was used for the exit site, and 2% chlorhexidine gluconate/70% isopropyl alcohol spray for the hub in 13 CVCs was used in 10 patients (chlorhexidine group), whose median age at the time of CVC placement was 10 years (range 1.2-19.2). Ten episodes of ESI were diagnosed in the iodopovidone group (incidence 3.4/1000 CVC days), and only one in the chlorhexidine group (incidence 0.36/1000 CVC days, P = 0.008). One TI was observed in the iodopovidone group (0.34/1000 CVC days), and none in the chlorhexidine group. The incidence of BSIs decreased from 1.7/1000 CVC days (5 cases) to 0.36/1000 CVC days (1 case, P = 0.06) after switching to chlorhexidine. Two CVCs were lost due to CVC-related infections in the iodopovidone group, whereas no CVC was lost due to infections in the chlorhexidine group. In comparison with 5% povidone-iodine, the use of chlorhexidine gluconate was associated with a reduction in the incidence of ESI, TI, and BSI in children on HD.

  2. Catheter-related infections in a northwestern São Paulo reference unit for burned patients care

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    Cláudio Penido Campos Júnior

    2010-04-01

    Full Text Available Despite improvements in care and rehabilitation of burned patients, infections still remain the main complication and death cause. Catheter-related infections are among the four most common infections and are associated with skin damage and insertion site colonization. There are few studies evaluating this kind of infection worldwide in this special group of patients. Padre Albino Hospital Burn Care Unit (PAHBCU is the only reference center in the Northwestern São Paulo for treatment of burned patients. This paper presents the results of a retrospective study aiming at describing the epidemiological and clinical features of catheter-related infections at PAHBCU.

  3. Assessment of central venous catheter-associated infections using semi-quantitative or quantitative culture methods

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    E. L. Pizzolitto

    2009-01-01

    Full Text Available

    Semiquantitative (Maki and quantitative (Brun- Buisson culture techniques were employed in the diagnosis of catheter-related bloodstream infections (CRBSI in patients who have a short-term central venous catheter (inserted for 30 days. The diagnosis of CRBSI was based on the results of semiquantitative and quantitative culture of material from the removed catheters. Catheter tips (118 from 100 patients were evaluated by both methods. Semiquantitative analysis revealed 34 catheters (28.8% colonized by ≥15 colonyforming units (cfu, while quantitative cultures (34 catheters, 28.8% showed the growth of ≥103 cfu/mL. Bacteremia was confirmed in four patients by isolating microorganisms of identical species from both catheters and blood samples. Using the semiquantitative culture technique on short-term central venous catheter tips, we have shown that with a cut-off level of ≥15 cfu, the technique had 100.0% sensitivity, specificity of 68.4%, 25.0% positive predictive value (PPV and 100.0% negative predictive value (NPV, efficiency of 71.4% and a prevalence of 9.5%. The quantitative method, with a cut-off limit of ≥103 cfu/mL, gave identical values: the sensitivity was 100.0%, specificity 68.4%, positive predictive value (PPV 25.0%, negative predictive value (NPV 100.0%, efficiency 71.4% and prevalence 9.5%. We concluded that the semiquantitative and quantitative culture methods, evaluated in parallel, for the first time in Brazil, have similar sensitivity and specificity. Keywords: central venous catheter; semi-quantitative culture; quantitative culture; catheter-related bacteremia.

  4. Central venous catheter-related thrombosis in senile male patients: New risk factors and predictors.

    Science.gov (United States)

    Liu, Gao; Fu, Zhi-Qing; Zhu, Ping; Li, Shi-Jun

    2015-06-01

    Central venous catheterization (CVC)-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aimed to investigate the incidence rate of CVC-related venous thrombosis in senile patients and give a further discussion on the related risk factors and predictors. A total of 324 hospitalized senile male patients subjected to CVC were selected. Retrospective investigation and analysis were conducted on age, underlying diseases, clinical medications, catheterization position and side, catheter retention time, and incidence of CVC-related venous thrombosis complications. Basic laboratory test results during catheterization and thrombogenesis were also collected and analyzed. Among the 324 patients, 20 cases (6.17%) of CVC-related venous thrombosis were diagnoseds. The incidence rate of CVC-related venous thrombosis in subclavian vein catheterization was significantly lower than that in femoral vein catheterization (Pvenous thrombosis history (Prisk factors or predictors of CVC-related venous thrombosis in senile male patients. Subclavian vein catheterization was the most appropriate choice among senile patients to decrease the incidence of CVC-related venous thrombosis. Previous venous thrombosis history, high lactate dehydrogenase level, low HDL level, and low albumin level were important risk factors in predicting CVC-related venous thrombosis.

  5. Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection

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    Suresh Babu Kale

    2013-01-01

    Full Text Available A central venous catheter (CVC is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.

  6. Catheter-related infections caused by Pseudomonas aeruginosa: virulence factors involved and their relationships.

    Science.gov (United States)

    Olejnickova, Katerina; Hola, Veronika; Ruzicka, Filip

    2014-11-01

    The nosocomial pathogen Pseudomonas aeruginosa is equipped with a large arsenal of cell-associated and secreted virulence factors which enhance its invasive potential. The complex relationships among virulence determinants have hitherto not been fully elucidated. In the present study, 175 catheter-related isolates were observed for the presence of selected virulence factors, namely extracellular enzymes and siderophore production, biofilm formation, resistance to antibiotics, and motility. A high percentage of the strains produced most of the tested virulence factors. A positive correlation was identified between the production of several exoproducts, and also between the formation of both types of biofilm. An opposite trend was observed between the two types of biofilm and the production of siderophores. Whereas the relationship between the submerged biofilm production (i.e. the biofilm formed on the solid surface below the water level) and the siderophore secretion was negative, the production of air-liquid interface (A-L) biofilm (i.e. the biofilm floating on the surface of the cultivation medium) and the siderophore secretion were positively correlated. All correlations were statistically significant at the level P = 0.05 with the correlation coefficient γ ≥ 0.50. Our results suggest that: (1) the co-production of the lytic enzymes and siderophores can play an important role in the pathogenesis of the catheter-related infections and should be taken into account when the virulence potential is assessed; (2) biofilm-positive strains are capable of forming both submerged and non-attached A-L biofilms; and (3) the different micro-environment in the submerged biofilm and A-L biofilm layers have opposite consequences for the production of other virulence factors.

  7. Intravascular catheter related infections and antimicrobial susceptibility pattern of isolated bacteria in a tertiary care hospital of Bangladesh

    Directory of Open Access Journals (Sweden)

    F J Mansur

    2014-01-01

    Full Text Available The aim of this study was to evaluate the rate of bacterial colonisation and catheter related blood stream infections (CRBSI together with the antibiotic susceptibility patterns in a tertiary care hospital. CRBSI was detected with semi-quantitative and quantitative methods. The antimicrobial susceptible patterns of the isolated organisms were performed by Kirby Bauer disk diffusion method. The rate of catheter colonisation and CRBSI were 42.1% and 14% (16.1/1000 catheter days respectively. The most common causative pathogens were Pseudomonas sp. (23.7%, Acinetobacter sp. (18.4%, Staphylococcus aureus (13.2% and Enterobacteriaceae (10.5%. The rate of isolation of methicillin resistance S. aureus, imipenem resistant Pseudomonas sp. and extended spectrum β lactamase producing Enterobacteriaceae were 60%, 44.0% and 100%. The result of this study would be useful for control and treatment of CRBSI.

  8. Factors influencing catheter-related infections in the Dutch multicenter study on high-dose chemotherapy followed by peripheral SCT in high-risk breast cancer patients

    NARCIS (Netherlands)

    Nieboer, P; de Vries, Elisabeth G. E.; Mulder, Nanno; Rodenhuis, S; Bontenbal, M; van der Wall, E; van Hoesel, Q G; Smit, W M; Hupperets, P; Voest, E E; Nooij, M A; Boezen, H M; van der Graaf, W T A

    2008-01-01

    Neutropenia following high-dose chemotherapy leads to a high incidence of infectious complications, of which central venous catheter-related infections predominate. Catheter-related infections and associated risk factors in 392 patients participating in a randomized adjuvant breast cancer trial and

  9. Factors influencing catheter-related infections in the Dutch multicenter study on high-dose chemotherapy followed by peripheral SCT in high-risk breast cancer patients.

    NARCIS (Netherlands)

    Nieboer, P.; Vries, E.G. de; Mulder, N.H.; Rodenhuis, S.; Bontenbal, M.; Wall, E. van der; Hoesel, Q.G.C.M. van; Smit, W.M.; Hupperets, P.; Voest, E.E.; Nooij, M.A.; Boezen, H.M.; Graaf, W.T.A. van der

    2008-01-01

    Neutropenia following high-dose chemotherapy leads to a high incidence of infectious complications, of which central venous catheter-related infections predominate. Catheter-related infections and associated risk factors in 392 patients participating in a randomized adjuvant breast cancer trial and

  10. Central venous catheter-related bacteremia caused by Kocuria kristinae: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    David Michael Z

    2011-08-01

    Full Text Available Abstract Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided.

  11. Corynebacterium diphtheriae as an emerging pathogen in nephrostomy catheter-related infection: evaluation of traits associated with bacterial virulence.

    Science.gov (United States)

    Gomes, Débora L R; Martins, Carlos A S; Faria, Lúcia M D; Santos, Louisy S; Santos, Cintia S; Sabbadini, Priscila S; Souza, Mônica C; Alves, Gabriela B; Rosa, Ana C P; Nagao, Prescilla E; Pereira, Gabriela A; Hirata, Raphael; Mattos-Guaraldi, Ana L

    2009-11-01

    Corynebacterium diphtheriae still represents a global medical challenge, particularly due to the significant number of individuals susceptible to diphtheria and the emergence of non-toxigenic strains as the causative agents of invasive infections. In this study, we characterized the clinical and microbiological features of what we believe to be the first case of C. diphtheriae infection of a percutaneous nephrostomy catheter insertion site in an elderly patient with a fatal bladder cancer. Moreover, we demonstrated the potential role of adherence, biofilm formation and fibrin deposition traits in C. diphtheriae from the catheter-related infection. Non-toxigenic C. diphtheriae isolated from the purulent discharge (named strain BR-CAT5003748) was identified by the API Coryne system (code 1 010 324) and a multiplex PCR for detection of dtxR and tox genes. Strain BR-CAT5003748 showed resistance to oxacillin, ceftazidime and ciprofloxacin. In experiments performed in vitro, the catheter isolate was classified as moderately hydrophobic and as moderately adherent to polystyrene surfaces. Glass provided a more effective surface for biofilm formation than polystyrene. Micro-organisms adhered to (>1.5 x 10(6) c.f.u.) and multiplied on surfaces of polyurethane catheters. Microcolony formation (a hallmark of biofilm formation) and amorphous accretions were observed by scanning electron microscopy on both external and luminal catheter surfaces. Micro-organisms yielded simultaneous expression of localized adherence-like and aggregative-like (LAL/AAL) adherence patterns to HEp-2 cells. Interestingly, the coagulase tube test resulted in the formation of a thin layer of fibrin embedded in rabbit plasma by the non-toxigenic BR-CAT5003748 strain. In conclusion, C. diphtheriae should be recognized as a potential cause of catheter-related infections in at-risk populations such as elderly and cancer patients. LAL/AAL strains may be associated with virulence traits that enable C

  12. Complications Related to Insertion and Use of Central Venous Catheters (CVC)

    Science.gov (United States)

    Hodzic, Samir; Golic, Darko; Smajic, Jasmina; Sijercic, Selma; Umihanic, Sekib; Umihanic, Sefika

    2014-01-01

    ABSTRACT Introduction: Central Venous Catheters (CVC) are essential in everyday medical practice, especially in treating patients in intensive care units (ICU). The application of these catheters is accompanied with the risk of complications, such as the complications caused during the CVC insertion, infections at the location of the insertion, and complications during the use of the catheter, sepsis and other metastatic infections. Patients and methods: This study is a retrospective-prospective and it was implemented in the period 1st January 2011- 31st December 2012. It included 108 examinees with CVC placed for more than 7 days. Results: The most common complications occurring in more than 2 attempts of CVC applications are: hearth arrhythmias in both groups in 12 cases, 7 in multi-lumen (12.72%) and 5 in mono-lumen ones (9.43%). Artery puncture occurs in both groups in 7 cases, 5 in multi-lumen (9.09%) and 2 in mono-lumen ones (3.77%). Hematoma occurred in both groups in 4 cases, 3 in multi-lumen CVCs (5.45%) and 1 in mono-lumen ones (1.88%). The most common complication in multi-lumen catheters was heart arrhythmia, in 20 cases (36.37%). The most common complications in mono-lumen CVCs was hearth arrhythmias, in 20 cases as extrasystoles and they were registered in 16 catheter insertions (30.18%). Out of total number of catheters of both groups, out of 108 catheters the complications during insertion occurred in 49 catheters (45.40%). The most common complications in both groups were heart arrhythmias, artery punctures and hematomas at the place of catheter insertion. PMID:25568558

  13. Improvement of hemodialysis catheter function with tenecteplase: a phase III, open-label study: TROPICS 4.

    Science.gov (United States)

    Fishbane, Steven; Milligan, Samuel L; Lempert, Kenneth D; Hertel, Joachim E W; Wetmore, James B; Oliver, Matthew J; Blaney, Martha; Gillespie, Barbara S; Jacobs, Joan R; Begelman, Susan M

    2011-01-01

    Hemodialysis (HD) catheters are prone to thrombotic occlusion. We evaluated tenecteplase, a thrombolytic, for the treatment of dysfunctional HD catheters. Patients with tunneled HD catheters and blood flow rate (BFR) tenecteplase (2 mg/lumen) for a 1 h intracatheter dwell. Treatment success was defined as BFR ≥ 300 mL/min and a ≥ 25 mL/min increase from baseline BFR, 30 min before and at the end of HD. Patients without treatment success at the end of the initial visit received another 2 mg dose of tenecteplase for an up to 72 h extended dwell. Of 223 enrolled patients, 34% (95% confidence interval [CI], 28-40%) had treatment success after a 1 h dwell. Mean (standard deviation [SD]) BFR change from baseline was 82 (124) mL/min. Treatment success in those who received extended-dwell tenecteplase (n = 116) was 49% (95% CI, 40-58%), with mean (SD) BFR change from baseline of 117 (140) mL/min. Reported targeted adverse events included five catheter-related bloodstream infections and one thrombosis. No intracranial hemorrhage, major bleeding, embolic events, or catheter-related complications were reported. Tenecteplase administered as a 1 h or 1 h plus extended dwell was associated with improved HD catheter function in the TROPICS 4 trial.

  14. Subphrenic Abscess as a Complication of Hemodialysis Catheter-Related Infection

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    Fernando Caravaca

    2014-01-01

    Full Text Available We describe an unusual case of subphrenic abscess complicating a central venous catheter infection caused by Pseudomonas aeruginosa in a 59-year-old woman undergoing hemodialysis. The diagnosis was made through computed tomography, and Pseudomonas aeruginosa was isolated from the purulent drainage of the subphrenic abscess, the catheter tip and exit site, and the blood culture samples. A transesophageal echocardiography showed a large tubular thrombus in superior vena cava, extending to the right atrium, but no evidence of endocarditis or other metastatic infectious foci. Catheter removal, percutaneous abscess drainage, anticoagulation, and antibiotics resulted in a favourable outcome.

  15. Cefotaxime resistance and outcome of Klebsiella spp bloodstream infection.

    Science.gov (United States)

    Ortega, M; Marco, F; Soriano, A; Almela, M; Martínez, J A; López, J; Pitart, C; Mensa, J

    2011-12-01

    We attempt to describe the epidemiology and outcome associated with cefotaxime-resistant (CTX-R) Klebsiella spp bacteraemia. Klebsiella spp bloodstream infection episodes prospectively collected through a blood culture surveillance programme from January 1991 to December 2008 in a single institution were analysed. A total of 910 monomicrobial episodes of Klebsiella spp bacteraemia were identified during the study period. The most important sources were from urinary tract infection, unknown sources, billiary focus and catheter related infection. There were 112 (12%) CTX-R isolates. Out of 112 isolates, 98 were CTX-R by Extended-Spectrum β-Lactamase production. Shock on presentation and mortality were significantly more frequent in CTX-R than in CTX susceptible isolates. Inappropriate empirical therapy was received in 50 (45%) cases in the CTX-R Klebsiella spp group (13 cases of death, 26%). Predictive factors associated with CTX-R Klebsiella spp isolate were: previous β-lactam therapy (OR = 4.16), nosocomial acquired bacteraemia (OR = 1.93), solid organ trasplantation (OR = 2.09) and shock (OR = 1.90). Independent risk factors associated with mortality in Klebsiella spp bacteraemia were: age (OR = 1.03), liver cirrhosis (OR = 2.63), ultimately or rapidly fatal prognosis of underlying disease (OR = 2.44), shock (OR = 8.60), pneumonia (OR = 4.96) or intraabdominal (OR = 3.85) source of bacteraemia and CTX-R isolate (OR = 4.63). Klebsiella spp is an important cause of bloodstream infection. CTX-R isolates have been increasing since 2000. CTX-R is an independent factor associated with mortality in Klebsiella spp bacteraemia.

  16. Catheter Angiography

    Medline Plus

    Full Text Available ... an artery through a small incision in the skin. Once the catheter is guided to the area ... small incision (usually a few millimeters) in the skin where the catheter can be inserted into an ...

  17. Current strategies for the prevention and management of central line-associated bloodstream infections

    Directory of Open Access Journals (Sweden)

    Zhuolin Han

    2010-11-01

    Full Text Available Zhuolin Han, Stephen Y Liang, Jonas MarschallDivision of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, MO, USAAbstract: Central venous catheters are an invaluable tool for diagnostic and therapeutic purposes in today’s medicine, but their use can be complicated by bloodstream infections (BSIs. While evidence-based preventive measures are disseminated by infection control associations, the optimal management of established central line-associated BSIs has been summarized in infectious diseases guidelines. We prepared an overview of the state-of-the-art of prevention and management of central line-associated BSIs and included topics such as the role of antibiotic-coated catheters, the role of catheter removal in the management, and a review of currently used antibiotic compounds and the duration of treatment.Keywords: central venous catheters, bloodstream infections, guidelines, prevention

  18. Dialysis catheter-related superior vena cava syndrome with patent vena cava: Long term efficacy of unilateral viatorr stent-graft avoiding catheter manipulation

    Energy Technology Data Exchange (ETDEWEB)

    Quaretti, Pietro; Galli, Franco; Maramarco, Lorenzo Paplo; Corti, Riccardo; Leati, Giovanni; Fiorina, Ilaria; Maestri, Marcello [IRCCS Policlinico San Matteo Foundation, Pavia (Italy)

    2014-06-15

    Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.

  19. Bloodstream infections in HIV-infected patients.

    Science.gov (United States)

    Taramasso, Lucia; Tatarelli, Paola; Di Biagio, Antonio

    2016-04-02

    In the combined antiretroviral therapy era, HIV-infected patients remain a vulnerable population for the onset of bloodstream infections (BSI). Worldwide, nontyphoid salmonellae, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and coagulase negative staphylococci are the most important pathogens. Intravenous catheter associated infection, skin-soft tissue infection and endocarditis are associated with Gram-positive bacteremia. Among the Gram-negative, nontyphoidal Salmonella have been previously correlated to sepsis. Other causes of BSI in HIV-infected patients are mycobacteria and fungi. Mycobacteria constitute a major cause of BSI in limited resource countries. Fungal BSI are not frequent and among them Cryptococcus neoformans is the most common life-threatening infection. The degree of immunosuppression remains the key prognostic factor leading to the development of BSI.

  20. Implantable insulin pump therapy: an unusual presentation of a catheter-related complication.

    Science.gov (United States)

    Moore, Kevin B; Saudek, Christopher D; Greene, Alicia; Dackiw, Alan

    2006-06-01

    We report the case of a 63-year-old man who has a 19-year history of involvement in the implantable insulin pump program at Johns Hopkins University. After his most recent pump implantation in February 2004, his 24-h insulin requirement gradually increased from a baseline of 75 units to a peak of almost 500 units in June 2005. Surprisingly, insulin delivery from the pump and glycemic control remained satisfactory despite the dramatic change in insulin requirement. Laparotomy revealed a fibrous mass in the peritoneal cavity, with the track of the catheter extending into the mass. Insulin requirement declined post-resection of the mass and relocation of the catheter tip.

  1. Preventing central venous catheter-related infection in a surgical intensive-care unit

    NARCIS (Netherlands)

    Bijma, R; Girbes, AR; Kleijer, DJ; Zwaveling, JH

    1999-01-01

    The cumulative effect of five measures (introduction of hand disinfection with alcohol, a new type of dressing, a one-bag system for parenteral nutrition, a new intravenous connection device, and surveillance by an infection control practitioner) on central venous catheter colonization and bacteremi

  2. Bloodstream infections during the onset of necrotizing enterocolitis and their relation with the pro-inflammatory response, gut wall integrity and severity of disease in NEC

    NARCIS (Netherlands)

    Heida, F. H.; Hulscher, J. B. F.; Schurink, M.; van Vliet, M. J.; Kooi, E. M. W.; Kasper, D. C.; Pones, M.; Bos, A. F.; Benkoe, T. M.

    2015-01-01

    Introduction: Bacterial involvement is believed to play a pivotal role in the development and disease outcome of NEC. However, whether a bloodstream infection (BSI) predisposes to NEC (e.g. by activating the pro-inflammatory response) or result from the loss of gut wall integrity during NEC developm

  3. Bloodstream infections during the onset of necrotizing enterocolitis and their relation with the pro-inflammatory response, gut wall integrity and severity of disease in NEC

    NARCIS (Netherlands)

    Heida, F.H.; Hulscher, J.B.; Schurink, M.; Vliet, M.J. van; Kooi, E.M.; Kasper, D.C.; Pones, M.; Bos, A.F; Benkoe, T.M.

    2015-01-01

    INTRODUCTION: Bacterial involvement is believed to play a pivotal role in the development and disease outcome of NEC. However, whether a bloodstream infection (BSI) predisposes to NEC (e.g. by activating the pro-inflammatory response) or result from the loss of gut wall integrity during NEC developm

  4. Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials

    Directory of Open Access Journals (Sweden)

    Baltazares-Lipp Enrique

    2005-08-01

    Full Text Available Abstract Background Septic thrombophlebitis is an iatrogenic life-threatening disease associated with use of central venous devices and intravenous (IV therapy. In cancer patients receiving chemotherapy, vein resection or surgical thrombectomy in large central venous lines is time-consuming, can delay administration of chemotherapy, and therefore can compromise tumor control. Experience with thrombolysis has been published for catheter-related thrombosis but for septic thrombosis, this experience is scarce. Results We describe three patients with cancer and septic thrombophlebitis of central veins caused by Staphylococcus aureus treated with catheter removal, thrombolysis, and intravenous (IV antibiotics. In our reported cases, an initial bolus of 250,000 international units (IU of streptokinase administered during the first h followed by an infusion of 20,000–40,000 IU/h for 24–36 h through a proximal peripheral vein was sufficient to dissolve the thrombus. After thrombolyisis and parenteral antibiotic for 4–6 weeks the septic thrombosis due to Staphylococcus aureus solved in all cases. No surgical procedure was needed, and potential placement of a catheter in the same vein was permitted. Conclusion Thrombolysis with streptokinase solved symptoms, cured infection, prevented embolus, and in all cases achieved complete thrombus lysis, avoiding permanent central-vein occlusion.

  5. 新生儿中心静脉导管相关性感染的预防%Prevention of central venous catheter-related infections in neonates

    Institute of Scientific and Technical Information of China (English)

    王欣宁

    2010-01-01

    Central venous catheters are indispensable in modern-day medical practice in neonatal intensive care units.Infection is the most frequent serious complication during these catheter-inserted days.Several strategies to prevent catheter-related infections are disputed all over the world.Studies have shown that some measures played a role in reducing the infection rate,which include maximal sterile barrier precautions,chlorhexidine preparation for skin antisepsis,routine replacement of catheter site dressings and connection sets,time-limited catheter insert,removal catheter after infected,antibiotic locked catheters and so on.%中心静脉导管是新生儿重症监护室常用的静脉通道,而感染是中心静脉导管置管术严重的并发症,各国的新生儿中心都在积极研究各种预防措施,但其有效性仍有争议.研究表明,严格无菌操作、洗必泰皮肤消毒剂、周期性更换辅料及导管连接装置、限期拔管、感染后及时拔管、抗生素封闭导管等措施在降低感染率方面有一定的作用.

  6. A Retrospective Study of Preferable Alternative Route to Right Internal Jugular Vein for Placing Tunneled Dialysis Catheters: Right External Jugular Vein versus Left Internal Jugular Vein.

    Directory of Open Access Journals (Sweden)

    Pei Wang

    Full Text Available Right internal jugular vein (IJV is a preferred access route for tunneled (cuffed dialysis catheters (TDCs, and both right external jugular vein (EJV and left IJV are alternative routes for patients in case the right IJV isn't available for TDC placement. This retrospective study aimed to determine if a disparity exists between the two alternative routes in hemodialysis patients in terms of outcomes of TDCs.49 hemodialysis patients who required TDCs through right EJV (n = 21 or left IJV (n = 28 as long-term vascular access were included in this study. The primary end point was cumulative catheter patency. Secondary end points include primary catheter patency, proportion of patients that never required urokinase and incidence of catheter-related bloodstream infections (CRBSI.A total of 20,870 catheter-days were evaluated and the median was 384 (interquartile range, 262-605 catheter-days. Fewer catheters were removed in the right EJV group than in the left IJV group (P = 0.007. Mean cumulative catheter patency was higher in the right EJV group compared with the left IJV group (P = 0.031. There was no significant difference between the two groups in the incidence of CRBSI, primary catheter patency or proportion of patients that never required urokinase use. Total indwell time of antecedent catheters was identified as an independent risk factor for cumulative catheter patency by Cox regression hazards test with an HR of 2.212 (95% CI, 1.363-3.588; p = 0.001.Right EJV might be superior to left IJV as an alternative insertion route for TDC placement in hemodialysis patients whose right IJVs are unavailable.

  7. Central venous catheter-related blood stream infection rate in critical care units in a tertiary care, teaching hospital in Mumbai

    Directory of Open Access Journals (Sweden)

    K Chopdekar

    2011-01-01

    Full Text Available Blood stream infections related to central venous catheterization are one of the major device-associated infections reported. Patients admitted in critical care units requiring central venous catheterization and presenting with signs of septicemia during catheterization period were investigated for catheter-related blood stream infections (CRBSI. The CRBSI rate was 9.26 per 1000 catheter days in general with highest rate in neonatal intensive care unit (27.02/1000 days. Site of insertion of catheter and duration of catheterization did not show the influence on the CRBSI rate. Coagulase-negative Staphylococci were the predominant cause. Mortality of 33% was observed in patients with CRBSI. Since central venous catheters are increasingly being used in the critical care, regular surveillance for infection associated them are essential.

  8. Risk factors for nosocomial bloodstream infection caused by multidrug resistant gram-negative bacilli in pediatrics

    Directory of Open Access Journals (Sweden)

    Mariana V. Arnoni

    2007-04-01

    Full Text Available The aim of this study was to identify the risk factors for nosocomial bloodstream infections by multidrug resistant Gram-negative bacilli. From November 2001 to December 2003, in the Pediatric Department of the Santa Casa de São Paulo, a retrospective case-control study was developed concerning patients who had nosocomial bloodstream infection caused by Gram-negative bacilli. Patients with multidrug resistant infections were designated as case patients, and control patients were those with an infection that did not meet the criteria for multidrug resistance. Previous use of central venous catheter and previous use of vancomycin plus third generation cephalosporins were associated to a higher chance of infections by multidrug resistant Gram-negative bacilli (Odds ratio - 5.8 and 5.2, respectively. Regarding sensitivity of the isolated agents, 47.8% were multidrug resistant, 54.2% were Klebsiella spp. ESBL producers and 36.4% were imipenem resistant Pseudomonas aeruginosa. The lethality rate was 36.9% in the studied cases and this rate was significantly higher in the group of patients with multidrug resistant infections (p=0.013. Risk factor identification as well as the knowledge of the susceptibility of the nosocomial infectious agents gave us the possibility to perform preventive and control strategies to reduce the costs and mortality related to these infections.

  9. Three-Dimensional Imaging of a Central Venous Dialysis Catheter Related Infected Thrombus

    Directory of Open Access Journals (Sweden)

    Diana Yuan Yng Chiu

    2015-01-01

    Full Text Available Three-dimensional (3D echocardiography is becoming widely available and with novel applications. We report an interesting case of a 68-year-old lady with a central venous thrombosis coincident with both a dialysis catheter infection and a recent pacemaker insertion. Two-dimensional transesophageal echocardiography was unable to delineate whether the thrombosis was involved with the pacemaker wire or due to the tunneled catheter infection. The use of 3D echocardiography was able to produce distinct images aiding diagnosis. This circumvented the need for invasive investigations and inappropriate, high-risk removal of the pacing wire. This case highlights the emerging application of 3D echocardiography in routine nephrology practice.

  10. Three-Dimensional Imaging of a Central Venous Dialysis Catheter Related Infected Thrombus

    Science.gov (United States)

    Chiu, Diana Yuan Yng; Green, Darren; Kalra, Philip A.; Abidin, Nik

    2015-01-01

    Three-dimensional (3D) echocardiography is becoming widely available and with novel applications. We report an interesting case of a 68-year-old lady with a central venous thrombosis coincident with both a dialysis catheter infection and a recent pacemaker insertion. Two-dimensional transesophageal echocardiography was unable to delineate whether the thrombosis was involved with the pacemaker wire or due to the tunneled catheter infection. The use of 3D echocardiography was able to produce distinct images aiding diagnosis. This circumvented the need for invasive investigations and inappropriate, high-risk removal of the pacing wire. This case highlights the emerging application of 3D echocardiography in routine nephrology practice. PMID:26688761

  11. Mechanic and surface properties of central-venous port catheters after removal: A comparison of polyurethane and silicon rubber materials.

    Science.gov (United States)

    Braun, Ulrike; Lorenz, Edelgard; Weimann, Christiane; Sturm, Heinz; Karimov, Ilham; Ettl, Johannes; Meier, Reinhard; Wohlgemuth, Walter A; Berger, Hermann; Wildgruber, Moritz

    2016-12-01

    Central venous port devices made of two different polymeric materials, thermoplastic polyurethane (TPU) and silicone rubber (SiR), were compared due their material properties. Both naïve catheters as well as catheters after removal from patients were investigated. In lab experiments the influence of various chemo-therapeutic solutions on material properties was investigated, whereas the samples after removal were compared according to the implanted time in patient. The macroscopic, mechanical performance was assessed with dynamic, specially adapted tests for elasticity. The degradation status of the materials was determined with common tools of polymer characterisation, such as infrared spectroscopy, molecular weight measurements and various methods of thermal analysis. The surface morphology was analysed using scanning electron microscopy. A correlation between material properties and clinical performance was proposed. The surface morphology and chemical composition of the polyurethane catheter materials can potentially result in increased susceptibility of the catheter to bloodstream infections and thrombotic complications. The higher mechanic failure, especially with increasing implantation time of the silicone catheters is related to the lower mechanical performance compared to the polyurethane material as well as loss of barium sulphate filler particles near the surface of the catheter. This results in preformed microscopic notches, which act as predetermined sites of fracture.

  12. Infectious complications associated with the use of central venous catheters in patients undergoing hematopoietic stem cell transplantation.

    Science.gov (United States)

    Martinho, Gláucia Helena; Romanelli, Roberta M C; Teixeira, Gustavo Machado; Macedo, Antonio V; Chaia, Juliana M C; Nobre, Vandack

    2013-07-01

    In this prospective, observational study, we sought to investigate the incidence, risk factors, and outcomes of central venous catheter-associated infection in 56 patients admitted for hematopoietic stem cell transplantation. In multivariate analysis, we found a 7-fold higher risk of central line-associated bloodstream infection with central venous catheter insertion in the internal jugular vein as compared with the subclavian access. Patients with central line-associated bloodstream infection had a higher incidence of acute renal failure.

  13. A 12-year review of Staphylococcus aureus bloodstream infections in haemodialysis patients: more work to be done.

    LENUS (Irish Health Repository)

    Fitzgerald, S F

    2012-02-01

    Staphylococcus aureus bloodstream infections (BSI) are a significant cause of morbidity and mortality in haemodialysis patients. This study describes a 12-year retrospective review of S. aureus BSI in a large haemodialysis centre in a tertiary referral hospital. The overall rate of S. aureus BSI was 17.9 per 100 patient-years (range 9.7-36.8). The rate of meticillin-resistant S. aureus (MRSA) BSI was 5.6 per 100 patient-years (range 0.9-13.8). Infective complications occurred in 11% of episodes, the most common being infective endocarditis (7.6%). Ten percent of patients died within 30 days of S. aureus being isolated from blood. Most cases of S. aureus BSI (83%) were related to vascular catheters. The provision of lower-risk vascular access, such as arteriovenous fistulae, and reduced use of intravascular catheters should be priorities in all haemodialysis units. Where alternative vascular access cannot be established, interventions to reduce the risk of catheter-related infections should be implemented to reduce morbidity and mortality in this vulnerable patient group.

  14. Risk factors and current recommendations for prevention of infections associated with central venous catheters: a literature review

    Directory of Open Access Journals (Sweden)

    Danielle de Mendonça Henrique

    2014-04-01

    Full Text Available Backgound and Objectives: Infections related to central venous catheter (CVC use constitute an important a problem. It is estimated that approximately 90% of bloodstream infections (BSI are caused by CVC use. This study aims at reviewing the risk factors and current recommendations for prevention of infections associated with central venous catheter use. Methods: A total of 12 articles published in the last 5 years and indexed in the databases of the Latin American and Caribbean Literature on Health Sciences (LILACS, Nursing Database (BDENF, International Literature on Health Sciences (Medline/Pubmed were selected, as well as publications related to the recommendations for BSI prevention, such as: Institute for Healthcare Improvement (IHI, Centers for Disease Control and Prevention (CDC and the National Health Surveillance Agency (ANVISA. Results: Two categories were identified: prevention and control measures and risk factors for BSI associated with central venous catheter use. Conclusions: Some recommendations that were well-defined over the years have been questioned by some authors and continuing training and education of the multidisciplinary team are the most important factors for the prevention of bloodstream infections associated with CVC use.

  15. Catheter-Related Candidemia Caused by Candida lipolytica in a Patient Receiving Allogeneic Bone Marrow Transplantation

    Science.gov (United States)

    D'Antonio, Domenico; Romano, Ferdinando; Pontieri, Eugenio; Fioritoni, Giuseppe; Caracciolo, Claudia; Bianchini, Stefano; Olioso, Paola; Staniscia, Tommaso; Sferra, Roberta; Boccia, Stefania; Vetuschi, Antonella; Federico, Giovanni; Gaudio, Eugenio; Carruba, Giuseppe

    2002-01-01

    Candida lipolytica was recovered from the blood and the central venous catheter in a patient receiving allogeneic bone marrow transplantation. Two C. lipolytica strains from different geographical areas and the ATCC 9773 strain of C. lipolytica were used as controls. C. lipolytica was identified by standard methods. MICs indicated antifungal susceptibilities to amphotericin B, fluconazole, and itraconazole for all strains. In vitro testing and scanning electron microscopy showed that C. lipolytica was capable of producing large amounts of viscid slime material in glucose-containing solution, likely responsible for the ability of the yeast to adhere to catheter surfaces. Restriction fragment length polymorphisms revealed an identical profile for all clinical isolates, unrelated to those observed for the control strains. This finding suggested the absence of microevolutionary changes in the population of the infecting strain, despite the length of the sepsis and the potential selective pressure of amphotericin B, which had been administered to the patient for about 20 days. The genomic differences that emerged between the isolates and the control strains were indicative of a certain degree of genetic diversity between C. lipolytica isolates from different geographical areas. PMID:11923360

  16. Efficacy of Linezolid and Fosfomycin in Catheter-Related Biofilm Infection Caused by Methicillin-Resistant Staphylococcus aureus

    Directory of Open Access Journals (Sweden)

    Dong Chai

    2016-01-01

    Full Text Available As long-standing clinical problems, catheter-related infections and other chronic biofilm infections are more difficult to treat due to the high antibiotic resistance of biofilm. Therefore, new treatments are needed for more effective bacteria clearance. In this study, we evaluated the antibacterial activities of several common antibiotics alone and their combinations against biofilm-embedded methicillin-resistant staphylococcus aureus (MRSA infections, both in vitro and in vivo. In brief, fosfomycin, levofloxacin, and rifampin alone or in combination with linezolid were tested in vitro against planktonic and biofilm-embedded MRSA infection in three MRSA stains. The synergistic effects between linezolid and the other three antibiotics were assessed by fractional inhibitory concentration index (FICI and time-kill curves, where the combination of linezolid plus fosfomycin showed the best synergistic effect in all strains. For further evaluation in vivo, we applied the combination of linezolid and fosfomycin in a catheter-related biofilm rat model and found that viable bacteria counts in biofilm were significantly reduced after treatment (P<0.05. In summary, we have shown here that the combination of linezolid and fosfomycin treatment had improved therapeutic effects on biofilm-embedded MRSA infection both in vitro and in vivo, which provided important basis for new clinical therapy development.

  17. Catheter Angiography

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    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... iodine. If angiography is essential, a variety of methods is used to decrease risk of allergy: You ...

  18. Catheter Angiography

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    Full Text Available ... injection of contrast material to examine blood vessels in key areas of the body for abnormalities such ... makes it possible to combine diagnosis and treatment in a single procedure. Catheter angiography produces very detailed, ...

  19. Catheter Angiography

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    Full Text Available ... of page What are some common uses of the procedure? Catheter angiography is used to examine blood ... an hour away. top of page What does the equipment look like? The equipment typically used for ...

  20. Catheter Angiography

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    Full Text Available ... atherosclerosis (plaque). The use of a catheter makes it possible to combine diagnosis and treatment in a ... the aorta in the chest or abdomen or its major branches. show the extent and severity of ...

  1. Central venous catheter (CVC) removal for patients of all ages with candidaemia

    DEFF Research Database (Denmark)

    Janum, Susanne; Afshari, Arash

    2016-01-01

    BACKGROUND: Candida bloodstream infections most often affect those already suffering serious, potentially life-threatening conditions and often cause significant morbidity and mortality. Most affected persons have a central venous catheter (CVC) in place. The best CVC management in these cases has...... conclusions. At this stage, RCTs have provided no evidence to support the benefit of early or late catheter removal for survival or other important outcomes among patients with candidaemia; no evidence with regards to assessment of harm or benefit with prompt central venous catheter removal and subsequent re......-insertion of new catheters to continue treatment; and no evidence on optimal timing of insertion of a new central venous catheter....

  2. Comparison of NHSN-defined central venous catheter day counts with a method that accounts for concurrent catheters.

    Science.gov (United States)

    Talbot, Thomas R; Johnson, James G; Anders, Theodore; Hayes, Rachel M

    2015-01-01

    Central venous catheter (CVC) day definitions do not consider concurrent CVCs. We examined traditional CVC day counts and resultant central line-associated bloodstream infection (CLABSI) rates with a CVC day definition that included concurrent CVCs. Accounting for concurrent CVCs increased device day counts by 8.5% but only mildly impacted CLABSI rates.

  3. [Clinical suspicion of vertebral osteomielitis: back pain in patients with hemodyalisis by catheter related infection].

    Science.gov (United States)

    Valero, R; Castañeda, O; de Francisco, A L M; Piñera, C; Rodrigo, E; Arias, M

    2004-01-01

    The overall incidence of vertebral osteomyelitis is increasing due to, the increasing rates of bacteraemia due to intravascular devices. We report a patient with end-stage renal failure under hemodialysis by internal jugular catheters who started with back pain after several episodes of Staphylococcus aureus bacteraemia, and whose magnetic resonance imaging was showed signs suggestive of spondylodiscitis. Other 4 similar cases from our service have been analysed, thereby we can conclude the most effective treatment of vertebral osteomyelitis and/or epidural abscess is premature diagnosis of these pathologies. Magnetic resonance imaging is the most sensitive radiologic technique whom we have. Treatment of vertebral osteomyelitis must be preceded by a correct bacteriological diagnosis. Surgery plays a central role in the successful treatment and should be performed as soon as neurological problems are apparent.

  4. Catheter-Related Acremonium kiliense Fungemia in a Patient with Ulcerative Colitis under Treatment with Infliximab

    Directory of Open Access Journals (Sweden)

    Fernando A. Díaz-Couselo

    2011-01-01

    Full Text Available Acremonium spp. are filamentous, cosmopolitan fungi commonly isolated from plant debris and soil. They are infrequent pathogens in humans. Acremonium fungemia has been reported in neutropenic patients associated with central venous catheters and in nonneutropenic patients receiving long-term total parenteral nutrition. TNF-α blockade is associated with fungal infections, but no Acremonium spp. infection had been reported up to the present. In this paper, we present a patient with ulcerative colitis who developed Acremonium kiliense fungemia associated with infliximab therapy while receiving total parenteral nutrition. The patient was successfully treated with voriconazole. Acremonium sp. infection must be suspected as another cause of fungal infection in patients under treatment with infliximab.

  5. Tunnelled Central Venous Catheter-Related Problems in the Early Phase of Haematopoietic Stem Cell Transplantation and Effects on Transplant Outcome

    Directory of Open Access Journals (Sweden)

    Mahmut Yeral

    2015-03-01

    Full Text Available OBJECTIVE: Haematopoietic stem cell recipients need central venous catheters (CVCs for easy administration of intravenous fluid, medications, apheresis, or dialysis procedures. However, CVCs may lead to infectious or non-infectious complications such as thrombosis. The effect of these complications on transplantation outcome is not clear. This manuscript presents the complication rates of double-lumen tunnelled CVCs and their effect on transplantation outcome. METHODS: Data from 111 consecutive patients, of whom 75 received autologous and 36 received allogeneic peripheral blood stem cell transplantations, were collected retrospectively. The data were validated by the Record Inspection Group of the related JACIE-accredited transplantation centre. RESULTS: Thrombosis developed in 2.7% of recipients (0.9 per 1000 catheter days. Catheter-related infection was identified in 14 (12.6% patients (3.6 per 1000 catheter days. Coagulase-negative Staphylococcus was the most common causative agent. Engraftment time, rate of 100-day mortality, and development of grade II-IV graft-versus-host disease were not found to be associated with catheter-related complications. CONCLUSION: Sonuçlarımız nakil hastalarında tünelli SVK komplikasyonlarının yönetilebilir olduğunu ve bu komplikasyonların nakil üzerine olumsuz bir etki yaratmadığını göstermektedir.

  6. The effectiveness of an educational intervention in changing nursing practice and preventing catheter-related infection for patients receiving total parenteral nutrition.

    Science.gov (United States)

    Dinç, L; Erdil, F

    2000-10-01

    Catheter-related infections are one of the most serious complications of TPN therapy. Nurses have important responsibilities in the care of patients who are receiving TPN. This quasi-experimental study was conducted for the purpose of investigating the effectiveness of an educational intervention on changing nursing practice and preventing catheter-related infections in patients receiving total parenteral nutrition. The nurses' practice and the colonisation rate of control and comparative group patients in the surgical clinics of Hacettepe University Hospital (Turkey), and related variables were examined before and after an educational intervention. The findings of the study indicate that the intervention was successful in improving appropriate nursing practice, mean scores of nurses' practices were 45.7 before and 66.5 after the intervention (p<0.05). The rate of microorganism colonisation was also decreased but statistical analysis demonstrated no association between nursing practices and microorganism colonisation of catheter cultures.

  7. 乳腺癌患者携带PICC化疗并发导管败血症的诊治探讨%Diagnosis and treatment of peripherally inserted central catheters (PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Lei Xing; Vishnu Prasad Adhikari; Lingquan Kong; Hongyuan Li; Guosheng Ren; Feng Luo; Kainan Wu

    2012-01-01

    Objective: The aim of our research was to study the incidence, clinical diagnosis and treatment of peripherally inserted central catheters (PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy. Methods: The data of the incidence, diagnosis and treatment of PICC-related sepsis in 215 cases of breast cancer patients carrying PICC catheter for chemotherapy in our hospital from August, 2009 to September, 2011 were analyzed retrospectively. Results: 216 PICCs had been successfully applied in 215 cases of breast cancer patients and followed for a total of 19,109 catheter days, (median catheterization duration, 88.9 days, range 1-212 days). Among those, 3 (1.39%) PICCs were removed respectively as a result of PICC-related sepsis in 29, 73 and 108 catheter-days (median 70 d), with a rate of 0.16 per 1000 catheter-days. Conclusion: Chemotherapeutic treatment via PICC for breast cancer patients is one of the most secure and effective measures but there exists small number of cases in which PICC catheter related sepsis is possible. Careful observation of relevant symptoms and signs, early diagnosis and treatment, not relying completely on blood culture tests and timely removal of PICC catheter can be very effective in treating PICC-related sepsis in these patients.

  8. [Catheter-related infection in home-based parenteral nutrition: outcomes from the NADYA group and presentation of a new protocol].

    Science.gov (United States)

    Cuerda, Compés C; Bretón, Lesmes I; Bonada Sanjaume, A; Planas Vila, M

    2006-01-01

    Hom parenteral nutrition (HPN) is a nutritional support modality that allows for the supply of parenteral nutrition bags to the patient's home. Since its first use in the late 60s, this therapy has allowed maintaining patients with intestinal failure alive that previously were doomed to death. In our country, this therapy is used by 2.15 patients pmp. According to the NADYA data, catheter-related infections account for 50% of all HPN-related complications. In larger series, infection rates are 0.5-2 infections/1000 days or 0.3-0.5 infections/patient/year. Most of them are produced by gram-positive organisms that migrate from the skin or from catheter connections to the tip. These infections are diagnosed by means of clinical data and with different microbiological cultures. When treating these infections, it is important to keep the catheter in place, and administering antibiotics through it, conventionally or with the antibioticolade technique.

  9. 留置途径对中心静脉导管感染的影响%Influence of remaining needle on central venous catheter-related infection

    Institute of Scientific and Technical Information of China (English)

    李丽华; 杨筱敏

    2011-01-01

    Objective To investigate the influence of central venous catheter-related infection among different remaining needle. Methods The infection of central venous catheter with remaining needle in patients of comprehensive ICU was analyzed. Results There was the highest infection rate (31.2%) in femoral vein catheter group, followed by subclavian vein catheter group and jugular vein catheter (13.7%, 15.4%), peripheral venous catheter infection rate was lowest (3.8%). The difference among three groups was statistical significance (P<0. 01 ). Gram-positive bacteria was the major pathogenic bacterium. Conclusion The infection of central venous catheter was correlated with the puncture approach, central venous catheter to adopt the peripheral venous puncture approach may lower significantly catheter-related infection rate.%目的 探讨不同留置途径对中心静脉导管相关性感染的影响.方法 对重症监护病房采用不同途径留置中心静脉导管的患者进行回顾性分析,比较经不同途径留置中心静脉置管而发生感染的差异.结果 股静脉发生感染率最高(31.2%),锁骨下和颈内静脉置管发生感染率次之(13.7%、15.4%),经外周静脉置管发生感染率最低(3.8%),三者差异有显著性(P<0.01),并且感染的致病菌以革兰氏阳性菌为主.结论 中心静脉置管的感染与留置途径有明显的相关性,采用外周静脉置管途径可以明显降低中心静脉置管的感染率.

  10. Peripheral Venous Catheter-Related Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project)

    Science.gov (United States)

    Miliani, Katiuska; Taravella, Raphaël; Thillard, Denis; Chauvin, Valérie; Martin, Emmanuelle; Edouard, Stéphanie; Astagneau, Pascal

    2017-01-01

    Introduction Peripheral venous catheters (PVC) are medical devices most frequently used during hospital care. Although the frequency of specific PVC-related adverse events (PVCAEs) has been reported, the global risk related to the insertion of this device is poorly estimated. The aim of this study is to determine the incidence of PVCAEs during the indwell time, after catheter removal, and to identify practice-mirroring risk factors. Methods A prospective observational study was conducted as a part of a research project, called CATHEVAL, in one surgery ward and four medicine wards from three public general tertiary care hospitals in Northern France that were invited to participate between June-2013 and June-2014. Each participating ward included during a two-month study period all patients older than 15 years carrying a PVC. All inserted PVCs were monitored from insertion of PVC to up to 48 hours after removal. Monitored data included several practice-mirroring items, as well as the occurrence of at least one PVCAE. A multivariate Cox proportional hazard model, based on a marginal risk approach, was used to identify factors associated with the occurrence of at least one PVCAE. Results Data were analysed for 815 PVCs (1964 PVC-days) in 573 patients. The incidence of PVCAE was 52.3/100 PVCs (21.9/100 PVC-days). PVCAEs were mainly clinical: phlebitis (20.1/100 PVCs), haematoma (17.7/100 PVCs) and liquid/blood escape (13.1/100 PVCs). Infections accounted for only 0.4/100 PVCs. The most frequent mechanical PVCAEs, was obstruction/occlusion of PVC (12.4/100 PVCs). The incidence of post-removal PVCAEs was 21.7/100 PVCs. Unstable PVC and unclean dressing were the two main risk factors. Conclusion Limitation of breaches in healthcare quality including post-removal monitoring should be reinforced to prevent PVC-related adverse events in hospital settings. PMID:28045921

  11. Systemic anticoagulation related to heparin locking of non-tunnelled venous dialysis catheters in intensive care patients.

    Science.gov (United States)

    Bong, Y C; Walsham, J

    2016-07-01

    Heparin locking of venous dialysis catheters is routinely performed in intensive care to maintain catheter patency when the catheters are not being used. Leakage of heparin into the circulation can potentially cause systemic anticoagulation and may present a risk to intensive care patients. To assess the effect of 5000 units per millilitre heparin locking of non-tunnelled dialysis catheters on systemic anticoagulation, we performed a prospective observational study of ten intensive care patients receiving heparin locking of dialysis catheters in an adult tertiary intensive care unit between July and September 2015. Activated partial thromboplastin time (APTT) was measured prior to, and three minutes after, heparin locking of catheter lumens with the manufacturer's recommended locking volume to assess the effect on systemic anticoagulation. Heparin locking of venous dialysis catheters resulted in a significant rise in APTT (P=0.002). The median rise was by 56 seconds (interquartile range 30-166.5). Following heparin locking, 80% of patients had APTT values within or above the range associated with therapeutic anticoagulation. Heparin locking of non-tunnelled venous dialysis catheters can cause systemic anticoagulation in intensive care patients and therefore poses a potential risk to patient safety.

  12. [Investigation of biofilm-associated antibiotic susceptibilities of methicillin-resistant staphylococci isolated from catheter-related nosocomial infections].

    Science.gov (United States)

    Bayındır Bilman, Fulya; Can, Füsun; Kaya, Melek; Yazıcı, Ayşe Canan

    2013-07-01

    Risks for development of local and/or systemic infections are the most important complications of catheters that are widely used during hospitalization process. The aims of this study were to investigate and compare the antibiotic susceptibilities of methicillin-resistant staphylococci isolated from catheters, in planktonic and biofilm forms, and to evaluate the antimicrobial effects of antibiotics on those forms alone and in combinations. A total of 30 strains [15 methicillin-resistant Staphylococcus aureus (MRSA) and 15 methicillin-resistant coagulase-negative staphylococci (MR-CNS)] isolated from catheter cultures of patients hospitalized in different clinics and intensive care units in Baskent University Medical School Hospital between 2006-2009, were included in the study. The antibiotic sensitivities of MRSA and MR-CNS isolates were investigated in vitro in planktonic phase and on sessile cells after biofilm was formed. Vancomycin, ciprofloxacin, rifampicin, gentamicin, meropenem, tigecycline, linezolid, ceftazidime and cephazolin were used for antibiotic susceptibility testing. The sensitivity of planktonic cells to antibiotics was primarily investigated, so that minimal inhibitor concentration (MIC) and minimal bactericidal concentration (MBC) values were determined by broth microdilution method. Afterwards, each strain was transformed to sessile cell in a biofilm environment, and MIC and MBC values were also determined for sessile cells. Double and triple antibiotic combinations were prepared, the effectiveness of combinations were studied on both planktonic and biofilm cells with multiple-combination bactericidal testing (MCBT) method. The data set obtained from planktonic and biofilm cells for each antibiotic analyzed via two proportion z test. Statistically significant decreases were found in the sensitivities of sessile cells when compared to planktonic cells (pantibiotic combinations also showed the susceptibility decrease between planktonic and

  13. Are central venous catheter tip cultures reliable after 6-day refrigeration?

    Science.gov (United States)

    Bouza, Emilio; Guembe, Maria; Gómez, Haydee; Martín-Rabadán, Pablo; Rivera, Marisa; Alcalá, Luis

    2009-07-01

    Present guidelines recommend culturing only central venous catheter (CVC) tips from patients with suspected catheter-related bloodstream infection (CR-BSI). However, a high proportion of these suspicions are not confirmed. Moreover, CVC tip culture increases laboratory workload, and reports of colonization may be meaningless or misleading for the clinician. Our working hypothesis was that CVC tips should be refrigerated and cultured only in patients with positive blood cultures. We evaluated the effect of 6-day refrigeration of 215 CVC tips. We selected all the catheters with a significant count according to the Maki's roll-plate technique and randomly assigned them to 2 groups. In group A, the catheters were recultured after 24 h of refrigeration, and in group B, the catheters were recultured after 6 days more of refrigeration, so that the refrigeration time evaluated would be of 6 days. The yield of refrigerated CVC tips that grow significant colony counts of primary culture in group B was compared with the yield of refrigerated catheter tips in group A. The difference showed that 6-day refrigeration reduced the number of significant CVCs by 15.2%. Only 61 CVCs were obtained from patients with CR-BSI, and in most of them, blood cultures were already positive before CVC culture, so only 0.91% of the CR-BSI episodes would have been misdiagnosed as culture negative after refrigeration. Refrigeration of CVC tips sent for culture and culturing only those from patients with positive blood cultures reduce the workload in the microbiology laboratory without misdiagnosing CR-BSI.

  14. Urinary catheterization diary – A useful tool in tracking causes of non-deflating Foley catheter

    Directory of Open Access Journals (Sweden)

    C.O. Okorie

    2015-06-01

    Conclusions: Most urinary catheters marketed in developing countries are unidentifiable after unpacking. A catheterization diary is a useful tool for solving catheter-related problems, and its application in health-care facilities should be encouraged. Companies marketing Foley catheters should print the catheter name on both the catheter packaging and on the catheter itself.

  15. Urinary catheters

    Science.gov (United States)

    ... incontinence. There is no tube placed inside the penis. Instead, a condom-like device is placed over the penis. A tube leads from this device to a ... too small Bladder spasms Constipation The wrong balloon size Urinary tract infections POSSIBLE COMPLICATIONS Complications of catheter ...

  16. Catheter Angiography

    Medline Plus

    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Catheter Angiography? Angiography is a minimally invasive medical test that helps physicians diagnose and treat medical conditions. ...

  17. EARLY AND LATE COMPLICATIONS RELATED TO CENTRAL VENOUS CATHETERS IN HAEMATOLOGICAL MALIGNANCIES: A RETROSPECTIVE ANALYSIS OF 1102 PATIENTS

    Directory of Open Access Journals (Sweden)

    Salvatore Giacomo Morano

    2014-02-01

    Full Text Available Several severe complications may be associated with the use of central venous catheters (CVC. We retrospectively evaluated on a large cohort of patients the incidence of CVC-related early and late complications. From 7/99 to 12/2005, 1102 CVC have been implanted at our Institution in 881 patients with haematological malignancies (142,202 total day number of implanted CVC. Early mechanic complications were 79 (7.2% - 0.55/1,000 days/CVC. Thirty-nine episodes of early infective complications (<1 week from CVC implant occurred (3.5% - 0.3/1000 days/CVC: furthermore, 187 episodes of CVC-related sepsis (17% - 1.3/1000 days/CVC were recorded. There were 29 episodes (2.6% of symptomatic CVC-related thrombotic complications, with a median interval from CVC implant of 60 days (range 7 – 395. The rate of CVC withdrawal due to CVC-related complications was 26%. The incidence of CVC-related complications in our series is in the range reported in the literature, notwithstanding cytopenia often coexisting in haematological patients.

  18. [A case of stage IV b pancreatic cancer in which a catheter-related infection caused by epidural/subcutaneous reservoir therapy affected palliative home-based care].

    Science.gov (United States)

    Kinoshita, Shoji; Inoue, Daisuke; Sakuyama, Toshikazu; Yoshizawa, Akitaka; Nagasaki, Eijiroh; Arakawa, Yasuhiro; Uwagawa, Tadashi; Kobayashi, Kazuma; Kobayashi, Tadashi; Saitoh, Nobuhiro; Aiba, Keisuke

    2012-12-01

    We report the case of a patient with a stage IV b pancreatic cancer in which epidural/subcutaneous reservoir therapy was effective for pain control. However, a catheter-related infection caused by methicillin-resistant Staphylococcus aureus (MRSA)was occurred. In recent years, the number of cancer patients desiring palliative home-based care in Japan has increased. Epidural/subcutaneous reservoir therapy is often offered to relieve refractory pain, and to reduce the side effects of systemic administration of opioids, such as drowsiness, in homecare patients. We believe that this patient may have been able to continue home-based care if the catheter-related infection did not occur, because a significant improvement was calculated in the pain level by the numerical rating scale(NRS)observed. It is important to establish and share common strict guidelines between hospital doctors and general practitioners for the management of the subcutaneous catheter and reservoir therapy in order to prevent catheter-related infections over a long period.

  19. Tunneled catheters with taurolidine-citrate-heparin lock solution significantly improve the inflammatory profile of hemodialysis patients.

    Science.gov (United States)

    Fontseré, Néstor; Cardozo, Celia; Donate, Javier; Soriano, Alex; Muros, Mercedes; Pons, Mercedes; Mensa, Josep; Campistol, Josep M; Navarro-González, Juan F; Maduell, Francisco

    2014-07-01

    Mortality and morbidity are significantly higher among patients with dialysis catheters, which has been associated with chronic activation of the immune system. We hypothesized that bacteria colonizing the catheter lumen trigger an inflammatory response. We aimed to evaluate the inflammatory profile of hemodialysis patients before and after locking catheters with an antimicrobial lock solution. High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), IL-10, and tumor necrosis factor alpha (TNF-α) were measured in serum, and levels of mRNA gene expression of IL-6, IL-10, and TNF-α were analyzed in peripheral blood mononuclear cells (PBMC). Samples were obtained at baseline and again after 3 months' use of taurolidine-citrate-heparin lock solution (TCHLS) in 31 hemodialysis patients. The rate of catheter-related bloodstream infections (CRBSI) was 1.08 per 1,000 catheter-days in the heparin period and 0.04 in the TCHLS period (P = 0.023). Compared with the baseline data, serum levels of hs-CRP and IL-6 showed median percent reductions of 18.1% and 25.2%, respectively (P < 0.01), without significant changes in TNF-α or IL-10 levels. Regarding cytokine gene expression in PBMC, the median mRNA expression levels of TNF-α and IL-6 decreased by 20% (P < 0.05) and 19.7% (P = 0.01), respectively, without changes in IL-10 expression levels. The use of TCHLS to maintain the catheter lumen sterility significantly reduces the incidence of CRBSI and improves the inflammatory profile in hemodialysis patients with tunneled catheters. Further studies are needed to evaluate the potential beneficial effects on clinical outcomes.

  20. Prevention of access-related infection in dialysis.

    Science.gov (United States)

    Barraclough, Katherine A; Hawley, Carmel M; Playford, E Geoffrey; Johnson, David W

    2009-12-01

    Access-related infections (ARIs), such as exit-site infections, tunnel infections, bacteremia, fungemia and peritonitis, are the Achilles' heel of dialysis, and contribute significantly to morbidity, mortality and excess healthcare costs in hemodialysis and peritoneal dialysis patient populations. Despite international guidelines recommending the avoidance of catheters for hemodialysis access, hospital admissions for vascular ARIs have doubled in the last decade. Moreover, repeated use of antibiotics to treat ARIs has been associated with the selection of multiresistant organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. ARIs result from direct inoculation of skin organisms during access cannulation/connection, migration of skin organisms along dialysis catheters into the bloodstream or peritoneal cavity, or contamination and colonization of catheter lumens with subsequent biofilm formation. This paper will review the epidemiology, pathogenesis and prevention of ARIs. It will focus specifically on randomized, controlled trial evidence in relation to the safety and efficacy of aseptic techniques, nasal eradication of S. aureus, oral antimicrobial prophylaxis, topical antimicrobial prophylaxis (including disinfectants, antibiotics and antibacterial honey), antimicrobial catheter lock solutions (including gentamicin, citrate and ethanol), antimicrobial-impregnated catheters, catheter design (straight vs coiled, single vs double cuff), peritoneal dialysis catheter connectology, catheter insertion technique, germicidal devices, vaccines and preinsertion antibiotic prophylaxis.

  1. Lidocaine-prilocaine cream reduces catheter-related bladder discomfort in male patients during the general anesthesia recovery period: A prospective, randomized, case-control STROBE study.

    Science.gov (United States)

    Mu, Li; Geng, Li-Cheng; Xu, Hui; Luo, Man; Geng, Jing-Miao; Li, Li

    2017-04-01

    Urethral catheterization is a predictor of agitation during the general anesthesia recovery period. The aim of this study was to determine the effect of intraurethral 5% lidocaine and 25 mg/g prilocaine cream in reducing catheter-related bladder discomfort (CRBD) in male patients during the general anesthesia recovery period. Adult male patients undergoing elective operations that required urinary catheterization under general anesthesia were enrolled and assigned randomly to 2 groups. In the lidocaine-prilocaine cream group (n = 72), approximately 5 g of topical cream was spread in the preputial sac, the glans, the meatus, and on the urinary catheter surface before urinary catheterization. In the control group (n = 74), the urinary catheter was lubricated with lidocaine gel. The incidence and severity of CRBD were assessed 15, 30, 45, and 60 minutes postoperatively. We found that the incidence of CRBD in the lidocaine-prilocaine cream group was significantly lower than in the control group. Multivariate logistic regression analysis showed that lidocaine-prilocaine cream applications reduced moderate or severe CRBD. Thirty minutes postoperation was the most frequent time point for the incidence of CRBD. Application of lidocaine-prilocaine cream on the surface of the urinary catheter is an efficient and safe method to reduce the incidence and severity of CRBD.

  2. 儿童中心静脉置管相关性血流感染病原菌分布及耐药性分析%Analysis of the distribution and drug resistance of pathogenic bacteria of children′s PICC related bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    李智英; 罗学群; 余慕雪

    2014-01-01

    OBJECTIVE To analyze the distribution and drug resistance of pathogenic bacteria in peripherally insert‐ed central catheter (PICC) related bloodstream infection on children ,and to provide the foundation for the clinical prevention and treatment .METHODS The clinical data of 72 children with PICC related bloodstream infection were chosen in our hospital from Jan .2009 to Jan .2014 ,the distribution and drug resistance of pathogenic bacte‐ria were analyzed .SPSS13 .0 was adopted for a statistic analysis .RESULTS Totally 98 strains of pathogenic bacte‐ria were isolated and identified ,including 48 strains of gram‐positive bacteria (48 .98% ) ,37 strains of gram‐nega‐tive bacteria (37 .75% ) and 13 strains of fungi (13 .27% ) .The main gram‐positive bacteria were with high resist‐ance to penicillin ,erythromycin and ampicillin G ,and the resistance rate was 61 .11% ~100 .00% .The gram‐neg‐ative bacteria were with high resistance to ceftazidime ,cefepime ,cefuroxime and ampicillint ,and the resistance rate was 58 .30% ~88 .89% .Fungi were sensitive to itraconazole ,amphotericin B ,fluconazole and flucytosine , and the resistance rate was less than 20 .00% ;The children with the PICC indwelling time less than 7 days accaunted for 6 .9% ,while the children with the indwelling time more than 21days accounted for 50 .00% ;with the increase of the indwelling time ,the proportion of the chlidren with blooclstream infections was increased . CONCLUSION To strengthen the monitoring of pathogenic bacteria in PICC related bloodstream infections can help us better understand the dynamic changes of pathogenic bacteria in bloodstream infection .It′s benefit for guiding the clinical rational use of antimicrobial drugs and improving the clinical effect to master the drug resistance of pathogenic bacteria .%目的:分析儿童中心静脉置管(PICC )相关性血流感染的感染病原菌分布及其耐药性,为临床防治奠

  3. A single-center experience of 2153 tunneled-cuffed catheter insertions radiologically placed via the internal jugular vein: An evaluation of technical success and complication rates relative to underlying disease conditions

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan; Yim, Nm Yeol; Kim, Yong Tae; Noh, Hoon; Ki, So Yeon; Kim Jae Kyu; Kim, Hyoung Ook; Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2015-01-15

    To evaluate the technical success and complication rates of tunneled-cuffed catheter insertions radiologically placed via the internal jugular vein in patients with different types of underlying diseases. A total of 2153 tunneled-cuffed catheter insertions performed in 1926 patients between January 2008 and December 2012 were retrospectively reviewed. All procedures were conducted using sonography and fluoroscopy. The number of catheter maintenance days, technical success rates, and complication rates were analyzed based on radiologic and medical records. A total of 204809 catheter maintenance days (mean, 95.35 days; range, 0-1710 days) were recorded. Technical success was achieved in 2148 insertions (99.77%). A total of 185 complications (8.61%, 0.903/1000 catheter days) were observed, including 22 procedure-related complications (1.02%). A total of 143 catheters (6.66%) were removed due to complications. Significant differences in complication rates were observed between patients with or without underlying hematologic diseases (11.65% vs. 7.02%, respectively; p = 0.000). Significant differences in catheter thrombosis were observed between patients in which right-sided or left-sided venous approaches were used (0.81% vs. 2.70%, respectively; p = 0.010). The very high technical success rates and very low procedure-related complication rates indicate insertion of a tunneled-cuffed catheter radiologically placed via the internal jugular vein is safe and effective.

  4. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections.

    LENUS (Irish Health Repository)

    de Kraker, Marlieke E A

    2011-04-01

    Antimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistant Staphylococcus aureus (MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June 2008, a multicenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptible S. aureus (MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8; P = 0.04), but not for hospital mortality (HR = 1.1; P = 0.63) or LOS (difference = 0.6 days; P = 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus.

  5. Identification, genotypic relation, and clinical features of colistin-resistant isolates of Acinetobacter genomic species 13BJ/14TU from bloodstreams of patients in a university hospital.

    Science.gov (United States)

    Lee, Seung Yeob; Shin, Jong Hee; Park, Kyung Hwa; Kim, Ju Hee; Shin, Myung Geun; Suh, Soon Pal; Ryang, Dong Wook; Kim, Soo Hyun

    2014-03-01

    Colistin resistance remains rare among clinical isolates of Acinetobacter species. We noted the emergence of colistin-resistant bloodstream isolates of the Acinetobacter genomic species (GS) 13BJ/14TU from patients at a university hospital between 2003 and 2011. We report here, for the first time, the microbiological and molecular characteristics of these isolates, with clinical features of Acinetobacter GS 13BJ/14TU bacteremia. All 11 available patient isolates were correctly identified as Acinetobacter GS 13BJ/14TU using partial rpoB gene sequencing but were misidentified using the phenotypic methods Vitek 2 (mostly as Acinetobacter baumannii), MicroScan (mostly as A. baumannii/Acinetobacter haemolyticus), and the API 20 NE system (all as A. haemolyticus). Most isolates were susceptible to commonly used antibiotics, including carbapenems, but all were resistant to colistin, for which it is unknown whether the resistance is acquired or intrinsic. However, the fact that none of the patients had a history of colistin therapy strongly suggests that Acinetobacter GS 13BJ/14TU is innately resistant to colistin. The phylogenetic tree of multilocus sequence typing (MLST) showed that all 11 isolates formed a separate cluster from other Acinetobacter species and yielded five sequence types. However, pulsed-field gel electrophoresis (PFGE) revealed 11 distinct patterns, suggesting that the bacteremia had occurred sporadically. Four patients showed persistent bacteremia (6 to 17 days), and all 11 patients had excellent outcomes with cleared bacteremia, suggesting that patients with Acinetobacter GS 13BJ/14TU-associated bacteremia show a favorable outcome. These results emphasize the importance of precise species identification, especially regarding colistin resistance in Acinetobacter species. In addition, MLST offers another approach to the identification of Acinetobacter GS 13BJ/14TU, whereas PFGE is useful for genotyping for this species.

  6. Iatrogenic catheter-related cardiac tamponade: a case report of fatal hydropericardium following subcutaneous implantation of a chemotherapeutic injection port.

    Science.gov (United States)

    Shields, Lisa B E; Hunsaker, Donna M; Hunsaker, John C

    2003-03-01

    The need to obtain dependable access to the vascular system constitutes a significant component in the treatment and management of critically ill patients. Intravenous chemotherapy administered to cancer patients over an extended period of time often results in loss of peripheral vascular access due to vein sclerosis, "exhaustion" or tissue necrosis. Medical investigators have designed and steadily upgraded a variety of devices constructed to improve venous access for long-term utilization. As with the introduction of any foreign object into the body, each of these devices has complications which may be life threatening and occasionally fatal. We present an unusual case of iatrogenic acute hydropericardium and cardiac tamponade caused by the percutaneous infusion of chemotherapeutic fluid via a right subclavian central venous implant system (Port-a-Cath). Failure to implant and monitor the device with a radiograph following placement according to manufacturer's guidelines and accepted standards of medical practice were causally related to an unusual complication, namely, perforation of the right cardiac ventricle by the catheter tip, resulting in sudden and unexpected cardiac death.

  7. Complications of total implantable access ports and efficacy of Taurolidine-citrate lock solution against catheter-related infections

    Directory of Open Access Journals (Sweden)

    Emine Ince

    2014-01-01

    Full Text Available Background: Totally, implantable access ports (TIAPs are used for long standing venous catheterization. This study was designed to present our experiences of the TIAPs applications and efficacy of Taurolidine-citrate lock solution (TCLS against catheter-related infections. Materials and Methods: We evaluated records of the 108 patients implanted with 112 TIAPs, which had been performed using heparin solution or TCLS between 2005 and 2013. Results: Duration of exposure to TIAPs was 17-2051 days (median: 411 days. The primary diagnoses were solid tumours (n = 57, lymphoma (n = 23, haematologic diseases (n = 23, nephrotic syndrome (n = 4, Hirschsprung disease (n = 1. The right external jugular vein was most frequently used vascular access route (72.3%. Mechanical complications were observed in four cases. TIAPs were removed due to remission in 19 cases and infection in 19 cases. Median time from implantation and to the development of infection was 60 days. Heparin solution had been used for care in 33 ports, whereas heparin and TCLS had been used in 79 ports. Based on statistical comparison, use of TCLS was considered to be an important factor for preventing infection (P = 0.03. Conclusion: We consider that TCLS reduces infection prevalence so TIAPs would be used more extensively and effectively to prevent infections.

  8. Bacteremic complications of intravascular catheter tip colonization with Gram-negative micro-organisms in patients without preceding bacteremia.

    Science.gov (United States)

    van Eck van der Sluijs, A; Oosterheert, J J; Ekkelenkamp, M B; Hoepelman, I M; Peters, Edgar J G

    2012-06-01

    Although Gram-negative micro-organisms are frequently associated with catheter-related bloodstream infections, the prognostic value and clinical implication of a positive catheter tip culture with Gram-negative micro-organisms without preceding bacteremia remains unclear. We determined the outcomes of patients with intravascular catheters colonized with these micro-organisms, without preceding positive blood cultures, and identified risk factors for the development of subsequent Gram-negative bacteremia. All patients with positive intravascular catheter tip cultures with Gram-negative micro-organisms at the University Medical Center, Utrecht, The Netherlands, between 2005 and 2009, were retrospectively studied. Patients with Gram-negative bacteremia within 48 h before catheter removal were excluded. The main outcome measure was bacteremia with Gram-negative micro-organisms. Other endpoints were length of the hospital stay, in-hospital mortality, secondary complications of Gram-negative bacteremia, and duration of intensive care admission. A total of 280 catheters from 248 patients were colonized with Gram-negative micro-organisms. Sixty-seven cases were excluded because of preceding positive blood cultures, leaving 213 catheter tips from 181 patients for analysis. In 40 (19%) cases, subsequent Gram-negative bacteremia developed. In multivariate analysis, arterial catheters were independently associated with subsequent Gram-negative bacteremia (odds ratio [OR] = 5.00, 95% confidence interval [CI]: 1.20-20.92), as was selective decontamination of the digestive tract (SDD) (OR = 2.47, 95% CI: 1.07-5.69). Gram-negative bacteremia in patients who received SDD was predominantly caused by cefotaxime (part of the SDD)-resistant organisms. Mortality was significantly higher in the group with subsequent Gram-negative bacteremia (35% versus 20%, OR = 2.12, 95% CI: 1.00-4.49). Patients with a catheter tip colonized with Gram-negative micro-organisms had a high chance of

  9. Retained Urethral Catheter Secondary to Placement in Proximal Ureter

    Directory of Open Access Journals (Sweden)

    Thomas B. McGregor

    2016-01-01

    Full Text Available We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter.

  10. Retained Urethral Catheter Secondary to Placement in Proximal Ureter.

    Science.gov (United States)

    McGregor, Thomas B; Sharda, Rajan

    2016-01-01

    We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter.

  11. A Survey of Invasive Catheter Practices in US Burn Centers

    Science.gov (United States)

    2012-12-01

    central venous cannulation in children: lessons learned from a 10-year experience placing more than 1000 catheters . J Burn Care Res 2006;27:713–18. ...741 Central venous catheters (CVCs) and arterial catheters (ACs) provide essential access for critically injured patients. Practices surrounding...consisted of 23 questions related to spe- cific practices in placement and maintenance of central venous catheters (CVCs), arte- rial catheters ,

  12. The catheter hub disinfection cap as esophageal foreign body.

    Science.gov (United States)

    Tawfik, Kareem O; Myer, Charles M; Shikary, Tasneem; Goldschneider, Kenneth R

    2015-12-01

    Disinfection caps are increasingly being used to prevent catheter-associated bloodstream infections. These devices, designed for continuous passive disinfection of catheter hubs, are typically small and often brightly colored. As such, they have the potential to become pediatric airway and esophageal foreign bodies. We report two patients who developed esophageal foreign body following ingestion of disinfection caps. Given the increasing use of these devices, it is imperative that health care providers be aware of this potential iatrogenic problem. We propose that the use of disinfection caps may not be appropriate in pediatric patients with risk factors for foreign body ingestion.

  13. Downhill Esophageal Varices Associated With Central Venous Catheter-Related Thrombosis Managed With Endoscopic and Surgical Therapy

    Science.gov (United States)

    Berkowitz, Joshua C.; Bhusal, Sushma; Desai, Deepak; Cerulli, Maurice A.

    2016-01-01

    Downhill esophageal varices are a rare cause of upper gastrointestinal hemorrhage. We present a case of downhill variceal bleeding due to superior vena cava thrombosis resulting from a prior central venous catheter. The patient was managed with endoscopic band ligation and later with surgical axillary vein to right atrium bypass grafting. Successful long-term resolution of varices was achieved at 1 year of follow-up. This is the longest follow-up described for combined endoscopic and surgical management in the existing literature for catheter-associated downhill varices. PMID:27807564

  14. Analysis the related infections central venous catheter in emergency observation ward and its nursing experience%急诊观察病房中心静脉导管相关性感染分析及护理体会

    Institute of Scientific and Technical Information of China (English)

    陈英; 翟飞飞; 陆萍

    2011-01-01

    Objective:To understand the emergency ward , observe with central venous catheter related infections and related experience in nursing. Methods : A retrospective survey of 448 patients were analyzed , cultivating catheter with indwelling catheter related infections , lien venous catheter time , type , etiology . Results :448 cases , positive catheter in 36 cases , isolated strains of pathogenic 39 , gram - positive ( 18 ) . Gram - negative 16 cases , plants ,5 strains.26 cases occurred catheter local engraftment , puncture infection7 cases , bacteremia 3 cases. Conclusion : The emergency ward , observe patients with central venous catheter infections catheter related to colonize bacteria. The correct choice catheter lien vein and catheter type. Strengthen catheter operation and nursing, as shorten time. The indwelling catheter strengthen nutrition, enhance immunity can reduce catheter infections.%目的:分析急诊观察病房病人中心静脉导管相关感染因素及护理体会.方法:回顾性调查448例中心静脉置管病人导管相关性感染与导管留置静脉、导管留置时间、导管类型、病原学的关系.结果:448例病人中,导管培养阳性36例,分离出病原菌39株,其中革兰氏阳性菌18株,革兰氏阴性菌16株,真菌5株;发生导管局部定植26例,穿刺部位感染7例,菌血症3例.结论:急诊观察病房病人中心静脉导管感染与导管细菌定植等因素有关.正确选择导管留置静脉和导管类型;加强置管操作与护理;尽可能缩短导管留置时间;加强病人营养,提高免疫力,可降低导管感染率.

  15. Roseomonas mucosa Isolated from Bloodstream of Pediatric Patient ▿

    OpenAIRE

    Bard, J. Dien; Deville, J. G.; Summanen, P. H.; Lewinski, M. A.

    2010-01-01

    We report a case of catheter-related bacteremia associated with Roseomonas mucosa isolated from an immunocompromised pediatric patient with a history of multiple episodes of urinary tract infection and bacteremia.

  16. Roseomonas mucosa isolated from bloodstream of pediatric patient.

    Science.gov (United States)

    Bard, J Dien; Deville, J G; Summanen, P H; Lewinski, M A

    2010-08-01

    We report a case of catheter-related bacteremia associated with Roseomonas mucosa isolated from an immunocompromised pediatric patient with a history of multiple episodes of urinary tract infection and bacteremia.

  17. Multi-sequence magnetic resonance imaging integration framework for image-guided catheter ablation of scar-related ventricular tachycardia

    Science.gov (United States)

    Tao, Qian; Milles, Julien; van Huls van Taxis, Carine; Reiber, Johan H. C.; Zeppenfeld, Katja; van der Geest, Rob J.

    2012-02-01

    Catheter ablation is an important option to treat ventricular tachycardias (VT). Scar-related VT is among the most difficult to treat, because myocardial scar, which is the underlying arrhythmogenic substrate, is patient-specific and often highly complex. The scar image from preprocedural late gadolinium enhancement magnetic resonance imaging (LGE- MRI) can provide high-resolution substrate information and, if integrated at the early stage of the procedure, can largely facilitate the procedure with image guidance. In clinical practice, however, early MRI integration is difficult because available integration tools rely on matching the MRI surface mesh and electroanatomical mapping (EAM) points, which is only possible after extensive EAM has been performed. In this paper, we propose to use a priori information on patient posture and a multi-sequence MRI integration framework to achieve accurate MRI integration that can be accomplished at an early stage of the procedure. From the MRI sequences, the left ventricular (LV) geometry, myocardial scar characteristics, and an anatomical landmark indicating the origin of the left main coronary artery are obtained preprocedurally using image processing techniques. Thereby the integration can be realized at the beginning of the procedure after acquiring a single mapping point. The integration method has been evaluated postprocedurally in terms of LV shape match and actual scar match. Compared to the iterative closest point (ICP) method that uses high-intensity mapping (225+/-49 points), our method using one mapping point reached a mean point-to-surface distance of 5.09+/-1.09 mm (vs. 3.85+/-0.60 mm, p<0.05), and scar correlation of -0.51+/-0.14 (vs. -0.50+/-0.14, p=NS).

  18. Implementation of a novel in vitro model of infection of reconstituted human epithelium for expression of virulence genes in methicillin-resistant Staphylococcus aureus strains isolated from catheter-related infections in Mexico

    OpenAIRE

    Paniagua-Contreras, Gloria Luz; Monroy-Pérez, Eric; Vaca-Paniagua, Felipe; RODRÍGUEZ-MOCTEZUMA,JOSÉ RAYMUNDO; Negrete-Abascal, Erasmo; Vaca, Sergio

    2014-01-01

    Background Methicillin-resistant Staphylococcus aureus (MRSA) are clinically relevant pathogens that cause severe catheter-related nosocomial infections driven by several virulence factors. Methods We implemented a novel model of infection in vitro of reconstituted human epithelium (RHE) to analyze the expression patterns of virulence genes in 21 MRSA strains isolated from catheter-related infections in Mexican patients undergoing haemodialysis. We also determined the phenotypic and genotypic...

  19. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications).

    Science.gov (United States)

    Pittiruti, Mauro; Hamilton, Helen; Biffi, Roberto; MacFie, John; Pertkiewicz, Marek

    2009-08-01

    When planning parenteral nutrition (PN), the proper choice, insertion, and nursing of the venous access are of paramount importance. In hospitalized patients, PN can be delivered through short-term, non-tunneled central venous catheters, through peripherally inserted central catheters (PICC), or - for limited period of time and with limitation in the osmolarity and composition of the solution - through peripheral venous access devices (short cannulas and midline catheters). Home PN usually requires PICCs or - if planned for an extended or unlimited time - long-term venous access devices (tunneled catheters and totally implantable ports). The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure. Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary. Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion

  20. Response of high-sensitive C-reactive protein to catheter ablation of atrial fibrillation and its relation with rhythm outcome.

    Directory of Open Access Journals (Sweden)

    Jelena Kornej

    Full Text Available AIMS: This study investigated the possible association between hs-CRP as well as hs-CRP changes and rhythm outcome after AF catheter ablation. METHODS: We studied 68 consecutive patients with AF undergoing catheter ablation. hs-CRP levels were measured using commercially available assays before and 6 months after catheter ablation. Serial 7-day Holter ECGs were used to detect AF recurrences. RESULTS: Early AF recurrence (ERAF, within one week was observed in 38%, while late AF recurrence (LRAF, between 3 and 6 months occurred in 18% of the patients. None of the baseline clinical or echocardiographic variables was predictive of ERAF or LRAF. Baseline hs-CRP measured 2.07 ± 1.1 µg/ml and was not associated with ERAF and LRAF. At 6 months, hs-CRP levels were comparable with baseline values (2.14±1.19 µg/ml, p = 0.409 and were also not related with LRAF. However, patients with LRAF showed an hs-CRP increase from 2.03 ± 0.61 to 2.62 ± 1.52 µg/ml (p = 0.028. Patients with an hs-CRP change in the upper tertile (>0.2 µg/ml had LRAF in 32% as opposed to 11% (p = 0.042 in patients in the lower (<-0.3 µg/ml or intermediate (-0.3-0.2 µg/ml tertile. CONCLUSIONS: Changes in hs-CRP but not baseline hs-CRP are associated with rhythm outcome after AF catheter ablation. This finding points to a link between an inflammatory response and AF recurrence in this setting.

  1. Catheter-related UTI

    Science.gov (United States)

    ... fluids that irritate your bladder, such as alcohol, citrus juices, and drinks that contain caffeine. After you ... Dolin R, eds. Principles and Practice of Infectious Diseases . 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009: ...

  2. Risk factors associated with central venous catheter related infection%中心静脉置管相关感染影响因素分析

    Institute of Scientific and Technical Information of China (English)

    张玥琪; 李敏; 葛圣金; 薛张纲

    2012-01-01

    Objective To study the risk factors associated with central venous catheter related infectioa Methods Fifty patients receiving central venous catheterization in the general surgical wards, surgical intensive care unit and hospital observation room from May to October, 2009 were studied. The factors including demographic data, distribution of medical resources, programs and the procedures of treatment, details about central venous catheter insertion were recorded and analyzed using logistic regression analysis. Results Fifty patients received totally 61 catheter insertion. There was no catheter related infection observed in the general surgical wards or the surgical intensive care unit, while 6 cases in the hospital observation room were diagnosed Logistic regression analysis outcome showed the different environments (OR = 2. 678, 95%CI 1.154-6.235), period of the preservation of the catheter(OR=1. 372, 95%CI 1. 326-5. 735) and the existence of other infection (OR= 2.712, 95% Cl 1.181-6.174) were predicting factor of catheter related infection. Conclusion Favourable environment and professional medical treatment team could effectively prevent central venous catheter related infection%目的 分析中心静脉置管相关感染的影响因素.方法 2009年5~10月普通外科病房、外科重症监护室和留院观察室接受中心静脉导管穿刺置管的患者.调查患者一般情况、诊疗方案及诊治过程、中心静脉穿刺置管相关情况,行多因素Logistic回归分析.结果 50例患者中心静脉穿刺置管61例次.普通外科病房和外科重症监护室未观察到导管相关感染的发生,留院观察室有6例次发生导管相关血流感染.不同科室(OR=2.678,95%CI 1.154~6.235)、导管留置时间(OR=1.372,95%CI 1.326~5.735)、是否存在他处感染(OR=2.712,95%CI 1.181~6.174)是中心静脉相关感染发生的独立影响因素.结论 良好的环境、专业性强的医疗团队对于预防与控制中心

  3. Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections

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    Al-Hazmi H

    2015-03-01

    : three patients had UTI out of 37 catheterized patients (8% at 10 days LOS, while 42 patients had UTI out of 49 catheterized patients (85.7% at 18 days LOS. The longer the LOS, the higher the UTI rate: LOS for each patient (median 18 days for infected patients versus 10 days for noninfected patients; P-value <0.05, and number of hospital-acquired catheter-related UTI (100 patients had UTI out of 250 catheterized patients, P=0.04.Conclusion: Reduction of the duration of catheterization and LOS of the patient have a positive impact in reduction of catheter-related UTI.Keywords: urinary catheters, catheter duration, adult

  4. Role of Echinocandins in Fungal Biofilm-Related Disease: Vascular Catheter-Related Infections, Immunomodulation, and Mucosal Surfaces.

    Science.gov (United States)

    Katragkou, Aspasia; Roilides, Emmanuel; Walsh, Thomas J

    2015-12-01

    Biofilm-related infections have become an increasingly important clinical problem. Many of these infections occur in patients with multiple comorbidities or with impaired immunity. Echinocandins (caspofungin, micafungin, and anidulafungin) exert their fungicidal activity by inhibition of the synthesis of the (1→3)-β-d-glucan. They are active among in vitro and in vivo model systems against a number of Candida species and filamentous fungi in their planktonic and biofilm phenotype. Their superior activity against biofilms poses them in an advantageous position among the antifungal armamentarium. However, additional studies are warranted to expand our knowledge on the role of echinocandins against biofilm-related infections.

  5. Infections associated with the central venous catheters.

    Science.gov (United States)

    Drasković, Biljana; Fabri, Izabella; Benka, Anna Uram; Rakić, Goran

    2014-01-01

    Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

  6. Efficacy of nursing interventions in prevention of central venous catheter-related infections%护理干预预防中心静脉导管相关性感染的效果评价

    Institute of Scientific and Technical Information of China (English)

    潘春芳; 窭英茹; 郑瑞强; 史甜

    2012-01-01

    目的 分析护理干预在预防ICU中心静脉导管相关性感染中的应用效果.方法 采用目标性监测方法,进行护理干预,包括:严格无菌技术、缩短导管留置时间、选择合适置管部位及导管、敷料的选择与更换、导管接头与输入装置的护理和防止血栓形成,对实施护理干预前后ICU中心静脉导管相关性感染的发生率进行统计分析.结果 实施护理干预措施之后,总置管天数明显增加(P<0.05),中心静脉导管相关性感染率从2008年的7.67/千导管日、2009年的5.69/千导管日,下降至2010年的2.28/千导管日(P<0.05).结论 护理干预能够有效降低ICU中心静脉导管相关性感染的发生率.%OBJECTIVE To analyze the effect of nursing interventions in prevention of central venous catheter-related infections in ICU. METHODS Different means of targeted surveillance and nursing interventions were carried out, including implementing strict aseptic techniques, shortening the time of catheter indwelling, selecting the appropriate site and catheter, choosing and replacing dressing, nursing of the catheter connector and input device, and preventing thrombopoiesis. The incidence of central venous catheter-related infections in ICU before and after implementing the nursing interventions was statistical analyzed. RESULTS The total indwelling catheter-days were significantly increased after the implementation of nursing interventions(P<0. 05). the incidence of central venous catheter-related infections decreased to 2. 28/thousand catheter-days in 2010, which was 7. 67/ thousand catheter-days in 2008 and 5. 69/thousand catheter-days in 2009 (P<0. 05). CONCLUSION Implementation of the nursing interventions significantly reduces the incidence rate of central venous catheter-related infections.

  7. Molecular Comparison of Bacterial Communities on Peripheral Intravenous Catheters and Matched Skin Swabs.

    Directory of Open Access Journals (Sweden)

    Md Abu Choudhury

    Full Text Available Skin bacteria at peripheral intravenous catheter (PIVC insertion sites pose a serious risk of microbial migration and subsequent colonisation of PIVCs, and the development of catheter related bloodstream infections (CRBSIs. Common skin bacteria are often associated with CRBSIs, therefore the bacterial communities at PIVC skin sites are likely to have major implications for PIVC colonisation. This study aimed to determine the bacterial community structures on skin at PIVC insertion sites and to compare the diversity with associated PIVCs. A total of 10 PIVC skin site swabs and matching PIVC tips were collected by a research nurse from 10 hospitalised medical/surgical patients at catheter removal. All swabs and PIVCs underwent traditional culture and high-throughput sequencing. The bacterial communities on PIVC skin swabs and matching PIVCs were diverse and significantly associated (correlation coefficient = 0.7, p<0.001. Methylobacterium spp. was the dominant genus in all PIVC tip samples, but not so for skin swabs. Sixty-one percent of all reads from the PIVC tips and 36% of all reads from the skin swabs belonged to this genus. Staphylococcus spp., (26%, Pseudomonas spp., (10% and Acinetobacter spp. (10% were detected from skin swabs but not from PIVC tips. Most skin associated bacteria commonly associated with CRBSIs were observed on skin sites, but not on PIVCs. Diverse bacterial communities were observed at skin sites despite skin decolonization at PIVC insertion. The positive association of skin and PIVC tip communities provides further evidence that skin is a major source of PIVC colonisation via bacterial migration but microbes present may be different to those traditionally identified via culture methods. The results provide new insights into the colonisation of catheters and potential pathogenesis of bacteria associated with CRBSI, and may assist in developing new strategies designed to reduce the risk of CRBSI.

  8. Molecular Comparison of Bacterial Communities on Peripheral Intravenous Catheters and Matched Skin Swabs.

    Science.gov (United States)

    Choudhury, Md Abu; Marsh, Nicole; Banu, Shahera; Paterson, David L; Rickard, Claire M; McMillan, David J

    2016-01-01

    Skin bacteria at peripheral intravenous catheter (PIVC) insertion sites pose a serious risk of microbial migration and subsequent colonisation of PIVCs, and the development of catheter related bloodstream infections (CRBSIs). Common skin bacteria are often associated with CRBSIs, therefore the bacterial communities at PIVC skin sites are likely to have major implications for PIVC colonisation. This study aimed to determine the bacterial community structures on skin at PIVC insertion sites and to compare the diversity with associated PIVCs. A total of 10 PIVC skin site swabs and matching PIVC tips were collected by a research nurse from 10 hospitalised medical/surgical patients at catheter removal. All swabs and PIVCs underwent traditional culture and high-throughput sequencing. The bacterial communities on PIVC skin swabs and matching PIVCs were diverse and significantly associated (correlation coefficient = 0.7, pskin swabs. Sixty-one percent of all reads from the PIVC tips and 36% of all reads from the skin swabs belonged to this genus. Staphylococcus spp., (26%), Pseudomonas spp., (10%) and Acinetobacter spp. (10%) were detected from skin swabs but not from PIVC tips. Most skin associated bacteria commonly associated with CRBSIs were observed on skin sites, but not on PIVCs. Diverse bacterial communities were observed at skin sites despite skin decolonization at PIVC insertion. The positive association of skin and PIVC tip communities provides further evidence that skin is a major source of PIVC colonisation via bacterial migration but microbes present may be different to those traditionally identified via culture methods. The results provide new insights into the colonisation of catheters and potential pathogenesis of bacteria associated with CRBSI, and may assist in developing new strategies designed to reduce the risk of CRBSI.

  9. Erroneous laboratory values obtained from central catheters.

    Science.gov (United States)

    Johnston, J B; Messina, M

    1991-01-01

    Serious analytic errors in potassium measurements have been identified in blood specimens obtained from newly inserted central catheters. Erroneous elevated readings have been related to interactions of chemistry analyzer electrodes and substances fixed to external and intraluminal walls of the central catheter. Anecdotal summaries of this phenomenon are presented to enable the nurse to recognize potential problems when sampling blood from central catheters. Studies were performed to determine the amount of flush necessary to clear the catheter of interfering residue. To eliminate this potentially hazardous occurrence, recommended flush volumes, nursing implications, and actions are described.

  10. 血液透析用中心静脉导管相关感染的研究%Study on Central Venous Catheter-related Infections in Hemodialysis Patients

    Institute of Scientific and Technical Information of China (English)

    张智敏; 钟汉声; 王昱景; 张志强

    2015-01-01

    目的:观察血液透析患者透析用中心静脉导管感染的相关致病菌及有效治疗。方法分别进行临时性颈内静脉置管390例次,与带cuff的中心静脉导管40例次,股静脉置管150例次,中心静脉导管留置期间共出现68例次导管感染。每例次导管感染均送实验室进行细菌培养。结果血液透析患者透析用中心静脉导管感染总感染率为11.7%,中心静脉导管感染主要致病菌分别是金黄色葡萄球菌、大肠埃希菌、鲍曼不动杆菌复合菌、表皮葡萄球菌。股静脉置管导管感染发生率高于颈内静脉置管。结论抗生素全身应用或封管局部应用及拔出中心静脉导管是中心静脉导管感染的有效治疗方法。%Objective To observe pathogens of central venous catheter-related infections in hemodialysis patients and to find an effective treatment. Methods We performed 390 cases ( cases/times) of temporary internal jugular vein catheterization, 40 cases of central venous catheter with cuffs and 150 cases of femoral vein catheterization respectively. There were 68 cases of catheter infection occurred in the central venous catheter indwelling period. Each case of catheter infection was sent to the labora-tory for bacterial culture. Results The total infection rate of central venous catheter in hemodialysis patients was 11. 7%. The predominant pathogens of central venous catheter-related infection were Staphylococcus aureus,Escherichia coli,Acinetobacter bau-mannii complex strains and Staphylococcus epidermidis respectively. The infection rate occurred in femoral vein catheter was higher than the internal jugular vein catheterization. Conclusion Systemic antibiotics or topical application for sealing central venous cathe-ters and pull out central venous catheters is effective in the treatment of central venous catheter-related infection.

  11. A prospective randomised trial comparing insertion success rate and incidence of catheterisation-related complications for subclavian venous catheterisation using a thin-walled introducer needle or a catheter-over-needle technique.

    Science.gov (United States)

    Kim, E; Kim, B G; Lim, Y J; Jeon, Y T; Hwang, J W; Kim, H C; Choi, Y H; Park, H P

    2016-09-01

    In clinical practice, both a thin-walled introducer needle and catheter-over-needle technique can be used to allow insertion of a guidewire during central venous catheterisation using the Seldinger technique. We compared the incidence of catheterisation-related complications (arterial puncture, haemothorax, pneumothorax, haematoma and catheter tip malposition) and insertion success rate for these two techniques in patients requiring right-sided subclavian central venous catheterisation. A total of 414 patients requiring infraclavicular subclavian venous catheterisation were randomly allocated to either a thin-walled introducer needle (needle group, n = 208) or catheter-over-needle technique (catheter group, n = 206). The catheterisation-related complication rate was lower in the needle group compared with the catheter group (5.8% vs. 15.5%; p = 0.001). Overall insertion success rates were similar (97.1% and 92.7% in the needle and catheter groups respectively; p = 0.046), although the first-pass success rate was higher in the needle group (62.0% vs. 35.4%; p technique for right-sided infraclavicular subclavian venous catheterisation.

  12. Postoperative coagulopathy after live related donor hepatectomy: Incidence, predictors and implications for safety of thoracic epidural catheter

    Directory of Open Access Journals (Sweden)

    S T Karna

    2015-01-01

    Full Text Available Background: Coagulopathy after living donor hepatectomy (LDH may endanger donor safety during removal of thoracic epidural catheter (TEC. The present study was conducted to evaluate the extent and duration of immediate postoperative coagulopathy after LDH. Materials and Methods: A retrospective analysis of perioperative record of LDH over three years was conducted after IRB approval. Variables such as age, gender, BMI, ASA classification, liver volume on CT scan, preoperative and postoperative INR, platelet count (PC and ALT of each donor for five days was noted. In addition, duration of surgery, remnant as percentage total liver volume (Remnant%, blood loss, day of peak in PC and INR were also noted. Coagulopathy was defined as being present if INR exceeded 1.5 or platelet count fell below 1 × 10 5 /mm 3 on any day. Data was analyzed using SPSS 20 for Windows. Between group comparison was made using the Student ′t′ test for continuous variables and chi square test for categorical variables. Univariate analysis was done. Multiple logistic regression analysis was used to find independent factor associated with coagulopathy. Results: Eighty four (84 donors had coagulopathy on second day (mean INR 1.9 ± 0.42. Low BMI, % of remnant liver and duration of surgery were independent predictors of coagulopathy. Right lobe hepatectomy had more coagulopathy than left lobe and low BMI was the only independent predictor. There was no correlation of coagulopathy with age, gender, blood loss, presence of epidural catheter, postoperative ALT or duration of hospital stay. High INR was the main contributor for coagulopathy. Conclusions: Coagulopathy is seen after donor hepatectomy. We recommend removal of the epidural catheter after the fifth postoperative day when INR falls below 1.5.

  13. Central venous catheter - flushing

    Science.gov (United States)

    ... during cancer treatment Bone marrow transplant - discharge Central venous catheter - dressing change Peripherally inserted central catheter - flushing Sterile technique Surgical wound care - open Review Date 9/22/2016 Updated by: ...

  14. Elimination of central line-associated bloodstream infections: application of the evidence.

    Science.gov (United States)

    Posa, Patricia J; Harrison, Denise; Vollman, Kathleen M

    2006-01-01

    Central line-associated bloodstream infections are considered to be an avoidable complication of care delivery. In addition to considerable morbidity and use of resources, central line-associated bloodstream infections carry an attributable morality between 12% and 25%. The estimated cost per infection is approximately 25,000 US dollars. Research over the last decade has focused on a number of care activities that have been shown to reduce the incidence of bloodstream infections related to central line placement in the critically ill patient. A significant reduction or elimination of central line-associated bloodstream infections can occur with implementation of a comprehensive central line-associated bloodstream infection prevention program that includes staff education, hand hygiene, use of maximal sterile barrier precautions, chlorhexidine gluconate skin antisepsis, avoidance of femoral lines, empowerment of staff to stop the procedure if sterile technique is broken, and daily assessment of the continued need for a central line. This article focuses on strategies for implementing a comprehensive central line-associated bloodstream infections prevention program and a tool and process for defect analysis as part of a statewide collaborative in Michigan.

  15. Long-term catheterization: current approaches in the diagnosis and treatment of port-related infections

    Directory of Open Access Journals (Sweden)

    Bustos C

    2014-02-01

    Full Text Available Cesar Bustos,1 Aitziber Aguinaga,1 Francisco Carmona-Torre,2 Jose Luis Del Pozo1,3 1Department of Clinical Microbiology, 2Department of Internal Medicine, 3Division of Infectious Diseases, Clinica Universidad de Navarra, Pamplona, Spain Abstract: Since the first description in 1982, totally implanted venous access ports have progressively improved patients' quality of life and medical assistance when a medical condition requires the use of long-term venous access. Currently, they are part of the standard medical care for oncohematologic patients. However, apart from mechanical and thrombotic complications, there are also complications associated with biofilm development inside the catheters. These biofilms increase the cost of medical assistance and extend hospitalization. The most frequently involved micro-organisms in these infections are gram-positive cocci. Many efforts have been made to understand biofilm formation within the lumen catheters, and to resolve catheter-related infection once it has been established. Apart from systemic antibiotic treatment, the use of local catheter treatment (ie, antibiotic lock technique is widely employed. Many different antimicrobial options have been tested, with different outcomes, in clinical and in in vitro assays. The stability of antibiotic concentration in the lock solution once instilled inside the catheter lumen remains unresolved. To prevent infection, it is mandatory to perform hand hygiene before catheter insertion and manipulation, and to disinfect catheter hubs, connectors, and injection ports before accessing the catheter. At present, there are still unresolved questions regarding the best antimicrobial agent for catheter-related bloodstream infection treatment and the duration of concentration stability of the antibiotic solution within the lumen of the port. Keywords: catheter-related infection, bacteremia, biofilm

  16. Application of interventional techniques on central venous catheter related diseases in hemodialysis patients%介入技术在血液透析患者中心静脉导管相关问题中的应用

    Institute of Scientific and Technical Information of China (English)

    杨涛; 侯西彬; 詹申; 王新玲; 王玉柱

    2015-01-01

    目的总结介入技术在血液透析患者中心静脉导管相关性问题诊断及治疗中的应用。方法回顾性分析我院肾内科82例中心静脉导管相关性介入诊断、治疗患者的临床资料,包括导管置入、导管位置调整及单纯诊断性造影,总结导管纤维鞘的诊断和介入处理方法。结果本组中伴有糖尿病者33例(40.2%),既往平均置管次数(3.2±1.7)次;介入下置管共55例次,导管位置调整24例次。置管的患者中,造影提示38例患者存在中心静脉狭窄或闭塞;导管调整的患者均为颈内静脉置管,13例为左侧颈内静脉置管,导管调整的原因多为导管末端不能达到适当的位置;经造影诊断纤维鞘13例次。结论 X线介入下中心静脉导管相关操作可实时明确中心静脉情况,确保导管置入适当位置,并可对病变的中心静脉治疗后置入导管,也是导管纤维鞘的诊断和处理的有效方法之一。%Objective To summarize the interventional therapy on central venous catheter related diseases in hemodialysis patients. Methods We retrospectively analyzed the clinical data of 82 patients who had received interven-tional therapy for catheter related diseases. The data was consisted of catheter insertion under the X ray, adjustment to the catheter and angiography for the catheter related diagnostic procedures. We also summarized the interventional diagnosis and therapy for catheter related fibrin sheath formation. Results The incidence of diabetes mellitus was 40.2%. On an av-erage, previous cannulation times was 3.2±1.7. The number of cannulation and adjustment to the catheter under X ray was 55 and 24 respectively. In all cannulation patients, venography revealed that central venous stenosis or obstruction were found in 38 patients. In patients whose catheter position was adjusted, the sites of puncture were internal jugular vein in all. Puncture sites were left internal jugular

  17. PROPHYLACTIC ADMINISTRATION OF DOXYCYCLINE REDUCES CENTRAL VENOUS CATHETER INFECTIONS IN PATIENTS UNDERGOING HEMATOPOIETIC CELL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    Mohamed Kharfan-Dabaja

    2013-02-01

    Full Text Available Hematopoietic stem cells are usually transfused through a central venous catheter (CVC, which also facilitates administration of medications and intravenous fluids. We had observed high rate of catheter-related blood-stream infection (CR-BSI at our Bone Marrow Transplantation (BMT unit despite prescribing fluoroquinolones for anti-bacterial prophylaxis. Accordingly, we implemented prophylactic use of a relatively inexpensive broad spectrum antibiotic, namely doxycycline to address this problem. We wanted to investigate whether doxycycline prophylaxis reduces CR-BSI rate. Data was collected retrospectively on 54 consecutive patients, 26 of whom received doxycycline (doxycycline group, and we compared their outcomes to a previous cohort of 28 patients who did not receive doxycycline (comparison group. The groups were comparable in regards to age, gender, hematopoietic cell transplant type, and primary diagnosis. No CVC infection (0% was observed in the doxycycline group, while 5 infection episodes (18.5% occurred in 4 patients in the comparison group (p<0.001. Episodes of CR-BSI were due to: Escherichia-coli (EC=1, coagulase-negative Staphylococcus-spp (CNSS=2, both EC & CNSS=1. Our results demonstrate that CR-BSI was reduced significantly after introducing doxycycline. This finding suggests a beneficial role for systemic use of doxycycline prophylaxis to prevent CR-BSI in adult BMT patients. Nevertheless, a randomized controlled study is warranted to confirm these findings.

  18. Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review

    Directory of Open Access Journals (Sweden)

    Daniele Cristina Perin

    Full Text Available ABSTRACT Objective: to identify evidence-based care to prevent CLABSI among adult patients hospitalized in ICUs. Method: systematic review conducted in the following databases: PubMed, Scopus, Cinahl, Web of Science, Lilacs, Bdenf and Cochrane Studies addressing care and maintenance of central venous catheters, published from January 2011 to July 2014 were searched. The 34 studies identified were organized in an instrument and assessed by using the classification provided by the Joanna Briggs Institute. Results: the studies presented care bundles including elements such as hand hygiene and maximal barrier precautions; multidimensional programs and strategies such as impregnated catheters and bandages and the involvement of facilities in and commitment of staff to preventing infections. Conclusions: care bundles coupled with education and the commitment of both staff and institutions is a strategy that can contribute to decreased rates of central line-associated bloodstream infections among adult patients hospitalized in intensive care units.

  19. 头孢拉定加肝素钠封管预防患者中心静脉置管相关性感染的效果%Preventive effect of cefradine plus heparin sealing catheters on central venous catheter-related infections

    Institute of Scientific and Technical Information of China (English)

    任昌菊; 刘静; 夏昌华; 蹇正清

    2014-01-01

    目的:探讨头孢拉定加肝素钠封管预防患者中心静脉置管相关性感染的效果。方法将112例中心静脉置管患者随机分为对照组57例和干预组55例,对照组患者中心静脉置管期间给予肝素钠封管,干预组患者给予头孢拉定加肝素钠封管。比较两组患者中心静脉置管期间导管相关性感染情况。结果对照组患者中心静脉置管期间导管相关性感染率为12.28%,干预组为0.00%,两组比较,差异具有统计学意义(P<0.01)。结论中心静脉置管患者采用头孢拉定加肝素钠溶液封管,可有效降低患者导管相关性感染。%Objective To explore the preventive effect of Cefradine plus heparin sealing catheters on central center venous (CVC)catheter-related infections.Methods One hundred and twelve patients with central venous catheter were randomly divided into control group(n=57)and intervention group(n=55).In the control group,heparin sodium was used to seal the catheters and in the intervention group Cefradine plus heparin were used.The two groups were compared in terms of central venous catheter(CVC)-related infections.Results The CVC-related infection rates are 12.28%and 0%in the control and intervention groups respectively, with statistical difference between them(P<0.01).Conclusions Cefazodine and heparin used to seal the catheters in the treatment of patients with central venous catheter can effectively reduce incidence of catheter-related infections.

  20. 降钙素原与真菌血流感染的相关性研究%Research on relativity between procalcitonin and fungal bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    任丽娟; 郑文亮; 艾根伟

    2011-01-01

    目的 分析降钙素原(PCT)与真菌血流感染的相关性,研究不同真菌感染PCT的差异及PCT与疾病预后的关系.方法 回顾性分析2009年1月-2010年12月血液培养真菌感染的患者33例,结合其PCT的检测结果,与随机抽取的100例血液培养阴性患者作统计学分析,研究真菌血流感染与PCT的相关性,同时分析不同真菌感染时PCT结果的差异及感染预后与PCT的相关性.结果 33例血液真菌感染患者中,检出假丝酵母菌属感染18例,隐球酵母菌属感染7例,荚膜组织胞浆菌及球孢子菌感染各4例;PCT<0.5 ng/L者5例,PCT>2 ng/L者23例,100例血液培养阴性的患者中,PCT<0.5 ng/L者83例,PCT>2 ng/L者9例,按行×列表的x2检验,x2=17.79,查x2界值表,得P<0.05,认为血流真菌感染时,PCT的检测结果有统计学意义;采用单因素方差分析的统计学方法研究不同真菌感染时PCT的检测均数,计算F值=3.341,查F界值表,得P>0.05,表明不同真菌感染时,PCT的检测结果差异无统计学意义;采用t检验的方法研究有效控制和死亡患者PCT的检测均数,t=-2.989,查t界值表,得P<0.01,表明真菌血流感染患者的预后与PCT的检测结果明显相关.结论 重视PCT的检测结果,结合患者感染症状,及时有效的控制真菌感染非常必要.%OBJECTIVE To. Analyze the relativity between procalcitonin and blood fungus infection, study the difference of PCT of different fungus infection and the connections between PCT and the prognosis. METHODS A total of 33 cases of blood fungus infection patients were analyzed, according to PCT value, and statistically compared to 100 patients with negative blood culture. The relativity between blood fungus infection and PCT was studied and the difference of PCT when different fungus infect and the connection between PCT and the prognosis were analyzed at the same time. RESULTS There were 18 infections caused by Candida, 7 by cryptococcus, 4 by Histoplasma

  1. Hematologic patients' clinical and psychosocial experiences with implanted long-term central venous catheter

    DEFF Research Database (Denmark)

    Møller, Tom; Adamsen, Lis

    2010-01-01

    A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients.......A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients....

  2. Standardizing central venous catheter care by using observations from patients with cancer.

    Science.gov (United States)

    Weingart, Saul N; Hsieh, Candace; Lane, Sharon; Cleary, Angela M

    2014-06-01

    To understand the vulnerability of patients with cancer to central line-associated bloodstream infections related to tunneled central venous catheters (CVCs), patients were asked to describe their line care at home and in clinic and to characterize their knowledge and experience managing CVCs. Forty-five adult patients with cancer were recruited to participate. Patients were interviewed about the type of line, duration of use, and observations of variations in line care. They also were asked about differences between line care at home and in the clinic, precautions taken when bathing, and their education regarding line care. Demographic information and primary cancer diagnosis were taken from the patients' medical records. Patients with hematologic and gastrointestinal malignancies were heavily represented. The majority had tunneled catheters with subcutaneous implanted ports. Participants identified variations in practice among nurses who cared for them. Although many participants expressed confidence in their knowledge of line care, some were uncertain about what to do if the dressing became loose or wet, or how to recognize an infection. Patients seemed to be astute observers of their own care and offered insights into practice variation. Their observations show that CVC care practices should be standardized, and educational interventions should be created to address patients' knowledge deficits.

  3. The Changing Epidemiology of Bloodstream Infections and Resistance in Hematopoietic Stem Cell Transplantation Recipients

    Directory of Open Access Journals (Sweden)

    Mücahit Yemişen

    2016-08-01

    Full Text Available Objective: Patients receiving hematopoietic stem cell transplantation (HSCT are exposed to highly immunosuppressive conditions and bloodstream infections (BSIs are one of the most common major complications within this period. Our aim, in this study, was to evaluate the epidemiology of BSIs in these patients retrospectively. Materials and Methods: The epidemiological properties of 312 patients with HSCT were retrospectively evaluated. Results: A total of 312 patients, followed between 2000 and 2011, who underwent autologous (62% and allogeneic (38% HSCT were included in the study. The most common underlying malignancies were multiple myeloma (28% and Hodgkin lymphoma (21.5%. A total of 142 (45% patients developed at least 1 episode of BSI and 193 separate pathogens were isolated from the blood cultures. There was a trend of increase in the numbers of BSIs in 2005-2008 and a relative increase in the proportion of gram-positive infections in recent years (2009-2011, and central venous catheter-related BSI was found to be most common source. Coagulase-negative staphylococci (49.2% and Acinetobacter baumannii (8.8% were the most common pathogens. Extended-spectrum beta-lactamase-producing strains were 23% and 22% among Escherichia coli and Klebsiella spp. isolates, respectively. Quinolone resistance was detected in 10% of Enterobacteriaceae. Resistance to carbapenems was not detected in Enterobacteriaceae, while it was seen at 11.1% and 23.5% in Pseudomonas and Acinetobacter strains, respectively. Conclusion: A shift was detected from gram-negative bacteria to gram-positive in the etiology over the years and central lines were the most common sources of BSIs.

  4. Risk factors for central venous catheter-related infections in NICU%NICU患者中心静脉导管相关性感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    王法欣

    2013-01-01

    目的 控制神经重症监护病房(NICU)患者中心静脉导管相关性感染的危险因素.方法 收集自2007-2011年入住NICU并进行中心静脉导管置管的患者资料,按照是否发生中心静脉导管感染进行分组,使用logistic回归分析方法明确NICU患者发生中心静脉导管相关性感染的危险因素.结果 自2007-2011年NICU进行中心静脉置管778例次,发生中心静脉导管感染175例次,发生率为22.4%,发生中心静脉导管相关性感染的平均时间9.1d;送检导管中病原菌检出阳性率为40.2%,导管血送检病原菌检出率为42.5%;logistic回归分析结果显示,糖尿病史及置入三腔导管进入最终的回归模型,OR值分别为3.777、9.094和7.342.结论 NICU患者中心静脉导管相关性感染的发病率高,中重度昏迷、糖尿病史及置入三腔导管是发生中心导管相关性感染的危险因素,建议临床对该类患者进行重点防护.%OBJECTIVE To identify the risk factors of central venous catheter-related infections in neurosurgery intensive care unit (NICU). METHODS We recruited the patients with central venous catheter-related infections in NICU from 2007 to 2011. The patients were divided according to the status of the infections, the logistic regression analysis method was employed to define the risk factors for the central venous catheter-related infections. RESULTS Of 778 case-time of patients who underwent central venous catheterization during 2007 - 2011, the centralvenous catheter-related infections occurred in 175 case-times of patients with the incidence rate of 22. 4% , the median time to onset of central venous catheters related infections was 9. 1 days. The positive rate of the pathogens isolated from submitted catheters was 40. 2%, 42. 5% of the submitted catheter blood. Logistic regression analysis showed that three factors including the history of diabetes mellitus and use of three-cavity catheter entered the final regression

  5. Catheter Ablation

    Science.gov (United States)

    ... ablation. Visit Cardiac ablation procedures and Cardiac conduction system for more information about this topic. Related ... National Institutes of Health Department of Health and Human Services USA.gov

  6. Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections

    Science.gov (United States)

    Al-Hazmi, Hamdan

    2015-01-01

    the LOS, the higher the UTI rate: LOS for each patient (median 18 days for infected patients versus 10 days for noninfected patients; P-value <0.05), and number of hospital-acquired catheter-related UTI (100 patients had UTI out of 250 catheterized patients, P=0.04). Conclusion Reduction of the duration of catheterization and LOS of the patient have a positive impact in reduction of catheter-related UTI. PMID:25848551

  7. Early oral switch therapy in low-risk Staphylococcus aureus bloodstream infection (SABATO) : Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Kaasch, Achim J.; Fätkenheuer, Gerd; Prinz-Langenohl, Reinhild; Paulus, Ursula; Hellmich, Martin; Weiß, Verena; Jung, Norma; Rieg, Siegbert; Kern, Winfried V.; Seifert, Harald; Lewalter, Karl; Lemmen, Sebastian; Stijnis, Cornelis; Van der Meer, Jan; Soriano, Alex; Ruiz, Laura Morata; Arastéh, Keikawus; Stocker, Hartmut; Kluytmans, Jan; Veenemans, Jacobien; Brodt, Hans Reinhard; Stephan, Christoph; Wolf, Timo; Kessel, Johanna; Joost, Insa; Sinha, Bhanu; van Assen, Sander; Wilting, Kasper; Tobias Welte, Welte; Christiane Mölgen, Mölgen; Julia Freise, Freise; Brunkhorst, Frank; Pletz, Mathias; Hagel, Stefan; Becker, Christian; Frieling, Thomas; Kösters, Katrin; Reuter, Stefan; Hsiao, Mikai; Rupp, Jan; Dalhoff, Klaus; Turner, David; Snape, Susan; Crusz, Shanika; Venkatesan, Pradhib; Salzberger, Bernd; Hanses, Frank; Rodriguez-Baño, Jesùs; Méndez, Adoración Valiente; López-Cortés, Luis Eduardo; Cisneros, José Miguel; Navarro-Amuedo, Maria Dolores; Bonten, Marc; Oosterheert, Jan Jelrik; Ekkelenkamp, Miquel

    2015-01-01

    Background: Current guidelines recommend that patients with Staphylococcus aureus bloodstream infection (SAB) are treated with long courses of intravenous antimicrobial therapy. This serves to avoid SAB-related complications such as relapses, local extension and distant metastatic foci. However, in

  8. Taurolidine locks significantly reduce the incidence of catheter-related blood stream infections in high-risk patients on home parenteral nutrition.

    Science.gov (United States)

    Saunders, J; Naghibi, M; Leach, Z; Parsons, C; King, A; Smith, T; Stroud, M

    2015-02-01

    Emerging evidence suggests taurolidine reduces the risk of repeated episodes of catheter related blood stream infections (CRBSI) in a subgroup of patients receiving home parenteral nutrition (HPN). We defined 3 indications where taurolidine could be considered and retrospectively analysed data from patients who were treated over a 10 year period to examine the validity of these criteria. Twenty-two patients were identified from a total HPN population of 81, representing 33.2 years of experience. The overall CRBSI rate pre- and post-taurolidine usage was reduced from 5.71 to 0.99 infections per 1000 patient parenteral nutrition days (P-value taurolidine is used as secondary prophylaxis and providing initial data suggesting the benefit of its use as primary prophylaxis.

  9. Incidencia de bacteriemia asociada a catéter en niños hospitalizados que reciben nutrición parenteral Blood-stream catheter related infection in inpatient children receiving parenteral nutrition

    OpenAIRE

    E. Vaquero Sosa; E. Izquierdo García; M.ª Arrizabalaga Asenjo; C. Gómez Peñalba; J. M. Moreno Villares

    2011-01-01

    Las infecciones relacionadas con el catéter son la complicación más grave en los pacientes portadores de un catéter venoso central. Se considera que la nutrición parenteral (NP) constituye un factor de riesgo de desarrollar una infección relacionada con el catéter (IRCat). Material y métodos: para conocer la tasa de infección y poder establecer estrategias de prevención de la infección nosocomial, se revisaron todas las historias de los 120 pacientes que recibieron NP a lo largo de 2008. Toda...

  10. Diferença de tempo de positividade: método útil no diagnóstico de infecção de corrente sanguínea relacionada com cateter? Differential time to positivity: a useful tool for the diagnosis of catheter-related infections?

    Directory of Open Access Journals (Sweden)

    Karoline de Lemes Giuntini Corrêa

    2012-06-01

    Full Text Available INTRODUÇÃO: As infecções de corrente sanguínea relacionadas com cateter (ICSRCs apresentam impacto significativo na morbidade e na mortalidade de pacientes internados, além de elevar custos hospitalares. A utilização de equipamentos automatizados no processamento de hemoculturas gerou uma alternativa para diagnóstico de ICSRC por meio da análise da diferença de tempo de positividade (DTP entre hemoculturas pareadas (coletadas simultaneamente de sangue periférico e sangue de cateter. Um diagnóstico acurado e rápido dessas infecções pode otimizar as condutas clínicas e terapêuticas, poupando a retirada precoce dos cateteres. OBJETIVOS: Avaliar na rotina a DTP como ferramenta auxiliar no diagnóstico de ICSRC e determinar os principais microrganismos isolados. MÉTODOS: Foram avaliadas retrospectivamente hemoculturas coletadas no complexo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP de maio a agosto de 2008. Somente amostras que apresentaram DTP maior que 120 minutos foram consideradas possíveis ICSRCs pelo critério laboratorial. RESULTADOS: A seção processou 11.017 hemoculturas aeróbias durante o período de estudo; somente 5% foram coletadas de forma pareada. Destas, 148 (28% foram positivas, sendo 9% com crescimento somente em sangue periférico, 41% somente em sangue de cateter e 50% em ambas as amostras com 88% de homologia de microrganismos identificados. A DTP apresentou valores acima de 120 minutos em 50% dos casos e os microrganismos mais isolados foram Staphylococcus aureus (22%, Candida spp. (18%, Klebsiella spp. (7% e Enterobacter spp. (7%. CONCLUSÃO: A determinação da DTP como ferramenta auxiliar no diagnóstico de ICSRC é viável e fácil de ser executada em laboratórios de rotina com automação, porém o processo de coleta das amostras pareadas deve ser rigidamente padronizado.INTRODUCTION: Not only do catheter related bloodstream infections (CRBSIs have

  11. Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter.

    Science.gov (United States)

    Chuang, Ming-Tsung; Wu, Ding-Kwo; Chang, Cheng-Ang; Shih, Ming-Chen Paul; Ou-Yang, Fu; Chuang, Chien-Han; Tsai, Yi-Fan; Hsu, Jui-Sheng

    2011-11-01

    The purpose of this study was to report our experience of percutaneous retrieval of dislodged port catheters with concurrent use of pigtail and loop snare catheters. During a 5-year period at our institute (June 2005 to July 2010), a total of 23 dislodged port catheters were retrieved. The interval between port catheter implantation and dislodged catheter retrieval ranged from 43 days to 1,414 days (mean 586.7 days). The time of delayed retrieval ranged from 1 day to 45 days (mean 4.6 days). All dislodged catheters were retrieved with the concurrent use of pigtail and loop snare catheters via femoral venous route. The prevalence of port catheter dislodgement at our institute was 3.4%. All dislodged port catheters were removed successfully with pigtail and loop snare catheters together. No procedure-related complications were encountered, except for transient arrhythmia in two patients, which required no medication. In conclusion, the concurrent use of pigtail and loop snare catheters is a feasible and easy way for percutaneous retrieval of a dislodged central venous port catheter.

  12. Potential Misclassification of Urinary Tract-Related Bacteremia Upon Applying the 2015 Catheter-Associated Urinary Tract Infection Surveillance Definition From the National Healthcare Safety Network.

    Science.gov (United States)

    Greene, M Todd; Ratz, David; Meddings, Jennifer; Fakih, Mohamad G; Saint, Sanjay

    2016-04-01

    The Centers for Disease Control and Prevention recently updated the surveillance definition of catheter-associated urinary tract infection to include only urine culture bacteria of at least 1 × 10(5) colony-forming units/mL. Our findings suggest that the new surveillance definition may fail to capture clinically meaningful catheter-associated urinary tract infections.

  13. Evaluating safety of tunneled small bore central venous catheters in chronic kidney disease population: A quality improvement initiative.

    Science.gov (United States)

    Bhutani, Gauri; El Ters, Mireille; Kremers, Walter K; Klunder, Joe L; Taler, Sandra J; Williams, Amy W; Stockland, Andrew H; Hogan, Marie C

    2016-09-20

    Introduction Peripherally inserted central venous catheters (PICCs) may adversely impact future successful arteriovenous fistulae (AVF). As part of a quality improvement project, the performance of tunneled small bore tunneled central venous catheters (TSB-CVCs), as alternatives to PICCs, was evaluated. Methods A retrospective observational study, involving individuals ≥18 years of age who underwent TSB-CVC placement by Interventional Radiology at Mayo Clinic, Rochester, MN between 1/1/2010 and 8/30/2013. Findings The study cohort included 92 patients with a median age of 55 (46-67) years, who underwent 108 TSB-CVC placements. Baseline renal disease was present in 71% (77/108). Most TSB-CVCs were placed in hospitalized patients (94%; 102/108); five French in diameter (61%; 66/108) and located in an internal jugular vein (84%; 91/108). Median catheter indwelling time was 20 (11-43) days (n = 84). TSB-CVC-related bloodstream infection, deep venous thrombosis (DVT), and superficial venous thrombosis (SpVT) rates per line were 0.009 (1/108), 0.018 (2/108), and 0.009 (1/108), respectively. Venous outcomes in a subgroup of 54 patients, who had documented PICC placements (n = 161) in addition to TSB-CVC (n = 58) were compared. TSB-CVC-DVT rate was lower than the PICC-DVT rate (0.017 [1/58] vs. 0.106 per line [17/161]; P = 0.04). The TSB-CVC-SpVT rate was not different from the PICC-SpVT rate (0 [0/58] vs. 0.037 [6/161] per line; P = 0.14). Discussion TSB-CVCs demonstrated an excellent safety profile in our study. These catheters should be preferentially utilized for arm vein preservation in advanced kidney disease. Their impact on future AVF success needs further evaluation.

  14. Going with the flow or swimming against the tide: should children with central venous catheters swim?

    Science.gov (United States)

    Miller, Jessica; Dalton, Meghan K; Duggan, Christopher; Lam, Shirley; Iglesias, Julie; Jaksic, Tom; Gura, Kathleen M

    2014-02-01

    Children who require long-term parenteral nutrition (PN) have central venous catheters (CVCs) in place to allow the safe and effective infusion of life-sustaining fluids and nutrition. Many consider recreational swimming to be a common part of childhood, but for some, the risk may outweigh the benefit. Children with CVCs may be at increased risk of exit site, tunnel, and catheter-related bloodstream infections (CRBSIs) if these catheters are immersed in water. The purpose of this review is to evaluate the current literature regarding the risk of infection for patients with CVCs who swim and determine if there is consensus among home PN (HPN) programs on this controversial issue. A total 45 articles were reviewed and 16 pediatric HPN programs were surveyed regarding swimming and CVCs. Due to the limited data available, a firm recommendation cannot be made. Recreational water associated outbreaks are well documented in the general public, as is the presence of human pathogens even in chlorinated swimming pools. As a medical team, practitioners can provide information and education regarding the potential risk, but ultimately the decision lies with the parents. If the parents decide swimming is worth the risk, they are encouraged to use products designed for this use and to change their child's dressing immediately after swimming. Due to our experience with a fatal event immediately after swimming, we continue to strongly discourage patients with CVCs from swimming. Further large and well-designed studies regarding the risk of swimming with a CVC are needed to make a strong, evidence-based recommendation.

  15. Antimicrobial activity and cytocompatibility of silver nanoparticles coated catheters via a biomimetic surface functionalization strategy

    Directory of Open Access Journals (Sweden)

    Wu K

    2015-12-01

    Full Text Available Ke Wu,1 Yun Yang,2,3 Yanmei Zhang,2,3 Jiexi Deng,1 Changjian Lin2,31Department of Cardiology, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, 2Department of Medical Materials, Beijing Medical Implant Engineering Research Center, Beijing Naton Technology Group, Beijing, 3State Key Laboratory of Physical Chemistry of Solid Surfaces, Department of Chemistry, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, People’s Republic of ChinaAbstract: Catheter-related bloodstream infections are a significant problem in the clinic and may result in a serious infection. Here, we developed a facile and green procedure for buildup of silver nanoparticles (AgNPs on the central venous catheters (CVCs surface. Inspired by mussel adhesive proteins, dopamine was used to form a thin polydopamine layer and induce AgNPs formation without additional reductants or stabilizers. The chemical and physicochemical properties of AgNPs coated CVCs were characterized by scanning electron microscopy, X-ray photoelectron spectroscopy, Raman spectroscopy, and water contact angle. The Staphylococcus aureus culture experiment was used to study the antibacterial properties. The cytocompatibility was assessed by water soluble tetrazolium salts (WST-1 assay, fluorescence staining, and scanning electron microscopy analysis. The results indicated that the CVCs surface was successfully coated with compact AgNPs. AgNPs were significantly well separated and spherical with a size of 30–50 nm. The density of AgNPs could be modulated by the concentration of silver nitrate solution. The antibacterial activity was dependent on the AgNPs dose. The high dose of AgNPs showed excellent antibacterial activity while associated with increased cytotoxicity. The appropriate density of AgNPs coated CVCs could exhibit improved biocompatibility and maintained evident sterilization effect. It is promising to design mussel-inspired silver releasing CVCs with both

  16. Indwelling urethral catheters in adults

    OpenAIRE

    Calleja, Edward

    2012-01-01

    This article focuses on indwelling urethral catheters in adults, their indications for the short and long term use, the types of urinary catheters available in Malta, an overview of the basic structure of a catheter, and the complications of urinary catheter insertion and maintenance. An attempt has been made to address in some depth the most common complication of indwelling catheterscatheter associated urinary tract infection in terms of pathophysiology and its management. Simple but cru...

  17. Investigation of central venous catheter-related in ICU and non-ICU patients%ICU与非ICU患者中心静脉导管感染调查

    Institute of Scientific and Technical Information of China (English)

    魏立娜; 陈兵; 张清照; 杨莉莉; 王冬芮

    2016-01-01

    目的:比较IC U与非IC U住院患者中心静脉导管感染的状况,提出预防对策,以降低患者中心静脉导管感染率。方法选择2010年1月-2015年6月在医院IC U和非IC U行中心静脉导管的患者各200例,对疑有中心静脉导管感染的患者进行血液及中心静脉导管尖端培养,比较IC U和非IC U患者的中心静脉导管感染率、置管部位、置管类型及病原菌分布。结果 IC U和非IC U患者血液、中心静脉导管培养阳性率及导管细菌定植率比较差异均无统计学意义;普通导管和血液透析导管的感染率较高,分别为12.66%和6.67%,抗感染导管感染率为11.11%明显较低;颈内静脉置管患者中心静脉导管感染率较高为38.46%;IC U与非IC U患者病原菌检出分布差异无统计学意义;IC U与非IC U患者留置中心静脉导管1~7 d的感染率<9.00%,8~14 d感染率为22.00%,≥15 d感染率为35.00%,IC U 与非 IC U 患者的置管时间比较差异无统计学意义。结论 IC U 与非IC U患者的中心静脉导管感染发病情况基本相同:抗感染导管的感染率较低,颈内静脉置管的感染率较高,病原菌以革兰阳性菌为主。%OBJECTIVE To compare the prevalence of central venous catheter-related infections in the hospitalized ICU and non-ICU patients and put forward the prevention countermeasures so as to reduce the incidence of central venous catheter-related infections .METHODS A total of 200 ICU patients and 200 non-ICU patients who under-went the central venous catheterization from Jan 2010 to Jun 2015 were enrolled in the study .The blood specimens and tips of central venous catheters were cultured for the patients with suspected central venous catheter-related infections;the incidence of central venous catheter-related infections ,sites of intubation ,types of catheters ,and distribution of pathogens were observed and compared between the ICU

  18. Radiologically placed tunneled peritoneal catheter in palliation of malignant ascites

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Erol, Bekir; Ciftci, Tuerkmen T. [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey); Akhan, Okan, E-mail: akhano@tr.net [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey)

    2011-11-15

    The purpose of this study was to evaluate retrospectively the safety and effectiveness of radiologically placed tunneled peritoneal catheter in palliation of malignant ascites. Between July 2005 and June 2009, 41 tunneled peritoneal catheters were placed under ultrasonographic and fluoroscopic guidance in 40 patients (mean age, 55 years; 22 women) who had symptomatic malignant ascites. No procedure related mortality was observed. Major complication occurred in one patient (2.5%) in the form of serious bacterial peritonitis that necessitated catheter removal. Minor complications such as minor bacterial peritonitis, catheter dislodgement, tunnel infection, and catheter blockage occurred in 11 patients (27.5%). The mean duration of survival after catheter placement was 11.8 weeks. All patients expired of their primary malignancies in the follow-up. Radiologically placed tunneled peritoneal catheter is safe and effective in palliation of symptomatic malignant ascites.

  19. [The bladder catheter].

    Science.gov (United States)

    Pestalozzi, D M

    1996-09-01

    The benefit of the transurethral catheter to protect or measure renal function is well accepted. Urethral stricture and infection of the lower urinary tract as the complications should lead to a cautious use of catheters. A careful placement, the choice of the best material and a correct management help to avoid complications. Alternatives are discussed.

  20. Effect of Arm Positioning on Entrapment of Infraclavicular Nerve Block Catheter

    Science.gov (United States)

    Reddy, Rahul; Kendall, Mark C.; Nader, Antoun; Weeks, Jessica J.

    2017-01-01

    Continuous brachial plexus nerve block catheters are commonly inserted for postoperative analgesia after upper extremity surgery. Modifications of the insertion technique have been described to improve the safety of placing an infraclavicular brachial plexus catheter. Rarely, these catheters may become damaged or entrapped, complicating their removal. We describe a case of infraclavicular brachial plexus catheter entrapment related to differences in arm positioning during catheter placement and removal. Written authorization to obtain, use, and disclose information and images was obtained from the patient.

  1. How long should umbilical venous catheters remain in place in neonates who require long-term (≥5-7 days) central venous access?

    Science.gov (United States)

    Keir, Amy; Giesinger, Regan; Dunn, Michael

    2014-08-01

    In this evidenced-based review, we examine the current available literature to help answer the question 'In neonates requiring long-term central access [patient], does removal of the umbilical venous catheter (UVC) on days 5-7 and replacement with a peripherally inserted central catheter line [intervention] compared with leaving the UVC in situ [comparison] reduce rates of central line-associated bloodstream infections [outcome]?'

  2. Effect of transparent dressings replacing in different frequency on neonatal central venous catheter-related infections%透明敷料不同更换频率对新生儿中心静脉导管相关性感染的影响

    Institute of Scientific and Technical Information of China (English)

    凌其英; 舒辉; 陈虹; 唐敏; 金夕辉

    2016-01-01

    OBJECTIVE To investigate neonatal peripherally inserted central catheter (PICC) ,and effect of trans‐parent dressings replacing in different frequency on neonatal central venous catheter‐related infections ,in order to select the appropriate transparent dressing change frequency to provide a theoretical basis .METHODS A total of 450 neonates indwelling PICC catheter in hospital from Jun .2012 to Jun .2015 were selected as research subjects , in a random manner patients were divided into three groups ,in which group Ⅰ dressing changed once every three days ,group Ⅱonce every five days ,group Ⅲ once every 7 days ,the catheter‐related infection were analyzed and compared in three groups of children .RESULTS A total of 21 cases of patients got infections from 450 patients , and the infection rate was 4 .67% ;Staphylococcus epidermidis were the top bacteria detected out from the three groups of children ,accounting for 57 .14% ,71 .42% and 49 .99% respectively ,followed by K lebsiella pneumoni‐ae ,accounting for 42 .86% ,14 .29% and 16 .67% respectively .The incident rates of catheter‐related infection in groupⅠand Ⅱ both 0 .67% ,and group Ⅲ had no catheter‐related bloodstream infections .CONCLUSION We rec‐ommend that the dressing central venous catheters in neonates replacement frequency is 7 days /time to reduce the workload of medical staff ,reduce the incidence of nosocomial infections ,but if dressings appear moist and loose phenomenon happen ,the cathether should be replaced .%目的:探讨新生儿经外周静脉置入中心静脉导管(PICC )后,透明敷料不同更换频率对导管感染发生的影响,为透明敷料选取合适的更换频率提供理论依据。方法选取2012年6月-2015年6月在医院接受留置PICC导管的450例新生儿为研究对象,按照随机的方式将其平均分成3组,其中Ⅰ组每3 d更换一次敷料,Ⅱ组每5 d更换一次敷料,Ⅲ组每7 d更

  3. Radiographic signs of non-venous placement of intended central venous catheters in children

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Erin C. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Taylor, George A. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2016-02-15

    Central venous catheters (CVCs) are commonly used in children, and inadvertent arterial or extravascular cannulation is rare but has potentially serious complications. To identify the radiographic signs of arterial placement of CVCs. We retrospectively reviewed seven cases of arterially malpositioned CVCs on chest radiograph. These cases were identified through departmental quality-assurance mechanisms and external consultation. Comparison of arterial cases was made with 127 age-matched chest radiographs with CVCs in normal, expected venous location. On each anteroposterior (AP) radiograph we measured the distance of the catheter tip from the right lateral border of the thoracic spine, and the angle of the vertical portion of the catheter relative to the midline. On each lateral radiograph we measured the angle of the vertical portion of each catheter relative to the anterior border of the thoracic spine. When bilateral subclavian catheters were present, the catheter tips were described as crossed, overlapping or uncrossed. On AP radiographs, arterially placed CVCs were more curved to the left, with catheter tip positions located farther to the left of midline than normal venous CVCs. When bilateral, properly placed venous catheters were present, all catheters crossed at the level of the superior vena cava (SVC). When one of the bilateral catheters was in arterial position, neither of the catheters crossed or the inter-catheter crossover distance was exaggerated. On lateral radiographs, there was a marked anterior angulation of the vertical portion of the catheter (mean angle 37 ± 15 standard deviation [SD] in arterial catheters versus 5.9 ± 8.3 SD in normally placed venous catheters). Useful radiographic signs suggestive of unintentional arterial misplacement of vascular catheters include leftward curvature of the vertical portion of the catheter, left-side catheter tip position, lack of catheter crossover on the frontal radiograph, as well as exaggerated

  4. Risk factors of bloodstream infection-related death after liver transplantation%肝移植术后血流感染死亡的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    万齐全; 谢建飞; 叶少军; 刘忠忠; 仲福顺; 周建党; 叶啟发

    2016-01-01

    发生≥3次的血流感染(最多发生了6次).41.12% (44/107)发生血流感染的肝移植受者接受了不恰当的抗感染处理.原发感染部位:腹腔内、肺、尿道、血管内导管、部位不明分别为40、39、3、1、24例.微生物感染类型:革兰氏阳性菌、革兰氏阴性菌、真菌、混合感染分别为28、24、4、51例.102例为院内感染.186株血液标本细菌培养结果显示:84株为革兰氏阳性菌是其主要的致病菌,其中又以肠球菌(31株)及金黄色葡萄球菌(23株)为优势菌株.血流感染病死率为37.38% (40/107),其中因感染性休克死亡35例.(2)影响肝移植受者术后血流感染相关死亡的危险因素分析指标:单因素分析结果显示:受者的性别、供肝来源、感染时体温、病原微生物类型、血清Cr水平、血清Alb水平、外周血WBC、外周血PLT、感染性休克是肝移植术后血流感染死亡的危险因素(x2=5.801,5.920,13.047,12.776,11.366,7.976,25.173,9.289,51.905,P<0.05).多因素分析结果表明:血清Alb水平<30 mg/L和感染性休克是肝移植术后血流感染相关死亡的独立危险因素(OR=5.839,44.983,95%可信区间:1.145~29.767,12.606~160.514,P <0.05).结论 肝移植术后易发生血流感染,血清Alb水平<30mg/L和感染性休克是肝移植术后血流感染相关死亡的独立危险因素.%Objective To investigate the risk factors of bloodstream infection-related death after liver transplantation.Methods The retrospective case-control study was adopted.The clinical data of the 107 patients with bloodstream infection from 365 liver transplantation patients who were admitted to the Third Xiangya Hospital of Central South University (220 patients) and South Central Hospital Affiliated to Wuhan University (145 patients) from January 1,2002 to December 31,2015 were collected.The patients received modified piggyback liver transplantation.The second or third generation celphalosporin or carbapenems antibiotics

  5. The study of the risk factors associated with central venous catheter related infection%ICU中心静脉导管相关性感染危险因素的调查研究

    Institute of Scientific and Technical Information of China (English)

    单荣芳; 孙华; 李峰

    2011-01-01

    目的 通过对ICU中心静脉置管患者感染的观察与分析,找出导管相关感染的危险因素.方法 选择2009年9月至2010年3月,在ICU行中心静脉置管的患者,观察并记录其年龄、性别、置管部位、导管放置时间、穿刺点周围皮肤情况、导管性质、管腔数量、有无静脉营养等内容.护士根据患者的实际情况结合动态护理记录单实施有针对性的导管护理并及早反馈相关信息.结果 患者年龄(58.1±18.9)岁,置管天数(8.76±6.89)d.行中心静脉置管的患者105例,其中77例次锁骨下静脉置管,23例次颈内静脉置管,6例次颈内静脉置入漂浮导管.中心静脉导管感染4例,置管时间分别为3、14、18、21 d,感染率为3.8%,每1000个导管日感染率3.95.结论 ICU患者病情危重,严格掌握中心静脉置管适应症;使用中心静脉导管动态护理记录单进行导管常规评价,对症护理,缩短留置时间;严格的无菌技术是控制导管感染的关键措施.%Objective To determine the risk factors of central venous catheter(CVC) - related infection in ICU(intensive care unit). Methods From September 2009 to May 2010, in the ICU, the patients with central venous catheter, were observed and recorded the parament (e. g.age, gender, catheter site, duration of catheterization, the situation surrounding skin puncture,with or without venous nutrition, et al). Based on the situation of patients and the care records,nurses managed the catheters individually and conveyed useful information to the doctors. Results The age of the patients was 58.1 + 18.9 years old, the duration of catheterization was 8.76 + 6.89 days. A total of 105 patients underwent the central venous catheterization, including 77 cases of subclavian vein catheterization, 23 cases of internal jugular vein catheterization, 6 cases of the internal jugular vein catheterization, the infection rate was 3.8% (4 cases) in all patients, the number of the infected catheter

  6. Impact of a modified Broviac maintenance care bundle on bloodstream infections in paediatric cancer patients

    Directory of Open Access Journals (Sweden)

    Furtwängler, Rhoikos

    2015-11-01

    Full Text Available Background: During intensive chemotherapy, bloodstream infection (BSI represents an important complication in paediatric cancer patients. Most patients carry a long-term central venous access device (CVAD. Improved maintenance care of these vascular catheters may decrease the risk of BSI.Methods: Intervention study (adapted CVAD prevention protocol with two observation periods (P1: 09-2009 until 05-2011; P2: 09-2011 until 05-2013; prospective surveillance of all laboratory confirmed BSIs. In P2, ready to use sterile NaCl 0.9% syringes were used for CVAD flushing and octenidine/isopropanol for the disinfection of catheter hubs and 3-way stopcocks. Results: During P1, 84 patients were included versus 81 patients during P2. There were no significant differences between the two patient populations in terms of median age, gender, underlying malignancy or disease status (first illness or relapse. Nearly all CVADs were Broviac catheters. The median duration from implantation to removal of the CVAD was 192 days (Inter-quartile-range (IQR; 110–288 days in P1 and 191 days (IQR; 103–270 days in P2. 28 BSI were diagnosed in 22 patients in P1 (26% of all patients experienced at least one BSI and 15 BSI in 12 patients in P2 (15% of all patients. The corresponding results for incidence density (ID were 0.44 (CI95 0.29–0.62 for P1 vs. 0.34 (0.19–0.53 BSI per 100 inpatient days for P2 and for incidence rate (IR 7.76 (5.16–10.86 in P1 vs. 4.75 (2.66–7.43 BSI per 1,000 inpatient CVAD utilization days. In P1, 9 BSI were caused by CoNS vs. only 2 in P2 (IR 2.49; CI95 0.17–4.17 vs. 0.63; CI95 0.08–1.72. In P1 two BSI (7% lead to early removal of the device. During P2 one CVAD was prematurely removed due to a Broviac-related BSI (6.7%.Conclusion: The preventive protocol investigated in this study led to a reduction of BSI in paediatric cancer patients. This result was clinically relevant but – due to insufficient power in a single centre observation

  7. ICU患者中心静脉导管相关性感染的危险因素分析%Risk factors for central venous catheter-related infections in ICU patients

    Institute of Scientific and Technical Information of China (English)

    张伟; 张宏; 苏萌萌

    2014-01-01

    目的:探讨重症监护病房(ICU )患者中心静脉导管相关性感染(CRI)的病原学特征以及相关危险因素,以指导临床实践,预防医院感染的发生。方法对2012年10月-2013年3月医院IC U 206例留置中心静脉导管患者进行回顾性研究,采用χ2检验及多因素非条件 logistic回归分析,统计CRI发生率、观察其病原学特征并依此分析其相关危险因素。结果206例中心静脉导管患者中34例发生CRI ,发生率为16.50%;共检出病原菌34株,其中革兰阳性球菌占50.00%、革兰阴性杆菌占26.47%、真菌占23.53%;多因素非条件 logistic回归分析提示,年龄、使用多腔导管、长期留置导管为CRI独立危险因素,差异有统计学意义(P<0.05)。结论应加强CRI危险因素控制,更换导管类型,缩短留置导管时间,预防医院感染的发生。%OBJECTIVE To explore the etiological characteristics of central venous catheter-related infections in patients of intensive care unit (ICU ) and analyze the related risk factors so as to guide the clinical practice and prevent nosocomial infections .METHODS A total of 206 patients who underwent the central venous catheterization in the ICU from Oct 2012 to Mar 2013 were retrospectively studied , then the chi-square test and the non-conditional multivariate logistic regression analysis were performed , the incidence of central venous catheter-related infections was taken for statistics ,and the etiological characteristics were observed to analyze the related risk factors .RESULTS Of the 206 patients ,the central venous catheter-related infections occurred in 34 cases with the infection rate of 16 .50% .Totally 34 strains of pathogens have been isolated ,among which the gram-positive cocci accounted for 50 .00% , the gram-negative bacilli 26 .47% , the fungi 23 .53% . The non-conditional multivariate logistic regression analysis indicated that the age ,use of

  8. Hemocultivos simultáneos y diagnóstico de sepsis relacionada a catéter Simultaneous haemocultures and diagnosis of catheter-related sepsis

    Directory of Open Access Journals (Sweden)

    G. González-Ávila

    2004-10-01

    Full Text Available Objetivo: determinar el valor diagnóstico de hemocultivos simultáneos. Antecedentes: El criterio clínico no es suficiente para establecer el diagnóstico de infección relacionada a catéter y en retiro por sospecha o el recambio rutinario no son prácticas recomendadas. Sujetos: Se evalúan 164 catéteres empleados para nutrición endovenosa colocados en 127 pacientes con cáncer, a quienes se les tomó una muestra simultánea de sangre a través del catéter y una vena periférica cuando existía sospecha de infección o bien cada 7 a 10 días de permanencia del catéter. Intervenciones: Se calculó la sensibilidad, especificidad y valores predictivos de los hemocultivos como método diagnóstico. El cultivo de punta constituyó el estándar de oro. Resultados: En presencia de un hemocultivo transcatéter positivo con hemocultivo negativo se identificó una sensibilidad de 87,5% y una especificidad de 97,9%, en cambio la presencia de un hemocultivo transcatéter negativo y periférico positivo mostró una sensibilidad de 62,5%. Cuando ambos hemocultivos fueron positivos se identificó correctamente la infección en el 83,3% de los casos con una sensibilidad de 93,7% y una especificidad de 93,9%. La correlación diagnóstica obtenida para ambos hemocultivos positivos fue de 0,87 y de 0,83 cuando el hemocultivo transcatéter fue positivo y el periférico negativo. Conclusiones: La toma de hemocultivos simultáneos tiene un alto valor diagnóstico.Objetive: To determine the diagnosis value of simultaneous blood cultures. Background: The clinical criteria is not enough to establish catheter-related sepsis diagnosis and remotion or replacement of catheter are not necessary. Subjects: We evaluated 164 catheters used for total parenteral nutrition placement in 127 patients with cancer. Simultaneous blood samples -central and peripheral venous- were taken after seven at ten days of permanency or infection suspicion and compared with tip culture

  9. Advanced Imaging Catheter: Final Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Krulevitch, P; Colston, B; DaSilva, L; Hilken, D; Kluiwstra, J U; Lee, A P; London, R; Miles, R; Schumann, D; Seward, K; Wang, A

    2001-07-20

    Minimally invasive surgery (MIS) is an approach whereby procedures conventionally performed with large and potentially traumatic incisions are replaced by several tiny incisions through which specialized instruments are inserted. Early MIS, often called laparoscopic surgery, used video cameras and laparoscopes to visualize and control the medical devices, which were typically cutting or stapling tools. More recently, catheter-based procedures have become a fast growing sector of all surgeries. In these procedures, small incisions are made into one of the main arteries (e.g. femoral artery in the thigh), and a long thin hollow tube is inserted and positioned near the target area. The key advantage of this technique is that recovery time can be reduced from months to a matter of days. In the United States, over 700,000 catheter procedures are performed annually representing a market of over $350 million. Further growth in this area will require significant improvements in the current catheter technology. In order to effectively navigate a catheter through the tortuous vessels of the body, two capabilities must exist: imaging and positioning. In most cases, catheter procedures rely on radiography for visualization and manual manipulation for positioning of the device. Radiography provides two-dimensional, global images of the vasculature and cannot be used continuously due to radiation exposure to both the patient and physician. Intravascular ultrasound devices are available for continuous local imaging at the catheter tip, but these devices cannot be used simultaneously with therapeutic devices. Catheters are highly compliant devices, and manipulating the catheter is similar to pushing on a string. Often, a guide wire is used to help position the catheter, but this procedure has its own set of problems. Three characteristics are used to describe catheter maneuverability: (1) pushability -- the amount of linear displacement of the distal end (inside body) relative to

  10. Catheter sepsis due to Staphylococcus epidermidis during parenteral nutrition.

    Science.gov (United States)

    Sitges-Serra, A; Puig, P; Jaurrieta, E; Garau, J; Alastrue, A; Sitges-Creus, A

    1980-10-01

    Staphylococcus epidermidis is a pathogenic organism with increasing importance in total parenteral nutrition therapy. Strict asepsis during catheter insertion prolongs the interval free from Staphylococcus epidermidis infection. Staphylococcus epidermidis colonizes the catheter after migrating from the skin. For protection, we advise a long subcutaneous tunnel for all catheters that are to be indwelling for longer than three weeks. Prompt recatheterization of a patient with Staphylococcus epidermidis sepsis can result in hematogenous seeding of the new catheter and persistence of the infection. Catheter related Staphylococcus epidermidis sepsis has subsided after catheter withdrawal, and there is no need for antibiotic therapy provided that other prosthetic materials are not placed in the vascular tree. Immunologic status of the patients is not related to the frequency or severity of Staphylococcus epidermidis infections, or both.

  11. Causes of central venous catheter associated infections and prevention countermeasures%中心静脉导管相关性感染原因分析及预防对策

    Institute of Scientific and Technical Information of China (English)

    桂煜

    2011-01-01

    OBJECTIVE To understand the central venous catheter related infections and to propose preventive measures. METHODS From Apr 2008 to Mar 2010, the causes of 54 patients with deep catheter related infections were analyzed, and the definite preventive measures were taken in accordance with the causes. RESULTS Among 54 patients received the central venous catheterization, the infection of catheter export was found in 5 cases,accounting for 9.3%, 3 cases of catheter-related bloodstream infection, accounting for 5.6%, both of which were recovery after the corresponding disposals. CONCLUSIONS The risk factors of catheter related infections are the inserted time of the catheter,the sites, tle catheter types, the dressing and the nursing care of medical staff. To improve the training of the medical personnel, establish the preventive barrier to a maximum and strictly execute the aseptic manifestation is better propitious to prevent the occurrence of central venous catheter associated infection.%目的 了解中心静脉导管相关性感染的原因及应采取的预防措施.方法 分析医院2008年4月-2010年3月住院的54例深静脉留置管患者发生的导管相关性感染原因,并针对原因采取一定的预防措施.结果 54例行中心静脉置管术的患者中,置管出口部位感染5例,占9.3%;导管相关血流感染3例,占5.6%;经相应处理后均好转.结论 导管相关性感染的危险因素中重要是导管留置时间、插管部位、导管类型、敷料及医务人员操作护理;加强人员教育培训、最大限度的建立防护屏障、严格执行无菌操作等有利于更好的预防中心静脉导管相关性感染的发生.

  12. PreventionandNursingOncologyCentreRiskFactorsofCatheter-relatedInfection%肿瘤科中心静脉导管感染危险因素的预防和护理

    Institute of Scientific and Technical Information of China (English)

    牟相玲

    2013-01-01

    Objective Through the investigation of patients in our hospital in oncology department of central venous catheter, through the analysis on the culture result catheter culture and blood, preventive oncology center for the study of risk factors for venous catheter-related infection and the nursing method. Methods 263 cases, patients in 2008 March to 2011 August is in the treatment of venous duct tumor coyne center in our hospital inpatients, carries on the investigation by the questionnaire. Results According to the results of the survey, this group of cases, 9 cases had phlebitis, catheter culture results were positive in 18 cases, 12 cases with positive blood culture results. This shows that lead to tumor of central venous catheter infection may be associated with age, gender, different nature of the drug, when treatment is whether the use of intravenous nutrition therapy, chemotherapy cycle time, catheter blockage and catheter indwelling time have direct or indirect relation. Conclusion As far as possible, reduce infection and prevention of central venous catheter related infection of central venous catheter, in medical usually work must regulate the related system and operating procedures, strict nursing.%  目的通过对我院就诊于肿瘤科进行中心静脉导管的患者进行调查,经过对导管培养及血培养结果的分析,研究肿瘤科中心静脉导管感染危险因素的预防及其护理方法。方法选取263例病例,病例患者是于2008年3月至2011年8月在我院肿瘤科因中心静脉导管问题就诊的住院患者,对其以问卷调查的方式进行调研。结果调查结果显示,在此组病例当中,有9例发生静脉炎,18例导管培养结果呈阳性,12例血培养结果呈阳性。这表明导致肿瘤中心静脉导管感染可能与患者的年龄、性别、不同的药物性质、治疗时是否使用静脉高营养治疗法、化疗进行的时间周期、导管的堵塞情况及置管后导

  13. Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality.

    Science.gov (United States)

    Ergönül, Ö; Aydin, M; Azap, A; Başaran, S; Tekin, S; Kaya, Ş; Gülsün, S; Yörük, G; Kurşun, E; Yeşilkaya, A; Şimşek, F; Yılmaz, E; Bilgin, H; Hatipoğlu, Ç; Cabadak, H; Tezer, Y; Togan, T; Karaoğlan, I; İnan, A; Engin, A; Alışkan, H E; Yavuz, S Ş; Erdinç, Ş; Mulazimoglu, L; Azap, Ö; Can, F; Akalın, H; Timurkaynak, F

    2016-12-01

    This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.

  14. Dedicated radial ventriculography pigtail catheter

    Energy Technology Data Exchange (ETDEWEB)

    Vidovich, Mladen I., E-mail: miv@uic.edu

    2013-05-15

    A new dedicated cardiac ventriculography catheter was specifically designed for radial and upper arm arterial access approach. Two catheter configurations have been developed to facilitate retrograde crossing of the aortic valve and to conform to various subclavian, ascending aortic and left ventricular anatomies. The “short” dedicated radial ventriculography catheter is suited for horizontal ascending aortas, obese body habitus, short stature and small ventricular cavities. The “long” dedicated radial ventriculography catheter is suited for vertical ascending aortas, thin body habitus, tall stature and larger ventricular cavities. This new design allows for improved performance, faster and simpler insertion in the left ventricle which can reduce procedure time, radiation exposure and propensity for radial artery spasm due to excessive catheter manipulation. Two different catheter configurations allow for optimal catheter selection in a broad range of patient anatomies. The catheter is exceptionally stable during contrast power injection and provides equivalent cavity opacification to traditional femoral ventriculography catheter designs.

  15. 枸橼酸和肝素封管液预防血液透析长期留置导管相关感染的Meta分析%Citrate lock versus heparin lock for the prevention of catheter related infections in hemodialysis patients with tunneled catheters: a Meta-analysis of randomized controlled trials

    Institute of Scientific and Technical Information of China (English)

    赵宇亮; 杨济桥; 张凌; 李峥; 杨莹莹; 唐怡; 付平

    2013-01-01

    Objective To study whether citrate lock is superior to heparin lock in the prevention of catheter related infections,bleeding complications and catheter malfunctions among hemodialysis patients with tunneled catheters.Methods By searching in Pubmed,the Cochrane Library,EMBASE,Ovid,WanFang,VIP,CNKI and CBM databases as well as related journals,qualified randomized controlled trials were included in a Meta-analysis using Revman 5.0 and STATA 10.0 software.The endpoints included catheter related infection,bleeding complication,thrombolytic treatment,catheter removal for malfunction,catheter thrombosis and all-cause death.Results Fifteen randomized controlled trials were included with 1621 patients involved.Eight studies compared citrate alone with heparin lock,while 7 trials focused on citrate in combination with other antimicrobials.Pooled analysis demonstrated that incidence of catheter related infections in patients receiving citrate lock decreased by 47% compared with those on heparin (RR=0.53,95%CI 0.36-0.77,P < 0.01).Subgroup analysis by types of citrate lock indicated that all combined lock solutions of citrate and other antimicrobials (citrate + gentamicin,citrate + taurolidine,citrate + methylene blue +methylparaben + propylparaben) were superior to heparin lock in preventing catheter-related infections (P =0.01,0.04,0.01,respectively); citrate alone seemed to reduce catheter-related infection risk (RR =0.68),but no statistically significant difference was observed (95%CI 0.38-1.21,P=0.19).There were fewer patients with bleeding complications in citrate group (RR =0.53,95% CI 0.34-0.S4,P < 0.01),while citrate showed no advantage over heparin lock in terms of thrombolytic treatment (P =0.93),catheter removal for malfunction (P =0.35),catheter thrombosis (P =0.64) and all-cause death (P =0.35).Conclusions For hemodialysis patients with tunneled catheters,combined lock solutions of citrate and other antimicrobials,rather than citrate alone

  16. 乳腺癌化疗患者PICC置管感染的相关因素研究%Risk factors of PICC catheter-related infections in breast cancer patients with chemotherapy

    Institute of Scientific and Technical Information of China (English)

    徐向玉

    2013-01-01

    目的 了解乳腺癌患者经外周穿刺中心静脉置管术(PICC)实施化疗发生导管相关性感染及相关因素,并制定对策.方法 回顾性调查2010年1月-2012年1月医院170例PICC置管化疗乳腺癌患者导管相关性感染发生率及其原因.结果 170例患者中导管局部感染20例,感染率为11.8%;引起PICC感染的相关高危因素有导管留置时间、化疗疗程、换药频次、血像、基础疾病,差异有统计学意义(P<0.05);logistic回归分析提示,这些危险因素对感染影响作用大小依次为留置时间>化疗疗程>换药频次>血像>伴有糖尿病(x2 =46.28、45.52、37.04、25.23);而导管感染与穿刺次数、穿刺部位、年龄等因素无明显相关性.结论 合理选择留置导管的部位,加强置管操作与维护管理、缩短导管留置时间、加强患者营养及提高免疫力,可降低导管相关性感染的发生率.%OBJECTIVE To investigate the related factors of catheter-related infections in the breast cancer chemotherapy patients with peripherally inserted central of catheter(PICC) so as to develop counter measures.METHODS The related factors of the catheter-related infections were retrospectively analyzed based on the data of 170 cases with PICC between Jan 2010 and Jan 2012.RESULTS Among 170 breast cancer patients,20 cases were complicated with local infections,the infection incidence was 11.8%.The PICC infections were related to the high-risk factors such as the catheter retention time,chemotherapy regimen,the frequency of dressing change,hemogram,and underlying diseases,there was statistical difference(P<0.05).The logistic regression analysis indicated that the impact of the risk factors on the infections,with the intensity from high to low,were in turn as follows:retention time,chemotherapy regimen,the frequency of dressing changes,hemogram and diabetes(x2 =46.28,45.52,37.04,25.23); but there was no significant correlation between the

  17. Risk factors and nursing countermeasures for central venous catheter-related infections in EICU%EICU中心静脉导管相关性感染的危险因素分析及护理对策

    Institute of Scientific and Technical Information of China (English)

    宋晓莉; 苗慧; 杨晓秋; 钱远宇; 孟庆义

    2012-01-01

    OBJECTIVE To investigate the risk factors and nursing countermeasures for central venous catheters related infections (CRI) in the emergency intensive care unit. METHODS Form-based recording methods were used to evaluate hand disinfection before the insertion of catheter, the choics, the sites, the frequency, the time, the care of puncture site, the connector of infusion and the choices of dressing and so on. RESULTS The incidence rate of CRI in 64 patients with venous catheters was 7. 8% , the risk factors mainly included venous catheter techniques, aseptic principles, the site of catheterization, using tine, and catheter maintenance. CONCLUSION In clinical practice, central venous catheter-related infection is inevitable because of a variety of factors. Form-based recording method for the nursing can remind ihe operators and maimainers of the preparation before the calhelerization, cooperation during the catheterization, and the nursing after the catheterization so as to reduce the incidence of infections.%目的 探讨急诊重症监护病房(EICU)患者深静脉置管后,中心静脉导管相关性感染的危险因素及护理对策.方法 采用表单式记录方法,记录置管前手消毒、置管时机、置管部位、置管顿次、置管时间、穿刺点护理、输液接头、敷料选择等内容.结果 通过对64例置管患者的—预,其导管相关性感染的发生率为7.8%,其危险因素主要与置管技术、无菌原则、插管部位、使用时间、导管维护等有关.结论 中心静脉导管在临床使用中由于多种因素的影响感染的发生难以避免,针对其危险因素,采用表单式的护理方法,可以提醒操作者及维护者在置管前的准备、置管中的配合及置管后的护理方法,从而降低感染的发生率.

  18. Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas, Brazil

    Directory of Open Access Journals (Sweden)

    Maria Tereza Freitas Tenório

    2010-04-01

    Full Text Available We observed the clinical and microbiological characteristics of several stages of bloodstream infections (BSI, as well as the mortality attributed to it in a tertiary hospital in the northeast of Brazil (in the city of Maceió, Alagoas. A prospective cohort of 143 patients who had at least one positive blood culture was enrolled in the study. Their clinical evolution was followed up for 30 days from October 2005 to December 2006. The relation among the qualitative variables was verified through Chi-square test. The significance level was 5%. The statistical package adopted was SPSS 15.0 for Windows. Up to the thirtieth day, 30.1% of the patients presented bacteremia and 69.9% developed sepsis.Among these, 20.3% developed severe sepsis and 10.5% septic shock. The mortality attributed to it was 37.8%. In bacteremia, sepsis, severe sepsis, and septic shock conditions, mortality rates were 9.3%, 50%, 65.5%, and 84.6%, respectively. Respiratory (32.2% and urinary (14% sources and the ones related to central venous catheter (14% were prevalent. In the wards 55.12% of the cases developed sepsis, whereas in the intensive care units, the rate was 87.69% (p < 0.05. Chronic renal failure, diabetes melitus, and neuropathy were present in 21.7%, 26.6%, and 29.4% of the cases, respectively. Coagulase-negative Staphylococcus (25.9%, Staphylococcus aureus (21%, and Klebsiella pneumoniae (14% were the most present microorganism in the sample. The high morbidity and mortality rates in this study are attributed to the lack of knowledge on BSI characteristics and on instituted protocols for detection and treatment in early stages.

  19. 中心静脉导管相关性感染危险因素调查分析%Risk factors of central venous catheter-related infections

    Institute of Scientific and Technical Information of China (English)

    杨梅

    2011-01-01

    OBJECTIVE To explore the risk factors and prevention measures of central venous catheter-related infections (CRI).METHODS Thirty-one cases from Jan 2007 to Dec 2008 in our hospital were analyzed retrospectively.RESULTS CRI was related to the indwelling time, location of catheter.The most susceptible crowd of central venous catheter-related infections was those patients in critical conditions, senile patients.CONCLUSION Shortening catheter indwelling time is important to prevent CRI through augmenting the monitoring and the careful nursing.%目的 通过对中心静脉导管相关性感染的调查分析,探讨中心静脉导管相关性感染的防治.方法 分析2007年1月-2008年12月临床31例中心静脉导管感染病例.结果 31例置管感染患者置管时间最短7 d,最长58 d,平均置管时间23.38 d;感染发生>7 d者29例,占93.55%,其中>2周的22例,占70.97%;20例感染前全身性使用抗菌药物,占64.52%;感染与导管留置时间、置管部位等相关,危重、老年患者是导管相关性感染的易感人群.结论 减少导管留置时间,长期留置导管患者需加强导管的监测与管理.

  20. Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Frydenberg, Morten

    2010-01-01

    BACKGROUND: Tunneled central venous catheters (CVCs) are inevitable in children with acute lymphoid leukemia (ALL). The aim of this study was to evaluate the risk of CVC-related complications in children with ALL in relation to timing of catheter placement and type of catheter. PROCEDURE: All chi...

  1. Catheter-related thrombosis in children with intestinal failure and long-term parenteral nutrition: How to treat and to prevent?

    NARCIS (Netherlands)

    C.H. van Ommen; M.M. Tabbers

    2010-01-01

    Survival of children with chronic intestinal failure has increased as result of administration of home parenteral nutrition. Crucial for the successful management of home parenteral nutrition is the availability of an adequate central venous access. Venous access can be fraught by episodes of cathet

  2. Central venous catheter - dressing change

    Science.gov (United States)

    ... during cancer treatment Bone marrow transplant - discharge Central venous catheter - flushing Peripherally inserted central catheter - flushing Sterile technique Surgical wound care - open Review Date 9/17/2016 Updated by: ...

  3. Effect of continuous quality improvement on central venous catheter-related infections in liver cancer patients%持续性质量改进对肝癌患者中心静脉置管相关感染的影响

    Institute of Scientific and Technical Information of China (English)

    李秀丽; 陈秀芳; 齐丽贞; 邱花叶; 刘百百

    2015-01-01

    bacterial colonization on catheters ,1 case of local catheter‐related infection ,and 2 cases of catheter‐related bloodstream infections .The central venous catheter‐related infections occurred in 31 cases in the control group with the infection rate of 21 .38% ,including 14 cases with bacterial colonization on catheters , 10 cases of local catheter‐related infections ,and 7 cases of catheter‐related bloodstream infections ;the incidence of the central venous catheter‐related infections of the intervention group was significantly lower than that of the con‐trol group (P< 0 .05) .CONCLUSION As is applied for the management of nosocomial infections ,the continuous quality improvement can significantly reduce the incidence of internal jugular central venous catheter‐related infec‐tions in the liver cancer patients .

  4. Analysis on the related factors of nosocomial urinary tract infection in elderly inpatients with indwelling catheter%老年患者留置尿管致院内泌尿系感染的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    杨君; 朱跃平

    2010-01-01

    目的 分析老年患者住院期间留置尿管发生泌尿系感染的相关因素,了解留置尿管老年患者泌尿系感染状况,为预防和控制泌尿系感染提供依据.方法 通过查阅病历、护理记录、尿常规和尿培养等化验报告与科室院内感染小组成员填写的医院获得性感染资料相结合的方法,对某院老年科2008年2月至2010年2月留置尿管老年患者(年龄≥60岁)的泌尿系感染状况进行分析.结果 本组224例留置尿管患者中发生泌尿系感染者82例,占36.5%.留置尿管的老年患者发生泌尿系感染情况与其年龄、性别、留置尿管的时间、尿管的护理措施等因素有关.结论 严格掌握老年患者留置尿管指征,尽量减少老年患者的置管率,缩短置管时间,积极治疗原发病,针对不同感染情况加强管道护理是降低院内泌尿系感染的有效措施.%Objective To explore the current status and related factors of nosocomial urinary tract infection in elderly inpatients with indwelling catheter so as to provide basis for prevention and control of urinary tract infection. Methods Medical records, nursing records, urine routine and urine culture of elderly patients aged 60 or above in a geriatric department from February 2008 to February 2010 were combined with data recorded by nosocomial infection supervisors to analyze the status of urinary tract infection caused by indwelling catheter. Results The rate of urinary tract infection in the 224 objects was 36.5% (82 cases). Factors related to urinary tract infection in elderly inpatients with indwelling catheter were age, gender, days of indwelling catheter use and its nursing care methods. Conclusions Nosocomial urinary tract infection rate can be effectively decreased by restrictedly controlling the use indication of indwelling catheter among elderly patients to minimize their use of such catheter, shortening the days of urinary catheter use, focusing on the control of primary

  5. Placement of a Hemodialysis Catheter using the Dilated Right External Jugular Vein as a Primary Route

    Energy Technology Data Exchange (ETDEWEB)

    Park, Mi Hyun [Dankook University Hospital, Cheonan (Korea, Republic of); Shin, Byung Seok [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2010-08-15

    To evaluate the feasibility that a dilated right external jugular vein (EJV) could be a primary venous access site for large bore hemodialysis catheter placement. Between January 2008 and April 2009, a total of 173 hemodialysis catheters (14.5 F) were placed. Among them, we evaluated the clinical data of 42 patients who underwent placement through a dilated right EJV. We evaluated technical success, duration of catheterization in days, and the presence of complications. Technical success was achieved for 41 patients (98%). Catheter placement was unsuccessful in one patient due to narrowing of the EJV. The catheter dwell time ranged between 14 and 305 days (mean; 76 days, total catheter days: 3,111 days). A total of 26 hemodialysis catheters were removed due to complications (n=2) and termination of hemodialysis via the hemodialysis catheter (n=24). There was air embolization (n=1) and catheter kinking (n=3) during procedures and catheter related infections (n=2) during the follow-up period. The incidence of catheter related infection was 0.06 per 100 catheter days. No cases of catheter malfunction or symptomatic venous thrombosis were observed. We suggest that a dilated right EJV could be considered as a preferred primary route for hemodialysis catheter placement with easy access

  6. Outcome of tunneled infusion catheters inserted via the right internal jugular vein

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Sung Wook; Do, Young Soo; Choo, Sung Wook; Yoo, Wi Kang; Choo, In Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jae Hyung [Sanggye Paik Hospital, Inje University, Seoul (Korea, Republic of)

    2003-03-01

    To assess the outcome of tunneled central venous catheter placement via the right internal jugular vein. Between June 2001 and May 2002, 670 consecutive Hickman catheters were placed in 654 patients via the right internal jugular vein. The procedural complications arising and follow-up data obtained from May to July 2002 were evaluated. The technical success rate for catheter placement was 99.9% (669/670). Procedural complications were limited to eight cases (1.2%), including three pneumothoraces, one early migration of the catheter, one clinically unimportant air embolism, one catheter injury, one catheter kinking and one primary malpositioning in the azygos vein. Catheter dwelling time ranged from 1 to 407 (mean 107.1) days. During the follow-up period, 416 catheter were removed for various reasons: treatment had ended (n=334), patients declined treatment or their drug regimen was changed (n=16), late complications arose (n=53), or other circumstances intervened (n=13). Late complications included 44 cases of catheter-related infection (6.6%), five of catheter migration (0.7%), two of catheter occlusion (0.3%), one of thrombophlebitis (0.15%), and one of catheter-related right atrial thrombosis (0.15%). Only one instance of symptomatic venous thrombosis or stenosis was noted, namely the one case of thrombophlebitis. Because the incidence of subsequent symptomatic venous thrombosis or stenosis is lower, the preferred route for tunneled central venous catheter placement is the right internal jugular vein.

  7. Bloodstream form pre-adaptation to the tsetse fly in Trypanosoma brucei.

    Science.gov (United States)

    Rico, Eva; Rojas, Federico; Mony, Binny M; Szoor, Balazs; Macgregor, Paula; Matthews, Keith R

    2013-01-01

    African trypanosomes are sustained in the bloodstream of their mammalian hosts by their extreme capacity for antigenic variation. However, for life cycle progression, trypanosomes also must generate transmission stages called stumpy forms that are pre-adapted to survive when taken up during the bloodmeal of the disease vector, tsetse flies. These stumpy forms are rather different to the proliferative slender forms that maintain the bloodstream parasitaemia. Firstly, they are non proliferative and morphologically distinct, secondly, they show particular sensitivity to environmental cues that signal entry to the tsetse fly and, thirdly, they are relatively robust such that they survive the changes in temperature, pH and proteolytic environment encountered within the tsetse midgut. These characteristics require regulated changes in gene expression to pre-adapt the parasite and the use of environmental sensing mechanisms, both of which allow the rapid initiation of differentiation to tsetse midgut procyclic forms upon transmission. Interestingly, the generation of stumpy forms is also regulated and periodic in the mammalian blood, this being governed by a density-sensing mechanism whereby a parasite-derived signal drives cell cycle arrest and cellular development both to optimize transmission and to prevent uncontrolled parasite multiplication overwhelming the host. In this review we detail recent developments in our understanding of the molecular mechanisms that underpin the production of stumpy forms in the mammalian bloodstream and their signal perception pathways both in the mammalian bloodstream and upon entry into the tsetse fly. These discoveries are discussed in the context of conserved eukaryotic signaling and differentiation mechanisms. Further, their potential to act as targets for therapeutic strategies that disrupt parasite development either in the mammalian bloodstream or upon their transmission to tsetse flies is also discussed.

  8. Analysis of risk factors and strategies for prevention of catheter- related infection in general intensive care unit%综合ICU导管相关性感染危险因素分析及预防对策

    Institute of Scientific and Technical Information of China (English)

    李素玲; 蒋仕银

    2012-01-01

    Objective: To study the risk factors of central venous catheter - related infection in general ICU and its strategies for prevention. Methods; To retrospectively analyze the results of bacterial culture of samples of 218 cases with central venous catheter indwelling admitted to the general ICU from 2009 to 2010. Result: Of the 21S samples cultured, 46 were positive and the general correlated infection rate wag 21.1 %, Out of the total bacteria, positive cocci accounted for 63.04% , fungus 28.3% and negative bacilli S. 7%. There were several significant factors concerning the infection related to central venous catheter; ages, the position of indwelling and the indwelling time of the catheter, application of parenteral nutrition and tracheotomy. Conclusion; The primary pathogen of central venous catheter - related infection in general ICU is staphylococcus, and the second one is fungus. Asepsis technique during the operation should be strictly handled. Special attention should be paid to the strict nursing care, the indwelling time of the central venous catheter should be shortened. In addition, rational use of antibiotics were significant in the prevention of the infection related to central venous catheter in general ICU.%[目的]:探讨并分析综合ICU患者中心静脉导管感染的危险因素及预防对策.[方法]:选择综合ICU 2009年7月~2010年6月中心静脉置管患者218例,对所有送检的中心静脉导管的培养结果进行回顾性分析.[结果]:218例样本中细菌培养阳性46例,感染率为21.10%,其中G+球菌占63.04%,真菌占28.26%,G一杆菌占8.70%.与中心静脉导管相关性感染有显著关系的因素有年龄、置管部位、导管留置时间、应用静脉高营养、气管切开应用呼吸机等(P<0.05).[结论]:引起综合ICU中心静脉导管感染的病原菌以葡萄球菌为首位,其次为真菌.严格的无菌操作、缩短置管时间和合理使用抗菌药物,对防止综合ICU患者中

  9. Using QCC to Reduce Peritoneal Dialysis Catheter Related Complications%运用品管圈降低腹膜透析患者导管并发症分析

    Institute of Scientific and Technical Information of China (English)

    惠菊芬; 薛菲; 李红仙; 施敏敏; 王颖

    2014-01-01

    目的:探讨品管圈对提高腹膜透析(简称:腹透)患者透析管维护质量、降低导管相关并发症发生率的作用。方法按品管圈理论进行现状把握、计划拟定、目标设定、要因分析、对策拟定、实施检讨、效果确认、标准化。结果导管堵塞,移位,管周渗漏,相关感染等发生率均下降,且前后差异具有统计学意义(P<0.05)。结论品管圈可以提高透析管维护质量,降低透析管相关并发症发生率;具有主动管理的优点,能够更好地促进临床实际问题的解决,促进透析管维护管理制度、标准化操作流程的建立和完善。%Objective To explore the effect of application of Quality Control Circle(QCC)to improve the quality of maintaining catheter in peritoneal dialysis patients and reduce the rate of catheter related compilation. Methods according to the QCC theory to master states, formulate plans, set goals, analysis, make decisions, re-view implementation confirm the effect and standardize procedure.Results The rates of catheter occlusion, drift, leakage, infection were lower in QCC group thou in non-QCC group( P<0.05) .Conclusions using the QCC to protect and manage the dialysis catheter is good for improving the quality of dialysis tube and reducing the incidence of catheter related compilations.It has the advantage of managing actively, and is a benefit to resolve some denial problems.It is able to contribute to the establishment and improvement of peritoneal dialysis standard operating pro-cedure.

  10. Effectiveness of Antimicrobial-coated Central Venous Catheters on Catheter-related Bloodstream Infections: A Systematic Review%抗感染导管预防导管相关性血流感染效果的系统评价

    Institute of Scientific and Technical Information of China (English)

    李惠萍; 周美玲

    2010-01-01

    目的 系统评价肿瘤患者使用抗感染导管预防导管相关性血流感染(CRBSI)的效果.方法 计算机检索Cochrane图书馆、中文、英文数据库中关于肿瘤患者使用抗感染导管的随机对照试验,同时筛检纳入文献的参考文献;对文献质量进行严格评价和资料提取,对符合质量标准的RCT进行荟萃分析.结果 共纳入6个RCT;显示抗感染导管能显著降低CRBSI的发生率(P<0.001),1个RCT显示涂抗菌药物的导管能有效预防CRBSI的发生(P=0.01),5个RCT显示涂消毒剂的导管能有效预防CRBSI的发生(P=0.02).结论 由于纳入研究少,均存在方法学上的不足,没有足够证据认为抗感染导管能够有效预防肿瘤患者发生CRBSI.

  11. Pacientes assintomáticos apresentam infecção relacionada ao cateter venoso utilizado para terapia nutricional parenteral Asymptomatic patients present infection related to the central venous catheter used for total parenteral nutrition

    Directory of Open Access Journals (Sweden)

    Juliana Deh Carvalho Machado

    2009-12-01

    Full Text Available OBJETIVO: Avaliar a freqüência de infecção relacionada ao cateter venoso central em pacientes submetidos a terapia nutricional parenteral. MÉTODOS: Foram analisados os cateteres venosos centrais de pacientes em terapia nutricional parenteral que tiveram a indicação de retirada do cateter venoso central por infecção, alta hospitalar, ou trombose. Os pacientes com infecção foram denominados de Grupo 1 e os demais de Grupo 2. RESULTADOS: Não houve diferença estatisticamente significante quanto ao estado nutricional dos 18 pacientes analisados. Foram analisados 28 cateteres e destes 68% estavam infectados, sendo 72% do Grupo 1 e 28% do Grupo 2 (assintomáticos. No Grupo 1, houve infecção sistêmica em 70% dos casos, já no Grupo 2 a hemocultura foi positiva em 17% dos casos. A colonização por Staphylococcus sp. ocorreu em 48% dos casos, seguida de Candida sp. (21%, Enterococcus faecalis (16%, Pseudomonas aerurginosa (10% e Proteus sp.(5%. CONCLUSÃO: A contaminação de cateter venoso central utilizado para terapia nutricional parenteral é freqüente. Mesmo pacientes assintomáticos recebendo nutrição parenteral têm uma incidência maior de infecção por Candida sp. Portanto é necessária a criação de barreiras que impeçam a colonização destes cateteres venosos centrais, a fim de diminuir a morbimortalidade de pacientes dependentes deste tipo de terapia.OBJECTIVE: The aim of this study was to evaluate the frequency of central venous catheter-related infections in hospitalized patients receiving total parenteral nutrition. METHODS: Central venous catheters were analyzed immediately after removal due to infection, hospital discharge or thrombosis. The patients with catheter-related infection were named Group 1 and the other patients were named Group 2. RESULTS: Eighteen patients were studied. There was no statistically significant difference in nutritional status between the two groups. A total of 28 catheters were analyzed

  12. 综合护理对中心静脉导管并发症的干预作用%INTERVENTION EFFECT OF COMPREHENSIVE CARE ON CENTRAL VENOUS CATHETER RELATED ;COMPLICATIONS

    Institute of Scientific and Technical Information of China (English)

    穆树敏; 穆树林; 刘晶; 柴囡; 史素丽; 尚秀娟; 程爱斌

    2016-01-01

    目的:探讨综合性护理对中心静脉导管相关并发症的干预作用。方法选取2013年6月—2015年6月在我院留置中心静脉导管患者256例为研究对象,采用对照研究,将2013年7月—2014年6月的126例作为对照组,2014年7月—2015年6月的130例为干预组。干预组患者实施综合性护理,对照组给予常规护理,对二组患者导管留置期间的并发症和健康教育的效果进行比较,并评价患者对护理工作的满意度。结果干预组导管破损率为6.9%、导管阻塞率为8.4%、导管移位脱出率为0.8%、导管相关性感染率为9.2%、导管相关性血栓形成率为3.8%、静脉炎率为6.9%均明显低于对照组,差异有统计学意义(P <0.05);干预组对导管相关知识和维护技能的掌握程度及对护理的依从性显著高于对照组,差异有统计学意义(P <0.05);干预组和对照组对护理工作的满意度分别为94.6%和80.2%,两者比较差异有统计学意义(P <0.05)。结论通过综合护理干预可以降低导管相关并发症的发生率,提高患者对导管知识和维护技能的掌握程度及对护理的依从性和满意度。%Objective To evaluate the intervention effect of comprehensive care on central venous catheter related complications.Methods A total of 256 patients with indwelling central venous catheter were se-lected in author's hospital as the research subjects from July 2013 to June 2015.Among them,126 cases were as the control group in July 2013 to June 2014,other 130 cases were as the intervention group in July 2014 to June 2015.The patients in the intervention group were given comprehensive care,while the control group received basic nursing.Catheter-related complications in patients with two groups were compared. The health education master degree and satisfaction of nursing work for all the subjects were evaluated.Re-sults In the intervention group,the rate of catheter breakage was 6.9%,catheter blocking 8.4%,cathe-ter

  13. Bacteriemia relacionada a catéter por Ochrobactrum anthropi Catheter-associated bacteremia caused by Ochrobactrum anthropi

    Directory of Open Access Journals (Sweden)

    Rolando Soloaga

    2009-12-01

    perspiration and sensorium deterioration. He had type 2 diabetes and antecedent of cerebrovascular accident. A double-lumen dialysis catheter was present due to chronic renal insufficiency. An episode of catheter-related bloodstream infection was documented by using Bact-Alert Blood Culture System and Differential-Time-to-Positivity Method for central venous catheter versus peripheral blood cultures (>120 min. Once removed, it was confirmed through Maki semi quantitative technique (>15 FCU. The microorganism was identified by API 20NE and Vitek 1 as Ochrobactrum anthropi.

  14. Percutaneous catheter use in newborn infants with parenteral nutrition.

    Science.gov (United States)

    García del Río, M; Lastra-Sanchez, G; Martínez-Léon, M; Martínez-Valverde, A

    1998-12-01

    The well known negative effect of infection on nutrition causes the cycle 'infection-malnutrition-infection'. Prolonged parenteral nutrition requires central venous catheterization. Due to the possibility of 'catheter related sepsis' (CRS) catheters should be used correctly to avoid septic complications. A very high percentage of central venous catheters (CVC) removed because of presumed infections are not infected when culture is done. In some patients infections are successfully treated with antibiotics without catheter removal. Removal of the line is recommended when catheter-associated sepsis is suspected or proven, but not for the extremely ill preterm infant or when such removal may be impractical. A therapeutic protocol is suggested to avoid future canalizations in the neonate, sometimes in a critical situation. Current literature referring to CRS in the newborn infant is reviewed.

  15. Diagnosis and Rescue of a Kinked Pulmonary Artery Catheter

    Directory of Open Access Journals (Sweden)

    Nicolas J. Mouawad

    2015-01-01

    Full Text Available Invasive hemodynamic monitoring with a pulmonary catheter has been relatively routine in cardiovascular and complex surgical operations as well as in the management of critical illnesses. However, due to multiple potential complications and its invasive nature, its use has decreased over the years and less invasive methods such as transesophageal echocardiography and hemodynamic sensors have gained widespread favor. Unlike these less invasive forms of hemodynamic monitoring, pulmonary artery catheters require an advanced understanding of cardiopulmonary physiology, anatomy, and the potential for complications in order to properly place, manage, and interpret the device. We describe a case wherein significant resistance was encountered during multiple unsuccessful attempts at removing a patient’s catheter secondary to kinking and twisting of the catheter tip. These attempts to remove the catheter serve to demonstrate potential rescue options for such a situation. Ultimately, successful removal of the catheter was accomplished by simultaneous catheter retraction and sheath advancement while gently pulling both objects from the cannulation site. In addition to being skilled in catheter placement, it is imperative that providers comprehend the risks and complications of this invasive monitoring tool.

  16. Bloodstream Infections with Mycobacterium tuberculosis among HIV patients

    Centers for Disease Control (CDC) Podcasts

    2010-09-23

    This podcast looks at bloodstream infections with Mycobacterium tuberculosis and other pathogens among outpatients infected with HIV in Southeast Asia. CDC health scientist Kimberly McCarthy discusses the study and why bloodstream infections occur in HIV-infected populations.  Created: 9/23/2010 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 9/23/2010.

  17. Bacterial infection of central venous catheters in short-term total parenteral nutrition.

    Science.gov (United States)

    Chan, L; Ngeow, Y F; Parasakthi, N

    1998-03-01

    Fourteen severely ill ventilated patients in an intensive care unit, requiring short-term total parenteral nutrition, were examined for catheter-related infection. Microbiological analysis using Maki's SQ technique was carried out on catheter exit site, catheter hub, proximal subcutaneous segment of catheter and catheter up. Qualitative cultures were carried out on total parenteral nutrition and peripheral blood samples. Twenty six of 29 catheters removed (90%) were culture positive but only 7 catheters were related to positive blood cultures, giving a catheter-related bacteremia (CRB) rate of 24%. Haematogenous seeding was strongly implicated in 7/29 (24%) of catheters. Patients' skin flora appeared to be the main source of catheter-related infection. The organisms isolated for patients with CRB included coagulase-negative staphylococci, Acinetobacter and Klebsiella. It is suggested that to control infective complications of central venous catheters, emphasis should be focused on specialised intravenous therapy teams and the use of strict protocols for insertion and care of central lines.

  18. 肿瘤患者中心静脉导管真菌感染的相关因素分析%Related factors for central venous catheter-related fungal infections in tumor patients

    Institute of Scientific and Technical Information of China (English)

    祖璎玲; 周健; 赵霞; 张小琴; 张龑莉; 房佰俊; 魏旭东; 宋永平

    2013-01-01

    OBJECTIVE To explore the incidence, etiology, and risk factors of central venous catheter (CVC)-related fungal infections in tumor patients so as to propose the effective prevention measures. METHODS The related factors for infections in 200 tumor patients who underwent CVC from Jan to Oct, 2011 were reviewed retrospectively. RESULTS The incidence of CVC-related fungal infections was 15. 0%. There were 26 cases with single CVC-related infections and 4 cases with fungemia. Candida parapsilosis, Candida tropicalis, Candida ruffle monilia , Candida albicans, and Candida glabrata accounted for 53. 3% , 16. 7% > 13. 3%, 10. 0% and 6. 7% , respectively. The gender, age, types of tumor, and surgery were negatively correlated with the incidence of CVC-related infections, the difference in the infection rates between the different sites of catheterization was statistically significant (P<0. 05), the difference in the catheterization duration between the patients with CVC-related infections was statistically significant(P<0. 05) , totally 26 cases with infections were cured after extuba-tion of CVC, 3 of 4 patients with fungemia were cured after the antifungal treatment, and 1 case died of the mixed pulmonary Candida infections. CONCLUSION Candida parapsilosis is the predominant pathogen causing CVC-related fungal infections in the tumor patients. Timely extubation of CVC can effectively prevent catheter-related blood stream infections.%目的 探讨肿瘤患者中心静脉导管(CVC)真菌感染的分布与发生率,分析其相关因素,提出有效的预防改进措施.方法 回顾性分析2011年1-10月医院留置CVC的200例肿瘤患者的感染情况及相关因素.结果 CVC相关性真菌感染发生率为15.0%,其中26例单纯CVC感染(CVC-RI),4例合并真菌血症,其中近平滑假丝酵母菌、热带假丝酵母菌、皱褶假丝酵母菌、白色假丝酵母菌及光滑假丝酵母菌分别占53.3%、16.7%、13.3%、10.0%及6.7%;CVC感染发

  19. When Prostate Cancer Circulates in the Bloodstream

    Directory of Open Access Journals (Sweden)

    Virginie Vlaeminck-Guillem

    2015-10-01

    Full Text Available Management of patients with prostate cancer is currently based on imperfect clinical, biological, radiological and pathological evaluation. Prostate cancer aggressiveness, including metastatic potential, remains difficult to accurately estimate. In an attempt to better adapt therapeutics to an individual (personalized medicine, reliable evaluation of the intrinsic molecular biology of the tumor is warranted, and particularly for all tumor sites (primary tumors and secondary sites at any time of the disease progression. As a consequence of their natural tendency to grow (passive invasion or as a consequence of an active blood vessel invasion by metastase-initiating cells, tumors shed various materials into the bloodstream. Major efforts have been recently made to develop powerful and accurate methods able to detect, quantify and/or analyze all these circulating tumor materials: circulating tumors cells, disseminating tumor cells, extracellular vesicles (including exosomes, nucleic acids, etc. The aim of this review is to summarize current knowledge about these circulating tumor materials and their applications in translational research.

  20. Case-control Study of Risk Factors of Central Venous Catheter Tip Bacterial Colonization%中心静脉导管尖端细菌定植危险因素的病例对照研究

    Institute of Scientific and Technical Information of China (English)

    闫沛; 李武平; 宋向阳; 孙惠英; 刘冰

    2011-01-01

    factors included 2 aspects including catheter type and use of antibiotics. Conclusion Choosing appropriate size of catheter, caring of the insert spot, controlling of catheter time and using reasonable antibiotics are all beneficial for effective prevention of catheter-related blood-stream infection.

  1. Soft robotic concepts in catheter design: an on-demand fouling-release urinary catheter.

    Science.gov (United States)

    Levering, Vrad; Wang, Qiming; Shivapooja, Phanindhar; Zhao, Xuanhe; López, Gabriel P

    2014-10-01

    Infectious biofilms are problematic in many healthcare-related devices and are especially challenging and ubiquitous in urinary catheters. This report presents an on-demand fouling-release methodology to mechanically disrupt and remove biofilms, and proposes this method for the active removal of infectious biofilms from the previously inaccessible main drainage lumen of urinary catheters. Mature Proteus mirabilis crystalline biofilms detach from silicone elastomer substrates upon application of strain to the substrate, and increasing the strain rate increases biofilm detachment. The study presents a quantitative relationship between applied strain rate and biofilm debonding through an analysis of biofilm segment length and the driving force for debonding. Based on this mechanism, hydraulic and pneumatic elastomer actuation is used to achieve surface strain selectively within the lumen of prototypes of sections of a fouling-release urinary catheter. Proof-of-concept prototypes of sections of active, fouling-release catheters are constructed using techniques typical to soft robotics including 3D printing and replica molding, and those prototypes demonstrate release of mature P. mirabilis crystalline biofilms (e.g., ≈90%) from strained surfaces. These results provide a basis for the development of a new urinary catheter technology in which infectious biofilms are effectively managed through new methods that are entirely complementary to existing approaches.

  2. Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal

    Science.gov (United States)

    Urbanetto, Janete de Souza; Peixoto, Cibelle Grassmann; May, Tássia Amanda

    2016-01-01

    ABSTRACT Objective: to investigate the incidence of phlebitis and its association with risk factors when using peripheral IV catheters (PIC) and following their removal - (post-infusion phlebitis) in hospitalized adults. Method: a cohort study of 171 patients using PIC, totaling 361 punctures. Sociodemographic variables and variables associated with the catheter were collected. Descriptive and analytical statistical analyses were performed. Results: average patient age was 56.96 and 51.5% of the sample population was male. The incidence of phlebitis was 1.25% while using PIC, and 1.38% post-infusion. The incidence of phlebitis while using PIC was associated with the length of time the catheter remained in place, whereas post-infusion phlebitis was associated with puncture in the forearm. Ceftriaxone, Clarithromycin and Oxacillin are associated with post-infusion phlebitis. Conclusions: this study made it possible to investigate the association between risk factors and phlebitis during catheter use and following its removal. The frequency of post-infusion phlebitis was larger than the incidence of phlebitis with the catheter in place, with Phlebitis Grade III and II being the most frequently found in each of these situations, respectively. Aspects related to post-infusion phlebitis can be explained, given the limited number of studies addressing this theme from this perspective. PMID:27508916

  3. Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal

    Directory of Open Access Journals (Sweden)

    Janete de Souza Urbanetto

    Full Text Available ABSTRACT Objective: to investigate the incidence of phlebitis and its association with risk factors when using peripheral IV catheters (PIC and following their removal - (post-infusion phlebitis in hospitalized adults. Method: a cohort study of 171 patients using PIC, totaling 361 punctures. Sociodemographic variables and variables associated with the catheter were collected. Descriptive and analytical statistical analyses were performed. Results: average patient age was 56.96 and 51.5% of the sample population was male. The incidence of phlebitis was 1.25% while using PIC, and 1.38% post-infusion. The incidence of phlebitis while using PIC was associated with the length of time the catheter remained in place, whereas post-infusion phlebitis was associated with puncture in the forearm. Ceftriaxone, Clarithromycin and Oxacillin are associated with post-infusion phlebitis. Conclusions: this study made it possible to investigate the association between risk factors and phlebitis during catheter use and following its removal. The frequency of post-infusion phlebitis was larger than the incidence of phlebitis with the catheter in place, with Phlebitis Grade III and II being the most frequently found in each of these situations, respectively. Aspects related to post-infusion phlebitis can be explained, given the limited number of studies addressing this theme from this perspective.

  4. Etiological analysis and prevention of central venous catheter related infections%中心静脉导管相关感染的病原学分析与预防

    Institute of Scientific and Technical Information of China (English)

    刘凤梅; 蔡益民; 任丽霞

    2013-01-01

    Objective To investigate the distribution of pathogens and routes of infection for central venous catheter-related infections, and thereafter to provide the basis for clinical prevention. Methods Randomly select-ed 52 patients that catheter tip culture results were positive, all the patients come from a same hospital in Jilin province, and then conducted a retrospective analysis of the data. Results There are 82 pathogenic bacteria ap-peared in the experiment among the 52 infected patients. The major pathogenic bacteria were G+ (65/82 or 79.27%), G-bacteria (16/82 or 19.51%)and Fungi (1/82 or 1.22%).The route of infection is consist of catheter ex-traluminal pathogens planting, catheter connector and cavity pathogens planting, blood flow propagating. Conclu-sion Strengthen the education and training of medical staff and take positive and effective prevention measures can reduce the infection.%目的:探讨中心静脉导管相关感染的病原菌分布及感染途径,为临床预防提供依据。方法:选取吉林省某三甲医院神经外科导管尖端培养结果阳性的52例患者进行回顾性分析。结果:52例感染病例中培养出细菌82株,其中G+菌65株占79.27%,G-菌16株占19.51%,真菌1株占1.22%;导管的腔外致病菌种植、导管接头和导管腔内致病菌种植、血流播散为感染途径。结论:加强医护人员的教育培训,采取积极有效的预防措施可降低导管相关感染。

  5. 中心静脉置管易被忽略的感染因素分析与对策%Easily ignored factors of central venous catheter-related infection and countermeasures

    Institute of Scientific and Technical Information of China (English)

    张黎明; 王黎梅; 步惠琴; 张美琪

    2011-01-01

    OBJECTIVE To analyze the easily ignored factors for central venous catheter-related infection (CVC-RI)and to seek certain strategy.METHODS The easily ignored factors of CVC-RI of 63 cases in ICU and geriatric wards of the two hospitals were analyzed with retrospective analysis method and prospective intervention method.Certain solutions were proposed.RESULTS The CVC-RI incidence of 279 cases who got central venous catheter from Jan to Jul in 2009 was 10.39 %, and the CVC-RI incidence of 264 cases who got central venous catheter from Jan to Jul in 2008 was 23.86 %, the difference of CVC-RI incidence in the two groups was statistically significant.CONCLUSION Paying close attention and strengthening the catheter puncture operation and daily care for puncture site can significantly reduce the incidence of CVC-RI.%目的 分析中心静脉置管相关性感染(CVC-RI)易被忽略的危险因素及进行环节上的改进.方法 采用回顾性调查分析和前瞻性干预的方法,对2所医院ICU、老年病区2008年63例CVC-RI患者进行原因分析,查找易被忽略的危险因素,提出对策,并与2009年1月起加强了环节管理后的CVC-RI结果进行统计分析.结果 2009年1-7月实施中心静脉穿刺279例患者发生CVC-RI29例,发生率10.39%,2008年同期置管的264例患者发生CVC-RI63例,发生率23.86%,两组感染率比较,差异有统计学意义(P<0.05).结论 关注并加强置管操作和穿刺部位日常护理中的环节管理,能有效降低CVC-RI的发生率.

  6. Analysis of integrated ICU catheter associated nosocomial infection and related factors%综合性ICU导管相关性医院感染及相关因素分析

    Institute of Scientific and Technical Information of China (English)

    范红莉

    2016-01-01

    Objective:To explore the integrated ICU catheter associated nosocomial infection and related factors.Methods:320 patients with integrated ICU catheter associated nosocomial infection were selected.The clinical data were retrospectively analyzed.Results:The positive rate of blood flow infection,pulmonary infection and urinary tract infection was 22.81%,51.56% and 25.63% respectively,and the positive rate of pulmonary infection was the highest(P0.05).Conclusion:Pulmonary infection was the most in integrated ICU catheter associated nosocomial infection,and gram negative bacteria were the main pathogens.Catheter associated nosocomial infection may not be an independent risk factor for mortality.%目的:探讨综合性ICU导管相关医院感染和相关因素。方法:收治综合性ICU导管相关性医院感染患者320例,回顾性分析临床资料。结果:血流感染、肺部感染及尿路感染阳性检出率分别为22.81%、51.56%及25.63%,其中,肺部感染阳性率最高(P<0.01)。革兰阴性菌、革兰阳性菌及假丝酵母菌构成比分别为67.81%、16.88%及15.31%,其中,革兰阴性菌构成比最高(P<0.01)。血流感染、肺部感染及尿路感染患者中死亡率分别为16.44%、15.76%及13.41%(P>0.05)。结论:ICU导管相关性医院感染以肺部感染为主,革兰阴性菌为主要病原菌。导管相关性医院感染可能并非影响死亡率的独立危险因素。

  7. The application of root cause analytical method in reducing infections related to central venous catheter%根因分析法在降低中心静脉导管相关性感染中的应用

    Institute of Scientific and Technical Information of China (English)

    江寅芳; 郭海珍; 夏娟; 夏肖枫; 冯惠春

    2015-01-01

    OBJECTIVE To reduce the incidence of central venous catheter‐related infections and improve the safety of the patients with central venous catheter by root cause analytical method .METHODS The clinical data of 768 cases and 838 cases treated with central venous catheter in 2012 and 2013 were investigated .Through using the method of root cause analysis to analyze proximal causes and root causes for the 84 cases of catheter‐related infections in 2012 ,the central venous catheter assessment and monitoring mechanism were set to improve the catheter insertion method and the maintenance method ,and strengthen the training of nurses and the mission to patients and their families .The effect was traced in 2013 .RESULTS There were 84 cases with central venous catheter‐related infections in 2012 ;the infection rate was 10 .9% .And in 2013 ,this number was 46 cases;the infection rate was 5 .5% .The differences of the two years′infection rate was significant(P<0 .05) .The insertion site infection and catheter‐related infection (CRBSI) incidence of 2013 were 29(3 .5% )and 17(2 .0% ) ,lower than those of 2012 ,60(7 .8% )and 24(3 .1% ) ,there was significant differences (P<0 .05) .According to the days of the central catheter indwelling statistics ,the daily infection rate fell from 7 .2/1000 to 3 .5/1000 .CONCLUSION Root cause analytical method can provide a scientific way for systematically and effectively reducing the occurrence of central venous catheter‐related infections .%目的:通过根因分析减少中心静脉置管后相关性感染的发生率,提高置管患者的安全性。方法调查2012、2013年行中心静脉置管各768、838例患者资料,对2012年发生中心静脉导管感染患者,运用根因分析方法进行近端原因、根本原因分析,制定中心静脉导管的评估和监控机制,改进导管的置管与维护方法,强化对护士的培训和对患者及家属的宣教,于2013年对改

  8. 银离子抗菌凝胶预防留置尿管相关尿路感染的效果观察%Effect of Ag+-antibacterial gelatin on prevention of catheter-related urinary tract infections

    Institute of Scientific and Technical Information of China (English)

    刘夕珍; 刘春生; 史广玲; 刘娟

    2013-01-01

    目的 探讨应用活性银离子抗菌凝胶外涂尿道口,预防留置尿管相关尿路感染的效果.方法 采取随机数字表法将145例符合纳入标准的研究对象分为观察组73例和对照组72例;对照组采取常规方法实施导尿管的日常维护;观察组在对照组的基础上于每次会阴护理后使用活性银离子抗菌凝胶涂抹尿道口;分别留取导尿后0、3、5、7、10 d尿标本送检,观察两组留置尿管相关尿路感染的发生率.结果 观察组有3例发生留置尿管相关尿路感染,千日感染率为3.27‰;对照组有8例发生留置尿管相关尿路感染,千日感染率为8.97‰,差异有统计学意义(x2 =18.40 P<0.05).结论 应用活性银离子抗菌凝胶外涂尿道口是预防留置尿管相关尿路感染简单有效的方法,临床值得推广.%OBJECTIVE To investigate the effect of Ag+-antibacterial gelatin coated to urethral meatus on the prevention of the catheter-related urinary tract infections. METHODS By means of the random number table, totally 145 qualified participants were enrolled in the study and were divided into the observation group with 73 cases and the control group with 72 cases; the control group was treated with conventional method for the maintenance of catheter, while the observation group was coated with Ag+-antibacterial gelatin to urethral meatus on the basis of control group after the perineal cleaning; the urine were respectively sampled and submitted at 0, 3, 5, 7 , and 10 days after the catheterization; the incidence rate of the catheter-related urinary tract infections between the two groups of patients was observed. RESULTS There were 3 (3. 27‰) cases of patients with the catheter-related urinary tract infections in the observation group and 8 (8. 97‰) cases in the control group, the difference was statistically significant (χ2 = 18. 40, P<0. 05). CONCLUSION The application of Ag+-antimicrobial gel to coat the urethral meatus is a

  9. Usefulness of multifunctional gastrointestinal coil catheter for colorectal stent placement

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae-Hyung; Shin, Ji Hoon; Kim, Jin Hyoung; Lim, Jin-Oh; Kim, Kyung Rae [Asan Medical Center, Radiology and Research Institute of Radiology, Seoul (Korea); Song, Ho-Young [Asan Medical Center - Radiology, Songpa-gu, Seoul (Korea); Park, In Kook [Dongguk University, Life Science, Seoul (Korea); Choi, Eugene K. [Weill Medical College of Cornell University, New York, NY (United States)

    2008-11-15

    The purpose of this study was to evaluate the usefulness of a multifunctional gastrointestinal coil catheter for stent placement in 98 patients with colorectal strictures. The catheter was used in 98 consecutive patients for stent placement in the rectum (n = 24), recto-sigmoid (n = 13), sigmoid (n = 38), descending (n = 6), transverse (n = 11), splenic flexure (n = 3), hepatic flexure (n = 2), and ascending (n = 1) colon. The catheter was made of a stainless steel coil (1.3 mm in inner diameter), a 0.4-mm nitinol wire, a polyolefin tube, and a hemostasis valve. Usefulness of the catheter was evaluated depending on whether the catheter could pass a stricture over a guide wire and whether measurement of the stricture length was possible. The passage of the catheter over a guide wire beyond the stricture was technically successful and well tolerated in 93 (94.9%) of 98 patients. In the failed five patients, it was not possible to negotiate the guide wire due to presence of nearly complete small bowel obstruction. The average length of stricture was 6.15 cm (range, 3 cm to 20 cm) in patients with the colorectal stricture. There were no procedure-related complications. In conclusion, the multifunctional coil catheter seems to be useful in colorectal stent placement. (orig.)

  10. Percutaneous catheter drainage of intraabdominal abscesses and fluid

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Kwon, Tae Hee; Yoo, Hyung Sik; Suh, Jung Ho [Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Young Ho [Cheil General Hospital, Seoul (Korea, Republic of)

    1986-10-15

    Percutaneous catheter drainage has been reported to be an effective method in the management of selected patients with abscess and fluid collection. Its high success rate and relatively low complications make the procedure an alternative to surgery in the individual cases. During past two years percutaneous catheter drainage in 25 patients with intraabdominal abscesses and fluid collection was performed at the Department of Radiology, Yonsei University College of medicine. Here the technique and author's results were summarized. 1. The total 25 patients who had percutaneous catheter drainage are 10 liver abscesses, 3 subphrenic, one subhepatic, 4 renal and perirenal, 2 pelvic, one psoas, one anterior pararenal fluid from acute pancreatitis, one pancreas pseudocyst and 2 malignant tumor necrosis. 2. The modified Seldinger technique used for all cases of abscess and fluid drainage under guidance of ultrasound scan. The used catheters were 10F. Pigtail and 14F. Malecot (Cook c/o) catheters. 3. The abscesses and fluid of 17 patients among 25 were cured by the percutaneous catheter drainage and 4 patients were clinically improved. The catheter drainage was failed in 2 patients and 3 complication were developed. 4. The success rate of this procedure was 91.3%, failure rate was 8.7% and complication rate was 12%.

  11. Risk factors for central venous catheter-related infections in pediatric intensive care Fatores de risco para as infecções relacionadas ao caracter venoso central em terapia intensiva pediátrica

    Directory of Open Access Journals (Sweden)

    Ricardo Vilela

    2007-01-01

    Full Text Available OBJECTIVES: To identify risk factors for short-term percutaneously inserted central venous catheter-related infections in children and to evaluate the accuracy of a mortality score in predicting the risk of infection. METHOD: After reviewing the charts of patients who developed catheter-related infection in a university hospital's pediatric intensive care unit, we conducted a case-controlled study with 51 pairs. Variables related to patients and to catheter insertion and use were analyzed. Risk factors were defined by logistic regression analysis. The accuracy of the Pediatric Risk of Mortality score to discriminate the risk for infection was tested using the Receiver Operating Characteristic curve. RESULTS: Infection was associated with respiratory failure, patient's length of stay, duration of tracheal intubation, insertion of catheter in the intensive care unit and parenteral nutrition. Insertion site (femoral or internal jugular was unimportant. Multivariate logistic regression analysis identified the following variables. Risk factors included more than one catheter placement (p=0.014 and duration of catheter use (p=0.0013, and protective factors included concomitant antibiotic use (p=0.0005 and an intermittent infusion regimen followed by heparin filling compared to continuous infusion without heparin (p=0.0002. Pediatric Risk of Mortality did not discriminate the risk of infection. CONCLUSIONS: Central parenteral nutrition and central venous catheters should be withdrawn as soon as possible. Femoral vein catheterization carries a risk of infection similar to internal jugular catheterization. The Pediatric Risk of Mortality score should not be used to predict the risk of central catheter-related infections.OBJETIVOS: Identificar fatores de risco para as infecções relacionadas a cateter venoso central de curta permanência, inserido por punção, em crianças e avaliar a eficiência de um escore de mortalidade pediátrica em prever o risco

  12. Co-release of dicloxacillin and thioridazine from catheter material containing an interpenetrating polymer network for inhibiting device-associated Staphylococcus aureus infection

    DEFF Research Database (Denmark)

    Stenger, Michael; Klein, Kasper; Grønnemose, Rasmus B;

    2016-01-01

    Approximately half of all nosocomial bloodstream infections are caused by bacterial colonization of vascular catheters. Attempts have been made to improve devices using anti-adhesive or antimicrobial coatings; however, it is often difficult to bind coatings stably to catheter materials, and the low...... amounts of drug in thin-film coatings limit effective long-term release. Interpenetrating polymer networks (IPNs) are polymer hybrid materials with unique drug release properties. While IPNs have been extensively investigated for use in tablet- or capsule-based drug delivery systems, the potential for use...

  13. Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil

    Directory of Open Access Journals (Sweden)

    Tamara Trelha Gauna

    2013-08-01

    Full Text Available Introduction Vascular access in patients undergoing hemodialysis is considered a critical determinant of bloodstream infection (BSI and is associated with high morbidity and mortality. The purpose of this study was to investigate the occurrence of BSI in patients with end-stage renal disease using central venous catheters for hemodialysis. Methods A cohort study was conducted in a public teaching hospital in central-western Brazil from April 2010 to December 2011. For every patient, we noted the presence of hyperemia/exudation upon catheter insertion, as well as fever, shivering, and chills during hemodialysis. Results Fifty-nine patients were evaluated. Thirty-five (59.3% patients started dialysis due to urgency, 37 (62.7% had BSI, and 12 (20% died. Hyperemia at the catheter insertion site (64.9% was a significant clinical manifestation in patients with BSI. Statistical analysis revealed 1.7 times more cases of BSI in patients with hypoalbuminemia compared with patients with normal albumin levels. The principal infective agents identified in blood cultures and catheter-tip cultures were Staphylococcus species (24 cases, non-fermentative Gram-negative bacilli (7 cases of Stenotrophomonas maltophilia and 5 cases of Chryseobacterium indologenes, and Candida species (6. Among the Staphylococci identified, 77.7% were methicillin-resistant, coagulase-negative Staphylococci. Of the bacteria isolated, the most resistant were Chryseobacterium indologenes and Acinetobacter baumannii. Conclusions Blood culture was demonstrated to be an important diagnostic test and identified over 50% of positive BSI cases. The high frequency of BSI and the isolation of multiresistant bacteria were disturbing findings. Staphylococcus aureus was the most frequently isolated microorganism, although Gram-negative bacteria predominated overall. These results highlight the importance of infection prevention and control measures in dialysis units.

  14. Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection—Scotland, 2012–2013

    Science.gov (United States)

    Rajendran, R.; Sherry, L.; Nile, C.J.; Sherriff, A.; Johnson, E.M.; Hanson, M.F.; Williams, C.; Munro, C.A.; Jones, B.J.; Ramage, G.

    2016-01-01

    Bloodstream infections caused by Candida species remain a significant cause of morbidity and mortality in hospitalized patients. Biofilm formation by Candida species is an important virulence factor for disease pathogenesis. A prospective analysis of patients with Candida bloodstream infection (n = 217) in Scotland (2012–2013) was performed to assess the risk factors associated with patient mortality, in particular the impact of biofilm formation. Candida bloodstream isolates (n = 280) and clinical records for 157 patients were collected through 11 different health boards across Scotland. Biofilm formation by clinical isolates was assessed in vitro with standard biomass assays. The role of biofilm phenotype on treatment efficacy was also evaluated in vitro by treating preformed biofilms with fixed concentrations of different classes of antifungal. Available mortality data for 134 patients showed that the 30-day candidaemia case mortality rate was 41%, with predisposing factors including patient age and catheter removal. Multivariate Cox regression survival analysis for 42 patients showed a significantly higher mortality rate for Candida albicans infection than for Candida glabrata infection. Biofilm-forming ability was significantly associated with C. albicans mortality (34 patients). Finally, in vitro antifungal sensitivity testing showed that low biofilm formers and high biofilm formers were differentially affected by azoles and echinocandins, but not by polyenes. This study provides further evidence that the biofilm phenotype represents a significant clinical entity, and that isolates with this phenotype differentially respond to antifungal therapy in vitro. Collectively, these findings show that greater clinical understanding is required with respect to Candida biofilm infections, and the implications of isolate heterogeneity. PMID:26432192

  15. Dialysis Catheters and Their Common Complications: An Update

    Directory of Open Access Journals (Sweden)

    Satyaki Banerjee

    2009-01-01

    Full Text Available Tunneled dialysis catheters (TDCs are associated with the highest rate of complications, morbidity, and mortality when compared to arteriovenous fistulas or grafts, and this relates to higher costs in their management. Over time, catheters are prone to higher rates of infection, thrombosis, and central venous stenosis, and, thereby, catheter dysfunction. Lower blood flow rates are a consequence of the dysfuncion. Despite efforts to reduce incident and prevalent rates of catheter use for dialysis by the National Kidney Foundation and Fistula First Initiative, they remain a common modality of hemodialysis. The management of common TDC-related complications is discussed, in addition to ways to reduce and prevent morbidity associated with their use.

  16. 综合重症监护病房肠杆菌科细菌致血流感染发生的危险因素%Risk factors of bloodstream infections caused by enterobacteriaceae and related prognostic factors in general intensive care unit

    Institute of Scientific and Technical Information of China (English)

    孙伏喜; 冯旰珠; 高天明; 张扬; 赵水娣

    2014-01-01

    目的 探讨综合监护病房医院获得性肠杆菌科细菌血流感染(BSI)的危险因素.方法回顾性分析南京医科大学第二附属医院重症医学科综合监护病房2007年1月至2012年12月间南京医科大学第二附属医院重症医学科获得性肠杆菌科及非肠杆菌科细菌BSI患者的临床资料,分析肠杆菌科细菌BSI发生的危险因素,并以是否存活作为预后判定的终点指标,对肠杆菌科细菌BSI分别进行单因素及多因素Logistic回归分析,探究影响其存活的相关因素.结果 在96例医院获得性血流感染患者中35例为肠杆菌科细菌BSI,35例肠杆菌科细菌BSI患者中15例死亡,病死率42.9%;就肠杆菌科与非肠杆菌科细菌BSI患者的基础及临床特征对比后发现,影响肠杆菌科细菌BSI发生的危险因素包括急性胰腺炎、接受腹部手术及使用制酸剂(17.1%比4.9%,31.4%比16.4%,77.1%比45.9%;P<0.05 或0.01).对肠杆菌科细菌BSI患者生存组和死亡组各项特征的单因素分析及多因素Logistic回归分析发现,对肠杆菌科细菌BSI患者存活的影响因素包括患者年龄、APACHEⅡ评分、气管插管或切开及ESBL阳性(P<0.05).结论 在入住综合监护病房的患者中,急性胰腺炎、接受腹部手术及使用制酸剂的患者更易罹患肠杆菌科细菌BSI;而一旦发生细菌BSI,患者的年龄、APACHEⅡ评分、气管插管或切开及ESBLs阳性是影响其预后的重要因素.%Objective To explore the risk factors and its related prognostic factors of hospital-acquired bloodstream infections caused by enterobacteriaceae in general intensive care unit(GICU). Methods The clinical data of hospital-acquired bloodstream infections caused by enterobacteriaceae in general intensive care unit from January 2007 to December 2012 were retrospectively analyzed to determine the risk factors and explore the related prognostic factors of bloodstream infections by mono-factor and Logistic regression

  17. Genotypic analysis of Acinetobacter bloodstream infection isolates in a Turkish university hospital.

    NARCIS (Netherlands)

    Alp, E.; Esel, D.; Yildiz, O.; Voss, A.; Melchers, W.J.G.; Doganay, M.

    2006-01-01

    Acinetobacter baumannii is a significant pathogen of bloodstream infections in hospital patients that frequently causes single clone outbreaks. We aimed to evaluate the genetic relatedness and antimicrobial susceptibility of Acinetobacter spp. bloodstream isolates, in order to obtain insight into th

  18. A Taurolidine-Citrate-Heparin Lock Solution Effectively Eradicates Pathogens From the Catheter Biofilm in Hemodialysis Patients.

    Science.gov (United States)

    Zwiech, Rafał; Adelt, Maria; Chrul, Sławomir

    2016-01-01

    Catheter-related bacteremia (CRB) is a typical complication of hemodialysis catheter use. Catheter lumen colonization by pathogens is regarded as a direct cause of CRB. Once settled, the catheter biofilm increases the risk of developing infection, thus necessitating insertion replacement and antibiotic treatment. The study assessed the self-sufficient efficacy of taurolidine-citrate-heparin lock solution in eradicating catheter biofilm bacteria and keeping it sterile in patients on hemodialysis. Twenty-nine chronic patients on hemodialysis with tunneled and nontunneled catheters locked with a heparin filling (the mean time of heparin lock use -30.1 ± 2.0 days) and subsequently converted to a taurolidine-citrate-heparin filling were included. Peripheral vein and catheter lumen blood cultures were obtained before the filling change and after taurolidine-citrate-heparin lock use (mean time 33.8 ± 7.6 days). Twenty-four participants with tunneled and nontunneled catheters locked with taurolidine-citrate-heparin filling served as the control group. During the heparin-locking period, CRB was diagnosed in 3 cases (only nontunneled catheters). The catheter blood cultures findings were positive in 23 patients (10 temporary and 13 permanent catheters), whereas both the catheter and peripheral vein blood cultures were sterile in 3 of 29 subjects (only permanent catheters). Irrespective of catheter type (tunneled or nontunneled), repeated culture revealed no pathogens in any of the 23 patients with initial positive catheter blood culture, after the use of taurolidine-citrate-heparin filling. No positive blood culture was noted in the control group. The taurolidine-citrate-heparin lock solution effectively eradicated pathogens from nontunneled and tunneled catheter biofilms and helped to maintain catheter lumen sterility.

  19. Anatomical Consideration in Catheter Ablation of Idiopathic Ventricular Arrhythmias.

    Science.gov (United States)

    Yamada, Takumi; Kay, G Neal

    2016-01-01

    Idiopathic ventricular arrhythmias (VAs) are ventricular tachycardias (VTs) or premature ventricular contractions (PVCs) with a mechanism that is not related to myocardial scar. The sites of successful catheter ablation of idiopathic VA origins have been progressively elucidated and include both the endocardium and, less commonly, the epicardium. Idiopathic VAs usually originate from specific anatomical structures such as the ventricular outflow tracts, aortic root, atrioventricular (AV) annuli, papillary muscles, Purkinje network and so on, and exhibit characteristic electrocardiograms based on their anatomical background. Catheter ablation of idiopathic VAs is usually safe and highly successful, but can sometimes be challenging because of the anatomical obstacles such as the coronary arteries, epicardial fat pads, intramural and epicardial origins, AV conduction system and so on. Therefore, understanding the relevant anatomy is important to achieve a safe and successful catheter ablation of idiopathic VAs. This review describes the anatomical consideration in the catheter ablation of idiopathic VAs.

  20. Bacterial bloodstream infections in liver transplantation: etiologic agents and antimicrobial susceptibility profiles.

    Science.gov (United States)

    Sganga, G; Spanu, T; Bianco, G; Fiori, B; Nure, E; Pepe, G; D'inzeo, T; Lirosi, M C; Frongillo, F; Agnes, S

    2012-09-01

    Liver transplantation (OLT) is a lifesaving procedure for the treatment of many end-stage liver diseases, but infection and acute rejection episodes still remain the main causes of morbidity and mortality. Bloodstream infections (BSIs), particularly, are the major cause of mortality among these patients. BSIs in OLT, are from intra-abdominal, biliary, respiratory, urinary, wound and/or central venous catheter sources. A certain percentage are of unknown origin. Using the computerized database of our microbiology laboratory, we analyzed all BSIs in 75 consecutive adult liver transplant patients in a single center between January 2008 and July 2011. BSIs occurred in 21/75 (28%) patients. Thirteen subjects had a single; two, two episodes, and the other six patients each >4 episodes. All episodes occurred in the first 60 days following OLT; the majority (74%), in the first month. Among 44 microorganisms recovered, 52.3% were gram-negative, the most frequent being Pseudomonas aeruginosa and Klebsiella pneumoniae; 47.7% were gram-positive, the most frequent being coagulase-negative staphylococci, particularly Staphylococcus epidermidis. Overall 65.9% of the isolates were resistant to several antibiotics: 40.9% displayed the multiding-resistant and 25% the panding-resistant phenotype. There was a high incidence of gram-negative and most importantly, resistant bacteria, which required appropriate therapy. These data showed that it is imperative to promote strategies to prevention and contain antimicrobial resistance.

  1. Bloodstream infections among patients treated with intravenous epoprostenol or intravenous treprostinil for pulmonary arterial hypertension--seven sites, United States, 2003-2006.

    Science.gov (United States)

    2007-03-02

    Pulmonary arterial hypertension (PAH) is a life-threatening disorder characterized by elevated pulmonary artery pressure and pulmonary vascular resistance. Continuous infusion of a prostanoid, which acts as a vasodilator and anti-proliferative agent, is indicated in the treatment of patients with severe PAH. Two prostanoids are approved for intravenous (IV) use in the United States: epoprostenol (epoprostenol sodium [brand name Flolan], Gilead, Foster City, California) and treprostinil (treprostinil sodium [brand name Remodulin], United Therapeutics, Silver Spring, Maryland). These drugs are administered to PAH patients at hundreds of treatment centers in the United States. In September 2006, CDC received a report from a PAH specialist of a suspected increase in the number of gram-negative bloodstream infections (BSIs) among PAH patients treated with IV treprostinil. CDC conducted a retrospective investigation with the assistance of several state health departments and the cooperation of seven PAH treatment centers to determine the relative rates of BSI in a sample of patients treated with IV treprostinil and IV epoprostenol during 2003--2006. This report describes the results of that investigation, which indicated that, based on combined data from seven separate PAH treatment centers, pooled mean rates of BSI (primarily gram-negative BSI) were significantly higher for patients on treprostinil than for those on epoprostenol. The results do not suggest intrinsic contamination of IV treprostinil as a cause of the infections; the difference in rates might have been caused by differences in preparation and storage of the two agents, differences in catheter care practices, or differences in the anti-inflammatory activity of the agents. Health-care providers who care for PAH patients should be aware of these findings. Further investigation is needed to determine the causes of the different infection rates at centers where this was observed and to determine whether such a

  2. System evaluation of nursing interventions in preventing catheter-related infection after PVCs%外周静脉置管导管相关性感染护理措施预防效果的系统评价

    Institute of Scientific and Technical Information of China (English)

    李芸芸; 余雪梅; 刘明秀

    2016-01-01

    Objective To system evaluate the nursing interventions in preventing catheter -related infection after PVCs.Methods Firstly, all the RCTs, quasi-RCTs and case-control studies that related to the nursing interventions in preventing catheter-related infection after PVCs were searched from the database including Cochrane Library ( issue 12, 2015 ), JBI evidence-based nursing center library, MEDLINE, EMBASE, China biomedical literature database ( time limit from December 2005 to December 2015 ), supplemented by the internet retrieval .Two researchers selected studies according to the inclusive and exclusive criteria.Then, the eligible studies were quality evaluated using the Cochrane handbook and the data were descriptively analyzed .Results The eligible studies included a total of 4 605 patients and were mainly foreign literatures including 3 RCTs, 7 quasi-RCTs and 1 case-control studies.Conclusions The nursing interventions in preventing catheter-related infection should focus on 9 aspects such as catheter location , material, disinfection and fixation .%目的:系统评价减少外周静脉置管导管相关性感染发生率的相关护理措施。方法计算机检索Cochrane图书馆(2015年第12期)、JBI循证护理中心图书馆、MEDLINE、EMBASE、中国生物医学文献数据库( CBM )(检索时限均从2005年12月—2015年12月),辅以互联网络检索;收集所有讨论不同护理干预措施对导管相关性感染发生率影响的随机对照试验、半随机对照试验和病例对照研究;由2名研究员按照纳入和排除标准筛选文献并提取资料,参考Cochrane Handbook 的质量评价标准进行质量评价,对结果仅进行描述性分析。结果主要纳入外文文献,其中含3项随机对照试验、7项半随机对照试验、1项病例对照研究,共4605例患者。结论从置管部位、材质、消毒方式、固定方式等9个方面的护理措施可减少导管相关性感染的发生。

  3. 金黄色葡萄球菌血流感染的临床特征分析%Clinical features of bloodstream infection caused by staphylococcus aureus

    Institute of Scientific and Technical Information of China (English)

    路明; 姚婉贞; 王筱宏; 刘振英

    2011-01-01

    OBJECTIVE To study the clinical characteristics and antimicrobial resistance of bloodstream infections caused by Staphylococcus aureus (SAU). METHODS Patients with bloodstream infections of SAU in our hospital from 2004 to 2008 were retrospectively reviewed. RESULTS All 28 patients had fever and 60. 7% with rigor. 18 cases had metastatic infection and lung was the most common metastasizing site. 85.7% of the patients had variety of vulnerable factors. 39% complicated by septic shock and the total mortality rate was 32.0%. 6 episodes were community acquired and 50. 0% of the primary infection site were from skin or soft tissues. All the six community-acquired SAU isolates were methicillin sensitive S. aureus (MSSA). The other 22 episodes were nosocomial infections, 45. 5% were related with central venous catheters, and 72. 0% of the SAU isolates were methicillin resistant S. aureus (MRSA). All the SAU isolates acquired from community and hospital were resistant to penicillin. CONCLUSION High fever with rigor and metastatic infection are common features of SAU bloodstream infection. MRSA isolates increased gradually with high mortality rate.%目的 了解金黄色葡萄球菌血流感染的临床特征及细菌耐药情况.方法 回顾分析医院2004-2008年由金黄色葡萄球菌所致血流感染患者的临床和微生物学资料.结果 共28例患者入选,均有发热,60.7%伴寒颤,18例有迁徙灶,肺受累最常见;85.7%的患者存在易感因素,39.0%合并感染性休克,死亡率32.0%;社区感染6例,多以皮肤为原发感染灶(50.0%),均为甲氧西林敏感金黄色葡萄球菌;医院内感染22例,多与中心静脉导管相关(45.5%),72.0%为耐甲氧西林金黄色葡萄球菌(MRSA);社区和医院内感染金黄色葡萄球菌株对青霉素100.0%耐药.结论 金黄色葡萄球菌血流感染多有高热、寒颤伴有迁徙灶,MRSA逐渐增多,导致很高的死亡率.

  4. Detection of mixed microbial biofilms on central venous catheters removed from Intensive care Unit Patients Detecção de biofilmes microbianos mistos em cateters venosos de pacientes de Unidades de Terapia Intensiva

    Directory of Open Access Journals (Sweden)

    Anisio Storti

    2005-09-01

    Full Text Available Central venous catheters from intensive care unit patients were subjected to microbiological methods (semiquantitative culture and scanning electron microscopy in order to assess microbial attachment and correlate it with blood cultures. During the period of the survey, 59 patients with inserted central venous catheters were studied. The type of catheter used was nontunneled, noncuffed, single lumen, made of polyurethane. Blood samples for cultures were collected at the moment of catheter removal. Data on the patient's age, gender, catheter insertion site, and duration of catheterization were also obtained. From 63 catheters tips analysed, 30 (47.6% showed microbial colonization. Infection proved to be more prevalent in 26 (41.3% patients with catheters inserted via subclavia vein than in 2 (3.2% inserted via the jugular vein. Infection was observed more frequently in catheters which were kept in place more than seven days. A. baumannii, Citrobacter freundii, E. aerogenes, P. aeruginosa and S. saprohyticus were isolated as causal agents of catheter-related bloodstream infections. The antimicrobial agent with greater in vitro activity against Gram-negative bacteria was imipenen and against Gram-positive were vancomycin, cefepime, penicillin, rifampin and tetracycline. The SEM analyses revealed biofilms on surfaces of all the catheters examined.Cateteres venosos centrais inseridos em pacientes internados em unidade de terapia intensiva foram avaliados por métodos microbiológicos (cultura semi-quantitativa e microscopia eletrônica de varredura a fim de detectar adesão microbiana e correlacionar com a cultura de sangue. Durante o período de estudo, foram avaliados 59 pacientes com cateter venoso central. A idade dos pacientes, sexo, sítio de inserção e tempo de permanência do cateter foram anotados. O cateter era de poliuretano não tunelizado e de único lúmen. O sangue para cultura foi coletado no momento da remoção do cateter. De 63

  5. Hydrodynamics of catheter biofilm formation

    CERN Document Server

    Sotolongo-Costa, Oscar; Rodriguez-Perez, Daniel; Martinez-Escobar, Sergio; Fernandez-Barbero, Antonio

    2009-01-01

    A hydrodynamic model is proposed to describe one of the most critical problems in intensive medical care units: the formation of biofilms inside central venous catheters. The incorporation of approximate solutions for the flow-limited diffusion equation leads to the conclusion that biofilms grow on the internal catheter wall due to the counter-stream diffusion of blood through a very thin layer close to the wall. This biological deposition is the first necessary step for the subsequent bacteria colonization.

  6. Interventional radiologic placement of tunneled central venous catheters : results and complications in 557 cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chan Kyo; Do, Young Soo; Paik, Chul H. [Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)] (and others)

    1999-05-01

    To evaluate prospectively the results of interventional radiologic placement of tunneled central venous catheters, and subsequent complications. Between April 1997 and April 1998, a total of 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in an interventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23 and transfusion in one. Complications were evaluated prospectively by means of a chart review, chest radiography, central vein angiography and blood/catheter culture. The technical success rate for tunneled central venous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean, 112{+-}4.6) days; Hickman catheters were removed in 252 cases during follow-up. Early complications included 3 cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1 case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 cases of venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%), and 1 case of pseudoaneurysm(0.2%). The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50, respectively. The technical success rate of interventional radiologic placement of tunneled central venous catheters was high. In comparison to conventional surgical placement, it is a more reliable method and leads to fewer complications.

  7. The changing epidemiology of Staphylococcus aureus bloodstream infection

    DEFF Research Database (Denmark)

    Laupland, K B; Lyytikäinen, O; Søgaard, M;

    2012-01-01

    Clin Microbiol Infect ABSTRACT: Although the epidemiology of Staphylococcus aureus bloodstream infection (BSI) has been changing, international comparisons are lacking. We sought to determine the incidence of S. aureus BSI and assess trends over time and by region. Population-based surveillance...

  8. Prevention of nosocomial bloodstream infections in preterm infants

    NARCIS (Netherlands)

    K. Helder MScN (Onno)

    2013-01-01

    textabstractProtecting patients from harm is the overarching theme of the studies presented here. More precisely, this thesis places a focus on the prevention of nosocomial or hospitalacquired bloodstream infections in preterm infants, thus saving them from further harm. A nosocomial infection is an

  9. Neonatal bloodstream infections in a pediatric hospital in Vietnam

    DEFF Research Database (Denmark)

    Kruse, Alexandra Yasmin; Thieu Chuong, D.H.; Phuong, C.N.;

    2013-01-01

    Septicemia and bloodstream infections (BSIs) are major causes of neonatal morbidity and mortality in developing countries. We prospectively recorded all positive blood cultures (BSI) among neonates admitted consecutively to a tertiary pediatric hospital in Vietnam during a 12-month period. Among...

  10. 静脉导管相关感染预防规范化护理流程的应用%Application of standardized nursing process for prevention of venous catheter-related infections

    Institute of Scientific and Technical Information of China (English)

    刘莉; 王海明; 陈松宽

    2015-01-01

    OBJECTIVE To investigate the clinical effect of the implementation of standardized clinical care process on deep venous catheter‐related infections (CRI) so as to provide reference for clinical nursing .METHODS Totally 616 cases in May 2011 to Dec .2013 treated with central venous catheters were enrolled ,in which 289 cases of pa‐tients with the implementation of routine care were set as the control group and 327 cases with the implementation of standardized care measures as the experiment group .The two groups of patients were compared for the infec‐tion rate and the clinical indexes .The software SPSS 21 .0 was used for statistical analysis .RESULTS The infec‐tion rate was 3 .36% in the experimental group ,which was significantly lower than 10 .73% in the control group (P=0 .021) .The number of short‐term infection cases in the experimental group was significantly less than that in the control group .The catheter plugging rate was 3 .06% ,the unplanned estuation rate 2 .45% ,the catheter days (13 .36 ± 0 .82) d ,and hospitalization days (12 .71 ± 0 .77) d in the experimental group ,which were signifi‐cently better than the control group (P<0 .05) .CONCLUSION The standardized care process helps to reduce deep venous catheter‐related infections ,prolong catheter time ,and reduce the incidence of adverse extubation ,which is beneficial for treatment recovery .%目的:探讨实施规范化护理流程对深静脉导管相关感染(CRI)的临床效果,为临床护理提供参考依据。方法选取2011年5月-2013年12月实施中心静脉导管患者616例,289例患者实施常规护理为对照组,327例患者实施规范化护理措施为试验组,对比两组患者的感染率及临床指标,采用SPSS 21.0软件进行统计分析。结果试验组患者感染率3.36%,明显低于对照组的10.73%,对比差异有统计学意义( P=0.021);试验组患者短期感染发生例数明显少于对照组;

  11. The laser driven short-term heating balloon catheter: Relation between the chronic neointimal hyperplasia formation and thermal damage to arterial smooth muscle cells.

    Science.gov (United States)

    Shimazaki, Natsumi; Hayashi, Tomoaki; Kunio, Mie; Igami, Yuka; Arai, Tsunenori; Sakurada, Masami

    2010-01-01

    We proposed a novel laser-driven short-term heating angioplasty to realize restenosis-suppressive angioplasty for peripheral artery disease. In this study, we investigated the chronic intimal hyperplasia formation after the short-term heating dilatation in vivo, as well as the thermal damage calculation on arterial smooth muscle cells (SMCs). The prototype short-term heating balloon catheter with 5.0, 5.5, 6.0 mm φ in balloon diameter and 25 mm in balloon length were employed. The short-term heating dilatation was performed in porcine iliac arteries with dilatation conditions of 75°C (N=4) and 65°C (N=5) as peak balloon temperature, 18 ± 4s as heating duration, 3.5 atm as balloon dilatation pressure. Four weeks after the balloon dilatation, the balloon-dilated artery segments were extracted and were stained with HE and picrosirius red for histological observation. In the case of 75°C as the peak balloon temperature, neointimal hyperplasia formation was significantly reduced. In this case, the SMCs density in the artery media measured from the HE-stained specimen was 20% lower than that in the reference artery. According to the thermal damage calculation, it was estimated that the SMCs lethality in artery media after the short-term heating angioplasty was 20% in the case of 75°C as the peak balloon temperature. We demonstrated that the short-term heating dilatation reduced the number of SMCs in artery media. We think this SMCs reduction might contribute to the suppression of chronic neointimal hyperplasia.

  12. Misplaced central venous catheters: applied anatomy and practical management.

    Science.gov (United States)

    Gibson, F; Bodenham, A

    2013-03-01

    Large numbers of central venous catheters (CVCs) are placed each year and misplacement occurs frequently. This review outlines the normal and abnormal anatomy of the central veins in relation to the placement of CVCs. An understanding of normal and variant anatomy enables identification of congenital and acquired abnormalities. Embryological variations such as a persistent left-sided superior vena cava are often diagnosed incidentally only after placement of a CVC, which is seen to take an abnormal course on X-ray. Acquired abnormalities such as stenosis or thrombosis of the central veins can be problematic and can present as a failure to pass a guidewire or catheter or complications after such attempts. Catheters can also be misplaced outside veins in a patient with otherwise normal anatomy with potentially disastrous consequences. We discuss the possible management options for these patients including the various imaging techniques used to verify correct or incorrect catheter placement and the limitations of each. If the course of a misplaced catheter can be correctly identified as not lying within a vulnerable structure then it can be safely removed. If the misplaced catheter is lying within or traversing large and incompressible arteries or veins, it should not be removed before consideration of what is likely to happen when it is removed. Advice and further imaging should be sought, typically in conjunction with interventional radiology or vascular surgery. With regard to misplaced CVCs, in the short term, a useful aide memoir is: 'if in doubt, don't take it out'.

  13. Interventional radiological imaging and treatment of port catheter dysfunctions; Angiografische Diagnostik und interventionelle Therapie von Portdysfunktionen

    Energy Technology Data Exchange (ETDEWEB)

    Kausche, S.; Nagel, S.N.; Teichgraeber, Ulf [Charite Universitaetsmedizin Berlin (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie

    2011-03-15

    To evaluate the impact of interventional radiological imaging and treatment of central venous port catheter complications. Materials and Methods: In this retrospective analysis 429 port catheter dysfunctions were evaluated in 393 port catheter systems for a total of 389 patients over a period of 10 years. The study included 193 (49.1 %) patients with radiologically implanted port catheter systems and 200 (50.9 %) referred patients with surgically implanted port systems. Port catheter dysfunctions were subdivided into early and late complications as well as into non-thrombotic and thrombotic events. After administration of contrast medium, the port system was visualized using digital subtraction angiography. Data were retrospectively collected from the in-house databases and then analyzed descriptively. Results: 429 contrast media injections via port catheters were performed in 393 port catheter systems. There were 359 (83.7 %) late complications and 70 (16.3 %) early complications. In 299 (69.7 %) cases thrombotic events occurred and 130 (30.3 %) non-thrombotic events were recorded. The most common reason for contrast media injection via port catheter system was port catheter-related thrombosis in 269 (62.7 %) cases. 70 (16.3 %) catheter migrations and 30 (7.0 %) fibrin sheath formations were detected. 18 (4.2 %) port needle malfunctions could be resolved through needle exchange. All 15 (3.5 %) catheter disconnections had to be revised in all cases. Also six port explantations were performed in 6 (1.4 %) catheter fractures. Conclusion: The possibilities of angiographic imaging and interventional radiological correction of port catheter dysfunctions must be exploited fully in order to avoid premature port explantation. (orig.)

  14. Zinc finger nuclease technology: A stable tool for high efficiency transformation in bloodstream form T. brucei.

    Science.gov (United States)

    Schumann, Gabriela; Kangussu-Marcolino, Monica M; Doiron, Nicholas; Käser, Sandro; de Assis Burle-Caldas, Gabriela; DaRocha, Wanderson D; Teixeira, Santuza M; Roditi, Isabel

    2017-02-20

    In Trypanosoma brucei, the generation of knockout mutants is relatively easy compared to other organisms as transfection methods are well established. These methods have their limitations, however, when it comes to the generation of genome-wide libraries that require a minimum of several hundred thousand transformants. Double-strand breaks with the meganuclease ISce-I dramatically increase transformation efficiency, but are not widely in use as cell lines need to be generated de novo before each transfection. Here we show that zinc finger nucleases are a robust and stable tool that can enhance transformation in bloodstream forms by more than an order of magnitude.

  15. Bacillus cereus Bloodstream Infection in a Preterm Neonate Complicated by Late Meningitis

    Directory of Open Access Journals (Sweden)

    Toshinobu Horii

    2012-01-01

    Full Text Available Central nervous system infections caused by Bacillus cereus have rarely been reported in infants. In this paper, the case of a 2-month-old low-birth-weight female who developed meningitis 45 days after resolution of a bloodstream infection (BSI is described. The pulsed-field gel electrophoresis results revealed that the patterns of both B. cereus isolates responsible for the acute meningitis and for the prior bacteraemic episode were closely related. Although the source of the infection from within the patient was not clear, it is suggested that the B. cereus BSI developed in the neonate was complicated by acute meningitis.

  16. ICU深静脉导管感染的病原菌分布和耐药性分析%Investigation of distribution and drug resistance of pathogenic bacteria causing deep venous catheter related infection in ICU

    Institute of Scientific and Technical Information of China (English)

    李静; 周利霞; 范秋生

    2012-01-01

    Objective To investigate the characteristics of distribution and drug resistance of pathogenic bacteria causing deep venous catheter related infection in ICU.Methods From January 2006 to August 2010,the culture and drug sensitivity test results of 342 deep venous catheter tip from ICU were analyzed retrospectively. Results Among the results of 342 catheter tip cultures,101 strains( 29. 5% )of pathogenic bacteria were detected. The proportion of G+ bacteria,enterobacteria ceae,non-fermentation G- bacteria and fungi was 29 strains( 28.7% ),25 strains( 24. 8% ),33 strains( 32. 6% )and 14 strains ( 13.9% )respectively. The six most common pathogenic bacteria were pseudomonas aeruginosa 20 strains( 19.8% ), Klebsiella pneumonia 12 strains( 11.9% ),Staphylococcus aureus 10 strains( 9. 9% ), Staphylococcus epidermis 8 strains( 7. 9% ),En-terococcus faecium 7 strains( 6. 9% ) and Saccharomyces albicans 7 strains( 6. 9% ). 8 strains( 80. 0% )of Staphylococcus aureus were MRSA,7 strains( 63. 6% )of coagulase negative Staphylococci were MRCNS and 14 strains( 56. 0% )of Enterobacte-riaceae were ESBLs. Most isolated strains were multiple drug resistant. Conclusion The most common pathogens cultured from the deep venous catheter tip in ICU were highly resistant to antibiotics. The clinical micro-organisms laboratory should report the results of bacterial culture and drug susceptibility quickly and accurately for reasonable use of antibiotic drugs in clinical treatment.%目的 探讨ICU深静脉导管感染的病原菌分布和细菌耐药性特征.方法 对2006年1月-2010年8月ICU送检的342例次深静脉导管标本的细菌培养和药敏试验结果进行分析.结果 342份标本中共检出病原菌101株(29.5%):革兰阳性球菌、肠杆菌科、非发酵革兰阴性杆菌和真菌分别为29株(28.7%)、25株(24.8%)、33株(32.6%)和14株(13.9%).病原菌分离率前6位依次为铜绿假单胞菌20株(19.8%)、肺炎克雷伯菌12株(11.9%)

  17. Epidemic increase in Salmonella bloodstream infection in children, Bwamanda, the Democratic Republic of Congo.

    Science.gov (United States)

    Phoba, M-F; De Boeck, H; Ifeka, B B; Dawili, J; Lunguya, O; Vanhoof, R; Muyembe, J-J; Van Geet, C; Bertrand, S; Jacobs, J

    2014-01-01

    Salmonella enterica is the leading cause of bloodstream infection in children in sub-Saharan Africa, but few data are available from Central-Africa. We documented during the period November 2011 to May 2012 an epidemic increase in invasive Salmonella bloodstream infections in HGR Bwamanda, a referral hospital in Equateur Province, DR Congo. Salmonella spp. represented 90.4 % (103 out of 114) of clinically significant blood culture isolates and comprised Salmonella Typhimurium (54.4 %, 56 out of 103), Salmonella Enteritidis (28.2 %, 29 out of 103) and Salmonella Typhi (17.5 %, 18 out of 103), with Salmonella Enteritidis accounting for most of the increase. Most (82 out of 103, 79.6 %) isolates were obtained from children infected with Salmonella Typhimurium and Salmonella Enteritidis were 14 months (14 days to 64 years) and 19 months (3 months to 8 years) respectively. Clinical presentation was non-specific; the in-hospital case fatality rate was 11.1 %. More than two thirds (69.7 %, 53 out of 76) of children infection. Most (83/85, 97.6 %) non-typhoid Salmonella isolates as well as 6/18 (33.3 %) Salmonella Typhi isolates were multidrug resistant (i.e. resistant to the first-line oral antibiotics amoxicillin, trimethoprim-sulfamethoxazole and chloramphenicol), one (1.0 %) Salmonella Typhimurium had decreased ciprofloxacin susceptibility owing to a point mutation in the gyrA gene (Gly81Cys). Multilocus variable-number tandem-repeat (MLVA) analysis of the Salmonella Enteritidis isolates revealed closely related patterns comprising three major and four minor profiles, with differences limited to one out of five loci. These data show an epidemic increase in clonally related multidrug-resistant Salmonella bloodstream infection in children in DR Congo.

  18. Increased biofilm formation ability and accelerated transport of Staphylococcus aureus along a catheter during reciprocal movements.

    Science.gov (United States)

    Haraga, Isao; Abe, Shintaro; Jimi, Shiro; Kiyomi, Fumiaki; Yamaura, Ken

    2017-01-01

    Staphylococcus spp. is a major cause of device-related infections. However, the mechanisms of deep-tissue infection by staphylococci from the skin surface remain unclear. We performed in vitro experiments to determine how staphylococci are transferred from the surface to the deeper layers of agar along the catheter for different strains of Staphylococcus aureus with respect to bacterial concentrations, catheter movements, and biofilm formation. We found that when 5-mm reciprocal movements of the catheter were repeated every 8h, all catheter samples of S. aureus penetrated the typical distance of 50mm from the skin to the epidural space. The number of reciprocal catheter movements and the depth of bacterial growth were correlated. A greater regression coefficient for different strains implied faster bacterial growth. Enhanced biofilm formation by different strains implied larger regression coefficients. Increased biofilm formation ability may accelerate S. aureus transport along a catheter due to physical movements by patients.

  19. Compensation for Unconstrained Catheter Shaft Motion in Cardiac Catheters

    Science.gov (United States)

    Degirmenci, Alperen; Loschak, Paul M.; Tschabrunn, Cory M.; Anter, Elad; Howe, Robert D.

    2016-01-01

    Cardiac catheterization with ultrasound (US) imaging catheters provides real time US imaging from within the heart, but manually navigating a four degree of freedom (DOF) imaging catheter is difficult and requires extensive training. Existing work has demonstrated robotic catheter steering in constrained bench top environments. Closed-loop control in an unconstrained setting, such as patient vasculature, remains a significant challenge due to friction, backlash, and physiological disturbances. In this paper we present a new method for closed-loop control of the catheter tip that can accurately and robustly steer 4-DOF cardiac catheters and other flexible manipulators despite these effects. The performance of the system is demonstrated in a vasculature phantom and an in vivo porcine animal model. During bench top studies the robotic system converged to the desired US imager pose with sub-millimeter and sub-degree-level accuracy. During animal trials the system achieved 2.0 mm and 0.65° accuracy. Accurate and robust robotic navigation of flexible manipulators will enable enhanced visualization and treatment during procedures. PMID:27525170

  20. Knowledge of nursing students about central venous catheters

    Directory of Open Access Journals (Sweden)

    Mlinar Suzana

    2012-01-01

    Full Text Available Background/Aim. Central venous catheters (CVC are at the crucial importance, particulary in the intensive therapy units. In order to handle a CVC safely, nursing students need to acquire theoretical and practical knowledge during the course of their studies. The aim of the study was to establish theoretical knowledge of nursing students about the procedures of nurses in placing and removing a central venous catheter (CVC, dressing the catheter entry point, the reasons for measuring central venous pressure (CVP, possible complications and risk factors for developing infections related to CVC. Methods. The questionnaire developed specifically for this cross-sectionl study was handed out to 87 full-time students and 57 part-time students. Results. The results show that all the surveyed nursing students know why chest radiography is carried out when inserting a catheter, have relatively good knowledge of CVC insertion points, procedures carried out in case of a suspected catheter sepsis and complications and risk factors for the development of infections related to CVC. However, the study show that the majority of students have insufficient knowledge of the procedures accompanying insertion of a catheter, signs that indicate correct functioning of CVC, frequency of flushing a catheter when it is not in use and the reasons for introducing an implanted CVC. Conclusion. Based on the results of the study it can be concluded that the second-year nursing students have insufficient knowledge of CVC. In order to correctly and safely handle a CVC, good theoretical knowledge and relevant practical experience are needed. The authors therefore believe that, in future, the classes should be organized in smaller groups with step-by-step demonstrations of individual procedures in handling a CVC, and the students encouraged to learn as actively as possible.

  1. Central venous catheter-related thrombosis in elderly patients%老年患者中心静脉导管相关性血栓发生情况调查

    Institute of Scientific and Technical Information of China (English)

    柳高; 付治卿; 李世军

    2015-01-01

    Objective To analyze the risk factors for thrombosis by investigating the incidence of central venous catheter‐related thrombosis in elderly patients .Methods Four hundred and five elderly patients who underwent central venous catheterization were divided into femoral vein group(n=46) ,internal jugular vein group (n=40) and subclavian vein group (n=319) according to their catheter position ,or into thrombosis group (n=31) and non‐thrombosis group (n=374) according to the incidence of central venous catheter‐related thrombosis .T heir gender ,age ,basic diseases ,catheter position ,retention time of catheter ,and complications of central venous catheter‐related thrombosis were retrospectively analyzed .Results The incidence of central venous cathe‐ter‐related thrombosis was significantly lower in subclavian vein group than in internal jugular vein group and femoral vein group (5 .0% vs 15 .0% ,5 .0% vs 19 .6% ,P<0 .05 ,P<0 .01) .The percentage of past venous thrombosis history was significantly higher in thrombosis group than in non‐thrombosis group (19 .4% vs 6 .4% ,P<0 .05) .Conclusions Subclavian vein catheterization can significantly reduce the incidence of central venous catheter‐related thrombosis and past ve‐nous thrombosis history can predict the incidence of central venous catheter‐related thrombosis in elderly patients .%目的:调查老年患者中心静脉导管相关性血栓的发生情况,比较不同置管部位下,导管相关性血栓的发生率,将与血栓发生相关联的各种危险因素进行对比分析。方法选取接受中心静脉置管操作的老年患者405例,根据置管部位不同分为股静脉组46例,颈内静脉组40例,锁骨下静脉组319例。又根据导管相关性血栓的发生情况分为血栓组31例,非血栓组374例。对入选患者的性别、年龄、基础疾病、置管部位、导管留置时间、导管相关性血栓的发生情况等进行回顾性调查分析。

  2. Clinical and microbiological characterization of carbapenem-resistant Acinetobacter baumannii bloodstream infections.

    Science.gov (United States)

    Song, Joon Young; Cheong, Hee Jin; Choi, Won Suk; Heo, Jung Yeon; Noh, Ji Yun; Kim, Woo Joo

    2011-05-01

    The incidence of carbapenem-resistant Acinetobacter baumannii infection is increasing, which might be associated with high morbidity and mortality among critically ill patients with limited therapeutic options. This study was conducted to evaluate the clinical and microbiological features of carbapenem-resistant A. baumannii bacteraemia. The medical records of 28 adult patients with this bacteraemia admitted to Korea University Guro Hospital, from January 2005 through December 2010, were reviewed. Using the 28 bloodstream isolates, we intended to detect genes encoding carbapenemases, and investigate the inoculum effect on each of the antimicrobial agents rifampicin, imipenem, colistin and tigecycline. With one blood isolate from a patient with pneumonia, rifampicin-inducible resistance was examined using the experimental mouse pneumonia model. Out of 28 carbapenem-resistant A. baumannii bloodstream infections (BIs), the most common primary focus was the central venous catheter (35.7 %) and then the lung (32.1 %). The 30 day overall mortality was 53.6 %; in most cases (80 %) the patients died within 10 days after the onset of the bacteraemia. By univariate analysis, inappropriate antimicrobial therapy (73.3 vs 30.8 %, P = 0.02), mechanical ventilation (53.3 vs 15.4 %, P = 0.04) and a high Pitt bacteraemia score (4.9±1.9 vs 2.2±1.2, P<0.01) were statistically significant risk factors for mortality, while only a high Pitt bacteraemia score (odds ratio 2.6; 95 % confidence interval 1.1-6.5) was independently associated with 30 day mortality by multivariate analysis. All 28 isolates had the bla(OXA-51)-like gene with upstream ISAbaI, 2 of which additionally had the bla(OXA-58)-like gene and the bla(OXA-23)-like gene. Inoculum effect and rifampicin inducible resistance were not detected. Considering the rapid progression to death in carbapenem-resistant A. baumannii BIs, early empirical antibiotic therapy would be warranted based on the local

  3. Bacteriological Profile of Epidural Catheters

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    B. M. Sahay, Sanjot Dahake, D. K Mendiratta*,Vijayshree Deotale*,B. Premendran, P.S.Dhande, Pratibha Narang*

    2010-01-01

    Full Text Available The bacteriological profile of epidural catheters was studied in 88 patients. Skin swabs before catheterizationand before removal of catheter with their controls were cultured in TSB Medium. The catheter hub, theportion at the skin puncture site and at the tip were cultured in TSB Medium. The 1cm of the catheter bitjust before the tip was cultured in TGB medium for anaerobes.Both, the skin controls swabs and theanaerobic culture, were negative. From the remaining, 56 positive cultures were obtained. Staphylococcusepidermidis was the predominant organism in 52% followed by staphylococcus aureus 25%. The remaining23% was shared by Acinetobacter, Pseudomonas, Klebsiella, and E. coli. All the positive cultures fromskin prior to epidural catheterization had turned sterile by 48 hours, indicating continued bactericidal actionof the disinfectant. The likely source of positive skin cultures at 48 hours is hair follicles.The catheter tipculture was positive in 9 specimen, none of which resulted in the formation of epidural abscess. In 3 casesthe cultures of skin puncture site and the tip were identical indicating tracking-in of the organisms.

  4. Central venous catheters in hemodialysis: To accept recommendations or to stick to own experience

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    Stolić Radojica

    2008-01-01

    Full Text Available Backgraund/Aim. Hemodialysis catheter, as an integral part of hemodialysis, is a catheter placed into the jugular, subclavian and femoral vein. The most common catheter-related complications are infections and thrombosis. The aim of the study was to analyze the prevalence of complications associated with differently inserted central-vein catheters for hemodialysis. Methods. The study was organized as a prospective examination during the period from December 2003 to November 2006, and included all patients who needed an active depuration by hemodialysis, hospitalized at the Clinical Center Kragujevac. The subject of the study were 464 centralvein catheters inserted during the mentioned period and there were recorded all complications related to the placement and usage of catheters. Results. The largest percent of inserted catheters was into the femoral vein − 403 (86.8%, significantly less into the jugular vein − 42 (9.2%, while into the subclavian vein there were placed only 19 catheters (4%. The average of femoral catheter functioning was 17 catheter days, in jugular catheters it was 17.3 days while the subclavian catheters had an average rate of functioning of 25.9 catheter days; there was found a statistically significant difference regarding the duration of functioning (p = 0.03. By microbe colonization of smear culture of the skin at the catheter insertion site, in clinically present suspicion of catheter infection, there was obtained a positive finding in 5.5% of catheters placed into the femoral vein and 7.1% of catheters instilled into the jugular vein, of which Staphylococcus aureus was the most important bacterial type, without statistically significant difference (p = 0.51. Haemoculture, done when there was a suspicion of bacteriemia, was positive in 3.7% of the patients with femoral and 4.8% with jugular catheters; Staphylococcus aureus was the most common bacteria type, but there was no statistically significant difference (p

  5. Catheter-based photoacoustic endoscope

    Science.gov (United States)

    Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

    2014-06-01

    We report a flexible shaft-based mechanical scanning photoacoustic endoscopy (PAE) system that can be potentially used for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The development of such a catheter endoscope has been an important challenge to realize the technique's benefits in clinical settings. We successfully implemented a prototype PAE system that has a 3.2-mm diameter and 2.5-m long catheter section. As the instrument's flexible shaft and scanning tip are fully encapsulated in a plastic catheter, it easily fits within the 3.7-mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo animal imaging capability of the PAE system.

  6. Evaluation of percutaneous radiologic placement of peritoneal dialysis catheters: technical aspects, results, and complications

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo; Oh, Joo Hyeong; Yoon, Yub; Lee, Tae Won; Ihm, Chun Gyoo [Kyunghee University Hospital, seoul (Korea, Republic of)

    2001-01-01

    To evaluate the technical aspects, results and complications of the percutaneous radiologic placement of peritoneal dialysis catheters. Between December 1999 and April 2001, 26 peritoneal dialysis catheters were placed percutaneously in 26 consecutive patients by interventional radiologists. The patient group consisted of 16 men and ten women with a mean age of 55 (range, 30-77) years. The results and complications arising were reviewed, and the expected patency of the catheters was determined by means of Kaplan-Meier survival analysis. The technical success rate for catheter placement was 100% (26/26 patients). Severe local bleeding occurred in one patient due to by inferior epigastric artery puncture, and was treated by compression and electronic cautery. The duration of catheter implantation ranged from 1 to 510 days and the patency rate was 416{+-}45 days. Catheter malfunction occurred in four patients. In two, this was restored by manipulation in the intervention room, and in one, through the use of urokinase. In three patients, peritonitis occurred. Catheters were removed from four patients due to malfunction (n=2), peritonitis (n=1), and death (n=1). Percutaneous radiologic placement of a peritoneal dialysis catheter is a relatively simple procedure that reduces the complication rate and improves catheter patency.

  7. 医护合作小组活动在预防重症监护患者导管相关感染中的作用%the Effects of Cooperative Group Activities in Preventing Catheter-related Infections in Intensive Care

    Institute of Scientific and Technical Information of China (English)

    胡小红; 陈谷霖; 张明芳; 吴玮; 黄英

    2014-01-01

    目的:探讨医护合作小组活动在预防重症监护患者导管相关感染中的作用。方法2011年1月~12月在重症监护室开展医护合作小组活动,随机抽查100例(A组)符合入选条件的患者,监测导管使用与患者导管相关性感染发生情况,并与2010年同期100例(B组)符合入选条件的患者进行对照分析。结果 A组中心静脉导管、呼吸机通气导管、导尿管使用率分别为81.13%、42、71%、60.60%,均低于B组中心静脉导管、呼吸机通气导管、导尿管使用率分别为82.95%、56.41%、81.28%,除中心静脉导管外,呼吸机通气导管与导尿管使用率两组比较有显著性差异(P<0.01);A组中心静脉导管、呼吸机通气导管、导尿管相关性感染率分别为0.52‰、3.97‰、3.48‰,均低于B组中心静脉导管、呼吸机通气导管、导尿管感染率分别为1.96‰、7.94‰、6.01‰,两组比较无显著性差异(P >0.05)。结论开展医护合作小组活动,有利于提高预防导管相关性感染各项措施执行力,降低各种导管使用率和导管相关性感染率。%Objective To explore the key role of the cooperative group activities in the prevention of intensive care pa-tients with catheter-related infections .Method To carry out medical cooperative group activities from January 2011 to De-cember 2011in the intensive care unit ,random inspection 100 cases (A group) met the inclusion criteria ,and monitor cathe-ters and the incidence of catheter-related infections ,and compared with the same period in 2010 .Results The central venous catheters ,ventilator and catheter utilization rates of A group were 81 .13% ,42 .71% ,60 .60% ,lower than that of B group which were 82 .95% ,56 .41% ,81 .28% .After statistics analysis ,breathing machine ventilation and catheter usage had sig-nificant differences except central venous catheter ,the differences had

  8. Prosthetic valve endocarditis and bloodstream infection due to Mycobacterium chimaera.

    Science.gov (United States)

    Achermann, Yvonne; Rössle, Matthias; Hoffmann, Matthias; Deggim, Vanessa; Kuster, Stefan; Zimmermann, Dieter R; Bloemberg, Guido; Hombach, Michael; Hasse, Barbara

    2013-06-01

    Prosthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected.

  9. Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium chimaera

    OpenAIRE

    Achermann, Yvonne; Rössle, Matthias; Hoffmann, Matthias; Deggim, Vanessa; Kuster, Stefan; Zimmermann, Dieter R.; Bloemberg, Guido; Hombach, Michael; Hasse, Barbara

    2013-01-01

    Prosthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected.

  10. Endothelial JAM-A promotes reovirus viremia and bloodstream dissemination.

    Science.gov (United States)

    Lai, Caroline M; Boehme, Karl W; Pruijssers, Andrea J; Parekh, Vrajesh V; Van Kaer, Luc; Parkos, Charles A; Dermody, Terence S

    2015-02-01

    Viruses that cause systemic disease often spread through the bloodstream to infect target tissues. Although viremia is an important step in the pathogenesis of many viruses, how viremia is established is not well understood. Reovirus has been used to dissect mechanisms of viral pathogenesis and is being evaluated in clinical trials as an oncolytic agent. After peroral entry into mice, reovirus replicates within the gastrointestinal tract and disseminates systemically via hematogenous or neural routes. Junctional adhesion molecule-A (JAM-A) is a tight junction protein that serves as a receptor for reovirus. JAM-A is required for establishment of viremia and viral spread to sites of secondary replication. JAM-A also is expressed on the surface of circulating hematopoietic cells. To determine contributions of endothelial and hematopoietic JAM-A to reovirus dissemination and pathogenesis, we generated strains of mice with altered JAM-A expression in these cell types and assessed bloodstream spread of reovirus strain type 1 Lang (T1L), which disseminates solely by hematogenous routes. We found that endothelial JAM-A but not hematopoietic JAM-A facilitates reovirus T1L bloodstream entry and egress. Understanding how viruses establish viremia may aid in development of inhibitors of this critical step in viral pathogenesis and foster engineering of improved oncolytic viral vectors.

  11. 《ICU导管相关性血流感染预防控制质量查检单》的设计及应用%Design and application of quality improvement checklist of catheter-related blood stream infection in the intensive care units

    Institute of Scientific and Technical Information of China (English)

    方琏; 徐建宁; 冯洁惠; 俞超; 陈瑜

    2013-01-01

    目的 通过设计《ICU导管相关性血流感染预防控制质量查检单》(简称查检单),指导医护人员在临床实践中进行质量查检,以提高护理质量,保证患者安全.方法 2012年4~6月将查检单应用于ICU的中心静脉置管患者,对患者的导管相关性血流感染(catheter-related blood stream infection, CRBSI)预防控制措施进行每日查检,观察中心静脉导管的使用率及CRBSI的发生率.结果 使用查检单干预后较干预前导管使用率下降,CRBSI发生率下降,差异有统计学意义.结论 将查检单应用于ICU患者的CRBSI预防控制的质量管理中,有助于降低CRBSI的发生率.%Objective To design quality improvement checklist of catheter-related blood stream infection (CRBSI),in order to improve the nursing quality of ICU and ensure nursing safety.Methods A new ICU quality improvement checklist of CRBSI was designed and applied for the quality control of the patients with central venous catheter from April to June 2012.The using rate of central venous catheter and incidence of CRBSI were observed.Results After application of the checklists,the using rate of central venous catheter was decreased and the incidence of CRBSI was decreased.Conclusions The checklist may help improve the prevention and control of CRBSI in ICU.

  12. Surface-Treated versus Untreated Large-Bore Catheters as Vascular Access in Hemodialysis and Apheresis Treatments

    Directory of Open Access Journals (Sweden)

    Rolf Bambauer

    2012-01-01

    Full Text Available Background. Catheter-related infections, thrombosis, and stenosis are among the most frequent complications associated with catheters, which are inserted in vessels. Surface treatment processes of the outer surface, such as ion-beam-assisted deposition, can be used to mitigate such complications. Methods. This retrospective study (1992–2007 evaluated silver-coated (54 patients and noncoated (105 patients implanted large-bore catheters used for extracorporeal detoxification. The catheters were inserted into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using scanning electron microscope. Results. The silver coated catheters showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant. Conclusion. The silver-coated catheters showed no significantly reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between both catheters in significantly reducing savings in treatment costs and in reducing patient discomfort. Other new developed catheter materials such as the microdomain-structured inner and outer surface are considered more biocompatible because they mimic the structure of natural biological surface.

  13. 21 CFR 870.1280 - Steerable catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Steerable catheter. 870.1280 Section 870.1280 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1280 Steerable catheter. (a) Identification. A steerable catheter is...

  14. 21 CFR 882.4100 - Ventricular catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ventricular catheter. 882.4100 Section 882.4100...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4100 Ventricular catheter. (a) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for...

  15. 老年危重症患者中心静脉导管相关性感染的危险因素分析%Risk factors for central venous catheter-related infections in elderly patients with critical diseases

    Institute of Scientific and Technical Information of China (English)

    孙卫; 司琴

    2012-01-01

    OBJECTIVE To study the related risk factors of central venous catheter-related infection in the elderly patient with critical diseases. METHODS A total of 160 elderly patients with critical diseases were retrospectively analyzed. Multiple factor non-conditional logistic regression analysis was performed for the related factors that may lead to the central venous catheter-related infections. RESULTS The incidence of central venous catheter infections in 160 elderly patients with critical diseases was 35. 6%(57 cases). The incidence of central venous catheter infections was mainly related to the age,APACHEⅡ score, the site of indwelling catheter, the number of catheter cavity, intravenousalimentation treatment, the duration of indwelling catheterization and coexistence with other site infections (P<0. 05 or 0. 01); logistic regression analysis revealed that APACHEⅡ score, intravenousalimentation treatment, the duration of indwelling catheter, and coexistence with other site infections were the independent risk factors for the central venous catheter-related infections in the elderly patients with critical diseases. CONCLUSION It is necessary to develop the prevention programs and actively treat and reduce the incidence of infections in accordance with the independent risk factors for the central venous catheter-related infections in the elderly patients with critical disease so as to improve the patients' prognosis.%目的 探讨影响老年危重症患者中心静脉导管相关性感染发生的危险因素.方法 回顾性分析医院160例老年危重症患者的临床资料,对可能影响中心静脉导管相关性感染发生的因素进行多因素非条件logistic回归分析.结果 160例老年危重症患者中,发生中心静脉导管相关性感染57例,发生率35.6%;老年危重症患者中心静脉导管相关性感染的发生与年龄、APACHEⅡ评分、导管留置部位、导管腔数、是否有静脉营养操作、导管留置时间及

  16. Antibody-Based Therapy for Enterococcal Catheter-Associated Urinary Tract Infections

    Science.gov (United States)

    Flores-Mireles, Ana L.; Walker, Jennifer N.; Potretzke, Aaron; Schreiber, Henry L.; Pinkner, Jerome S.; Bauman, Tyler M.; Park, Alyssa M.; Desai, Alana

    2016-01-01

    ABSTRACT Gram-positive bacteria in the genus Enterococcus are a frequent cause of catheter-associated urinary tract infection (CAUTI), a disease whose treatment is increasingly challenged by multiantibiotic-resistant strains. We have recently shown that E. faecalis uses the Ebp pilus, a heteropolymeric surface fiber, to bind the host protein fibrinogen as a critical step in CAUTI pathogenesis. Fibrinogen is deposited on catheters due to catheter-induced inflammation and is recognized by the N-terminal domain of EbpA (EbpANTD), the Ebp pilus’s adhesin. In a murine model, vaccination with EbpANTD confers significant protection against CAUTI. Here, we explored the mechanism of protection using passive transfer of immune sera to show that antisera blocking EbpANTD-fibrinogen interactions not only is prophylactic but also can act therapeutically to reduce bacterial titers of an existing infection. Analysis of 55 clinical CAUTI, bloodstream, and gastrointestinal isolates, including E. faecalis, E. faecium, and vancomycin-resistant enterococci (VRE), revealed a diversity of levels of EbpA expression and fibrinogen-binding efficiency in vitro. Strikingly, analysis of 10 strains representative of fibrinogen-binding diversity demonstrated that, irrespective of EbpA levels, EbpANTD antibodies were universally protective. The results indicate that, despite diversity in levels of fibrinogen binding, strategies that target the disruption of EbpANTD-fibrinogen interactions have considerable promise for treatment of CAUTI. PMID:27795399

  17. Antibody-Based Therapy for Enterococcal Catheter-Associated Urinary Tract Infections

    Directory of Open Access Journals (Sweden)

    Ana L. Flores-Mireles

    2016-10-01

    Full Text Available Gram-positive bacteria in the genus Enterococcus are a frequent cause of catheter-associated urinary tract infection (CAUTI, a disease whose treatment is increasingly challenged by multiantibiotic-resistant strains. We have recently shown that E. faecalis uses the Ebp pilus, a heteropolymeric surface fiber, to bind the host protein fibrinogen as a critical step in CAUTI pathogenesis. Fibrinogen is deposited on catheters due to catheter-induced inflammation and is recognized by the N-terminal domain of EbpA (EbpANTD, the Ebp pilus’s adhesin. In a murine model, vaccination with EbpANTD confers significant protection against CAUTI. Here, we explored the mechanism of protection using passive transfer of immune sera to show that antisera blocking EbpANTD-fibrinogen interactions not only is prophylactic but also can act therapeutically to reduce bacterial titers of an existing infection. Analysis of 55 clinical CAUTI, bloodstream, and gastrointestinal isolates, including E. faecalis, E. faecium, and vancomycin-resistant enterococci (VRE, revealed a diversity of levels of EbpA expression and fibrinogen-binding efficiency in vitro. Strikingly, analysis of 10 strains representative of fibrinogen-binding diversity demonstrated that, irrespective of EbpA levels, EbpANTD antibodies were universally protective. The results indicate that, despite diversity in levels of fibrinogen binding, strategies that target the disruption of EbpANTD-fibrinogen interactions have considerable promise for treatment of CAUTI.

  18. 留置尿管患者尿路感染的相关因素及预防对策%Related factors for urinary tract infections in patients with indwelling catheter and preventive countermeasures

    Institute of Scientific and Technical Information of China (English)

    苗桂萍; 王娟; 朱欢

    2012-01-01

    目的 分析留置尿管患者尿路感染的相关因素,并探讨预防对策,以降低尿路感染发生率.方法 运用回顾性调查方法对23例留置尿管发生尿路感染患者进行原因分析;观察不同留置尿管时间尿路感染的发生率.结果 随着留置尿管时间的增加,发生尿路感染例数显著增加,留置尿管10、20、30、>30 d患者发生尿路感染分别占8.70%、17.39%、30.43%、43.48% ;23例感染患者中有16例行尿培养检查,送检率为69.57%,培养结果均为阳性,分离出的病原菌以革兰阴性杆菌为主,占52.17%,其中主要为大肠埃希菌、肺炎克雷伯菌,分别占30.43%、21.74%,革兰阳性球菌占26.09%,以屎肠球菌为主,占17.39%,除此之外真菌感染增加,以白色假丝酵母菌为主,占21.74%.结论 留置尿管时间、集尿系统密闭性不良等原因是造成尿路感染的主要危险因素,针对各种危险因素,采取有效的预防措施,可降低尿路感染的发生.%OBJECTIVE To analyze the related factors for urinary tract infection due to indwelling urinary catheter and discuss the preventive countermeasures.so as to reduce the incidence of urinary tract infection.METHODS The causes of urinary tract infections in 23 cases with indwelling urinary catheter were retrospectively analyzed, the incidence of urinary tract infections of different catheterization durations was investigated.RESULTS The urinary tract infections significantly increased as the catheter indwelling duration increased.For the duration of 10ds, 20ds, 30ds, >30 ds, the morbidity were 8.70%, 17.39% , 30.43%, 43.48% respectively, 16 of 23 cases were enrolled in urine culture, the submitted rate was 69.57%.Gram-negative bacilli were the predominant pathogens, accounting for 52.17%, E.coli and PAE were the major pathogens, accounting for 30.43% and 21.74%, respectively; Gram-positive bacilli accounted for 26.09%, among which Enterococcus feces was 17.39%.In

  19. Risk factors for central venous catheter-related infections in patients with severe trauma and countermeasures%严重创伤患者中心静脉插管相关性感染因素的分析与对策

    Institute of Scientific and Technical Information of China (English)

    鲍乐乐; 程正祥; 王秀环; 马漪洁; 陈占军; 魏丽

    2012-01-01

    OBJECTIVE To discuss the risk factors for the central venous catheter-related infections in patients with severe trauma so as to provide basis for developing treatment measures of infections. METHODS A follow-up surveillance was carried out for the patients with central venous catheter-related infections from Jan. To Dec, 2009 and from Jan. To Dec. 2010. Statistical analysis of surveillance result was performed, RESULTS The major risk factors for central venous catheter-related infections included poor sterile operation, did not pay attention to intubation care, decrease in immunity and so on. After implementing targeted monitoring and a series of intervention measures, the incidence of central venous catheter-related infections dropped from 11, 9% in 2009 to 5. 4% in 2010. CONCLUSION For the risk factors of catheter-related infections in patients with severe trauma, implementing targeted interventions can significantly reduce the incidence of the catheter-related infections,%目的 对严重创伤患者中心静脉插管相关性感染因素进行分析,为制定预防治疗对策、降低感染的发生提供依据.方法 对医院2009年1-12月及2010年1-12月中心静脉插管感染患者进行随访监测,并对监测结果进行统计分析.结果 2010年开始目标监测并实施一系列干预措施后,感染发生率由2009年的11.9%下降至2010年的5.4%;无菌操作不严格、不重视插管的护理、患者免疫力下降等是引起中心静脉插管相关性感染的主要原因.结论 针对严重创伤患者中心静脉插管的感染相关性因素,采取相应的干预措施,可明显减少中心静脉插管相关性感染的发生.

  20. Ethanol causes protein precipitation--new safety issues for catheter locking techniques.

    Directory of Open Access Journals (Sweden)

    Gernot Schilcher

    Full Text Available OBJECTIVE: The ethanol lock technique has shown great potential to eradicate organisms in biofilms and to treat or prevent central venous catheter related infections. Following instillation of ethanol lock solution, however, the inherent density gradient between blood and ethanol causes gravity induced seepage of ethanol out of the catheter and blood influx into the catheter. Plasma proteins so are exposed to highly concentrated ethanol, which is a classic agent for protein precipitation. We aimed to investigate the precipitating effect of ethanol locks on plasma proteins as a possible cause for reported catheter occlusions. METHODS: Plasma samples were exposed in-vitro to ethanol (concentrations ranging from 7 to 70 v/v% and heparin lock solutions. In catheter studies designed to mimic different in-vivo situations, the catheter tip was placed in a plasma reservoir and the material contained within the catheter was analyzed after ethanol lock instillation. The samples underwent standardized investigation for protein precipitation. RESULTS: Protein precipitation was observed in plasma samples containing ethanol solutions above a concentration of 28%, as well as in material retrieved from vertically positioned femoral catheters and jugular (subclavian catheters simulating recumbent or head down tilt body positions. Precipitates could not be re-dissolved by dilution with plasma, urokinase or alteplase. Plasma samples containing heparin lock solutions showed no signs of precipitation. CONCLUSIONS: Our in-vitro results demonstrate that ethanol locks may be associated with plasma protein precipitation in central venous catheters. This phenomenon could be related to occlusion of vascular access devices locked with ethanol, as has been reported. Concerns should be raised regarding possible complications upon injection or spontaneous gravity induced leakage of such irreversibly precipitated protein particles into the systemic circulation. We suggest

  1. Complications Involving Central Venous Catheter Insertion in Newborns Admitted to the Neonatal Intensive Care Unit (NICU

    Directory of Open Access Journals (Sweden)

    Torkaman

    2016-04-01

    Full Text Available Background Developments in the use of central venous catheters have improved the treatment of critically ill newborns. Objectives The aim of this retrospective study was to evaluate the rate of catheter-related complications and associated risk factors in newborns. Patients and Methods This cross sectional study evaluated 60 infants with indications for central venous catheters who were selected by census from 2007 to 2014 in Baqiyatallah Hospital in Tehran, Iran. The catheters were Broviac numbers 14 - 16. Results Ultimately, 60 cases (17 males and 43 females with a mean age of 26.25 ± 20.09 days (Min = 1 day and Max = 153 days underwent analysis. The most common reasons for venous catheter placement (98.3% were prolonged hospitalization and lack of peripheral vessels. The most common complication was catheter-related infection, which occurred in 20 patients (33.3%. Death occurred in 24 patients (40.0%, but only 3 deaths (5% were due to complications from the central venous catheter. A significant relationship was evident between infection and catheterization duration (P = 0.02. Conclusions Most of the catheter-related deaths were due to severe sepsis and hemothorax, and a significant relationship was noted between infection and both the mortality rate and catheterization duration. A significant relationship was also evident between birth weight and infection rates.

  2. Cytometric Catheter for Neurosurgical Applications

    Energy Technology Data Exchange (ETDEWEB)

    Evans III, Boyd Mccutchen [ORNL; Allison, Stephen W [ORNL; Fillmore, Helen [ORNL; Broaddus, William C [ORNL; Dyer, Rachel L [ORNL; Gillies, George [ORNL

    2010-01-01

    Implantation of neural progenitor cells into the central nervous system has attracted strong interest for treatment of a variety of pathologies. For example, the replacement of dopamine-producing (DA) neural cells in the brain appears promising for the treatment of patients affected by Parkinson's disease. Previous studies of cell-replacement strategies have shown that less than 90% of implanted cells survive longer than 24 - 48 hours following the implantation procedure. However, it is unknown if these cells were viable upon delivery, or if they were affected by other factors such as brain pathology or an immune response. An instrumented cell-delivery catheter has been developed to assist in answering these questions by facilitating quantification and monitoring of the viability of the cells delivered. The catheter uses a fiber optic probe to perform flourescence-based cytometric measurments on cells exiting the port at the catheter tip. The current implementation of this design is on a 3.2 mm diameter catheter with 245 micrometer diameter optical fibers. Results of fluorescence testing data are presented and show that the device can characterize the quantity of cell densities ranging from 60,000 cells/ml to 600,000 cells/ml with a coefficient of determination of 0.93.

  3. Transhepatic venous catheters for hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed El Gharib

    2014-06-01

    Conclusion: Based on our findings, transhepatic hemodialysis catheters have proven to achieve good long-term functionality. A high level of maintenance is required to preserve patency, although this approach provides remarkably durable access for patients who have otherwise exhausted access options.

  4. KREX2 is not essential for either procyclic or bloodstream form Trypanosoma brucei.

    Directory of Open Access Journals (Sweden)

    Jason Carnes

    Full Text Available BACKGROUND: Most mitochondrial mRNAs in Trypanosoma brucei require RNA editing for maturation and translation. The edited RNAs primarily encode proteins of the oxidative phosphorylation system. These parasites undergo extensive changes in energy metabolism between the insect and bloodstream stages which are mirrored by alterations in RNA editing. Two U-specific exonucleases, KREX1 and KREX2, are both present in protein complexes (editosomes that catalyze RNA editing but the relative roles of each protein are not known. METHODOLOGY/PRINCIPAL FINDINGS: The requirement for KREX2 for RNA editing in vivo was assessed in both procyclic (insect and bloodstream form parasites by methods that use homologous recombination for gene elimination. These studies resulted in null mutant cells in which both alleles were eliminated. The viability of these cells demonstrates that KREX2 is not essential in either life cycle stage, despite certain defects in RNA editing in vivo. Furthermore, editosomes isolated from KREX2 null cells require KREX1 for in vitro U-specific exonuclease activity. CONCLUSIONS: KREX2 is a U-specific exonuclease that is dispensable for RNA editing in vivo in T. brucei BFs and PFs. This result suggests that the U deletion activity, which is required for RNA editing, is primarily mediated in vivo by KREX1 which is normally found associated with only one type of editosome. The retention of the KREX2 gene implies a non-essential role or a role that is essential in other life cycle stages or conditions.

  5. Outbreak of Pantoea agglomerans Bloodstream Infections at an Oncology Clinic-Illinois, 2012-2013.

    Science.gov (United States)

    Yablon, Brian R; Dantes, Raymund; Tsai, Victoria; Lim, Rachel; Moulton-Meissner, Heather; Arduino, Matthew; Jensen, Bette; Patel, Megan Toth; Vernon, Michael O; Grant-Greene, Yoran; Christiansen, Demian; Conover, Craig; Kallen, Alexander; Guh, Alice Y

    2017-03-01

    OBJECTIVE To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections. DESIGN Epidemiologic investigation of the outbreak. SETTING Oncology clinic (clinic A). METHODS Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012-May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility's water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis. RESULTS Twelve cases were identified; median (range) age was 65 (41-78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates. CONCLUSIONS Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed. Infect Control Hosp Epidemiol 2017;38:314-319.

  6. Causes of central venous catheter-related infections after cardiac surgery and intervention measures%心脏术后中心静脉导管感染的原因分析及干预措施的研究

    Institute of Scientific and Technical Information of China (English)

    郭舒婕; 王晓敏; 张瑜; 张艳丽

    2012-01-01

    OBJECTIVE To analyze the causes of central venous catheter-related infections after the cardiac surgery and to explore the intervention countermeasures. METHODS A total of 100 patients who underwent cardiac surgery were selected, and all the patients underwent the central venous catheterization. RESULTS Of the 100 patients investigated, the central venous catheter-related infections occurred in 22 patients with the infection rate of 22. 0% , including 6 cases of Staphylococcus epidermidis infections, 5 cases of S. aureus infections, 4 cases of Klebsiella pneumoniae infections, 3 cases of Enterococcus faecalis infections, 1 case of Acinetobacter baumannii infection, 1 case of Enterobacter cloacae infection, 1 case of Candida albicans infection, and 1 case of Pseudomonas aeruginosa infection. The infections disappeared after being given appropriate antibiotics on the basis of drug susceptibility testing. The incidence rate of the central venous catheter-related infections in the patients with less than 50 years of age was 12. 5%, and 26. 5% of the patients with more than 50 years, the difference was statistically significant (P<0. 05). The infection rate of the patients without complications was 9. 1 % , and 28. 3% of the patients with complications, the difference was statistically significant (P<0. 05). The infection rate of the patients with the subclavian vein as puncture site was 17. 8%. and 21. 8% of the patients with internal jugular vein as the puncture site, the difference was not statistically significant. The infection rate of the patients with the joints and sealing solution optimized was 17. 6%, the conventional 37. 5%, the difference was statistically significantP<0. 05). The infection rate of the patients with dual-chamber was 21. 4% , 27. 3% of the patients with three-cavity, the difference was not statistically significant. The infection rate of the patients with the catheterization duration less than 7 days was 9. 1% , 20. 1% of the patient with the

  7. The female experience of ISC with a silicone catheter.

    Science.gov (United States)

    Logan, Karen

    2017-01-26

    Intermittent self-catheterisation (ISC) is a safe and effective treatment in the management of neuropathic bladder, voiding dysfunction and urinary incontinence in women. ISC has been shown to improve quality of life when used appropriately. It provides freedom for individuals who require bladder drainage as they can choose where and when to catheterise to empty the bladder. ISC requires minimum equipment, is a more discreet solution than an indwelling catheter and is relatively easy to teach in one patient visit. There are a range of different ISC catheters available on prescription. Many have been designed specifically for women and patient choice regarding product selection is an important consideration. This article describes a UK patient-satisfaction survey evaluating the female patient's perspective of learning ISC using a silicone intermittent catheter called HydroSil Go(™) that is manufactured by C.R. Bard, Inc.

  8. Bacterial Biofilms and Catheters: A Key to Understanding Bacterial Strategies in Catheter-Associated Urinary Tract Infection

    Directory of Open Access Journals (Sweden)

    J Curtis Nickel

    1992-01-01

    Full Text Available Despite major technological improvements in catheter drainage systems, the indwelling Foley catheter remains the most common cause of nosocomial infection in medical practice. By approaching this common complicated urinary tract infection from the perspective of the biofilm strategy bacteria appear to use to overcome obstacles to produce bacteriuria, one appreciates a new understanding of these infections. An adherent biofilm of bacteria in their secretory products ascends the luminal and external surface of the catheter and drainage system from a contaminated drainage spigot or urethral meatus into the bladder. If the intraluminal route of bacterial ascent is delayed by strict sterile closed drainage or addition of internal modifications to the system, the extraluminal or urethral route assumes greater importance in the development of bacteriuria, but takes significantly longer. Bacterial growth within these thick coherent biofilms confers a large measure of relative resistance to antibiotics even though the individual bacterium remains sensitive, thus accounting for the failure of antibiotic therapy. With disruption of the protective mucous layer of the bladder by mechanical irritation, the bacteria colonizing the catheter can adhere to the bladder’s mucosal surface and cause infection. An appreciation of the role of bacterial biofilms in these infections should suggest future directions for research that may ultimately reduce the risk of catheter-associated infection.

  9. Knowledge level on administration of chemotherapy through peripheral and central venous catheter among oncology nurses

    Directory of Open Access Journals (Sweden)

    Sevgisun Kapucu

    2017-01-01

    Full Text Available Objective: The aim of this study is to determine the knowledge levels of oncology nurses about peripheral and central venous catheter during their chemotherapy administration. Methods: Data collection of this descriptive study was started on April 15, 2015–July 15, 2015. The data presented in this summary belong to 165 nurses. Data were collected with data collection form including questions related to sociodemographic qualifications and knowledge levels of nurses. Data collection forms were E-mailed to the members of Turkish Oncology Nursing Society. Data presented with numbers, percentages, and mean ± standard deviation. Results: The mean age of nurses was 33.60 ± 7.34 years and mean duration for oncology nursing experience was 2.65 ± 0.91 years. Nurses had correct information about the importance of selecting peripheral venous catheter and choosing the placement area for chemotherapy administration (63.6%, control of catheter before the administration (93.9%, influence of chemotherapeutic agent on length of catheter (40.6%, and management of extravasation (75.7%. Nurses also had correct information about the first use of port catheter (67.3% and checking the catheter whether it is working properly or not (75.8%. Conclusions: In General, nurses' level of knowledge related to catheter is 50% and higher. It is recommended to increase the knowledge of nurses about evidence-based information for catheter care as a step to safe chemotherapy practice.

  10. Imaging of the complications of peripherally inserted central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Amerasekera, S.S.H. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)], E-mail: steve.amerasekera@nhs.net; Jones, C.M.; Patel, R.; Cleasby, M.J. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)

    2009-08-15

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  11. Imaging of the complications of peripherally inserted central venous catheters.

    Science.gov (United States)

    Amerasekera, S S H; Jones, C M; Patel, R; Cleasby, M J

    2009-08-01

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  12. Clinical analysis of 74 cases of bloodstream infections caused by multidrug-resist-ant Acinetobacter%多重耐药不动杆菌属血流感染74例临床分析

    Institute of Scientific and Technical Information of China (English)

    邹颖; 徐晓刚; 郭庆兰; 李光辉

    2014-01-01

    Objective To study the clinical characteristics,antimicrobial restistance of bloodstream infections (bacteremia) caused by multidrug-resistant Acinetobacter and analyze the outcomes of antibacterial therapy.Methods The clinical data were reviewed retrospectively for 74 patients with bloodstream infection caused by multidrug-resistant Acinetobacter who were trea-ted in HuaShan hospital from January 2005 to December 2011 .Results During the 6-year period,74 patients were diagnosed with multidrug-resistant Acinetobacter bacteremia,73 of which were nosocomial infections.The remaining one was community-acquired. Primary bloodstream infection accounted for 51 .4% (38/74),and secondary infection 48.6% (36/74), mainly secondary to pulmonary infections (23.0%,17/74). Solid tumor was the most common underlying disease (24.3%,18/74).Prior corticosteroid therapy,indwelling deep venous catheter,surgery and invasive procedures were predisposing factors of bacteremia. Acinetobacter-related bloodstream infections were associated with higher white blood cell count,increased neutrophil percentage,higher APACHE II score and lower serum albumin level.The bloodstream infection was caused by Acinetobacter baumannii in 65 pa-tients,Acinetobacter lwoffi in 7 patients,both Acinetobacter baumannii and Acinetobacter junii in one patient.The all-cause mortality rate was 27.0% (20/74).In vitro susceptibility testing showed that 20.0% (15/75 )of the Acinetobacter isolates were resistant to cefoperazone-sulbactam,which was the lowest among all the antibiotics tested.About 40.0% to 42.7% of the isolates were resistant to carbapenems.The outcome was related to the antimicrobial restistance.Carbapenem non-suscepti-ble Acinetobacter was associated with poorer outcome compared with carbapenem-susceptible Acinetobacter (mortality 46.9%vs 11 .9%,P <0.05 ).Cefoperazone-sulbactam non-susceptible Acinetobacter was also associated with poorer outcome com-pared with cefoperazone-sulbactam susceptible

  13. Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP).

    Science.gov (United States)

    Giordano, Paola; Saracco, Paola; Grassi, Massimo; Luciani, Matteo; Banov, Laura; Carraro, Francesca; Crocoli, Alessandro; Cesaro, Simone; Zanazzo, Giulio Andrea; Molinari, Angelo Claudio

    2015-11-01

    Central venous catheters (CVC), used for the management of children with hemato-oncological disorders, are burdened by a significant incidence of mechanical, infective, or thrombotic complications. These complications favor an increasing risk in prolongation of hospitalization, extra costs of care, and sometimes severe life-threatening events. No guidelines for the management of CVC-related occlusion and CVC-related thrombosis are available for children. To this aim, members of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) reviewed the pediatric and adult literature to propose the first recommendations for the management of CVC-related occlusion and CVC-related thrombosis in children with hemato-oncological disorders.

  14. 3D/2D Registration of Mapping Catheter Images for Arrhythmia Interventional Assistance

    CERN Document Server

    Fallavollita, Pascal

    2009-01-01

    Radiofrequency (RF) catheter ablation has transformed treatment for tachyarrhythmias and has become first-line therapy for some tachycardias. The precise localization of the arrhythmogenic site and the positioning of the RF catheter over that site are problematic: they can impair the efficiency of the procedure and are time consuming (several hours). Electroanatomic mapping technologies are available that enable the display of the cardiac chambers and the relative position of ablation lesions. However, these are expensive and use custom-made catheters. The proposed methodology makes use of standard catheters and inexpensive technology in order to create a 3D volume of the heart chamber affected by the arrhythmia. Further, we propose a novel method that uses a priori 3D information of the mapping catheter in order to estimate the 3D locations of multiple electrodes across single view C-arm images. The monoplane algorithm is tested for feasibility on computer simulations and initial canine data.

  15. 3D/2D Registration of Mapping Catheter Images for Arrhythmia Interventional Assistance

    Directory of Open Access Journals (Sweden)

    Pascal Fallavollita

    2009-09-01

    Full Text Available Radiofrequency (RF catheter ablation has transformed treatment for tachyarrhythmias and has become first-line therapy for some tachycardias. The precise localization of the arrhythmogenic site and the positioning of the RF catheter over that site are problematic: they can impair the efficiency of the procedure and are time consuming (several hours. Electroanatomic mapping technologies are available that enable the display of the cardiac chambers and the relative position of ablation lesions. However, these are expensive and use custom-made catheters. The proposed methodology makes use of standard catheters and inexpensive technology in order to create a 3D volume of the heart chamber affected by the arrhythmia. Further, we propose a novel method that uses a priori 3D information of the mapping catheter in order to estimate the 3D locations of multiple electrodes across single view C-arm images. The monoplane algorithm is tested for feasibility on computer simulations and initial canine data.

  16. Comparison of Step Tip Type and Split Tip Type Hemodialysis Catheter: HemoGlide Versus the HemoSplit

    Energy Technology Data Exchange (ETDEWEB)

    Park, Mi Hyun [Dankook University Hospital, Cheonan (Korea, Republic of); Shin, Byung Seok [Chungnam National University, Daejeon (Korea, Republic of)

    2009-08-15

    To evaluate the results and complications of the step tip type and split tip type tunneled hemodialysis catheters. Between March 2008 and December 2008, a total of 147 tunneled hemodialysis catheters of step tip (n=89) and split tip (n=58) type were placed in 126 patients to perform hemodialysis. We evaluated the number of catheterization days, as well as complications with respect to catheter tip types. A tunneled hemodialysis catheter was placed successfully in all cases. The duration of catheterization ranged from 7 to 180 days (mean 68, total catheter days: 10,504 days). A significantly higher complication rate was observed in the step tip type (n=23) as compared to the split tip type (n=4) (p=0.004), especially due to catheter dysfunction and catheter laceration. Five cases of catheter-related infection (3.4%, 0.48/1000 catheter days) were observed. Placement of the tunneled hemodialysis catheter of step tip type and spit tip type were performed safely. However, the split tip type is more useful because of the greater rate of complication in step tip type

  17. Untangling of knotted urethral catheters.

    Science.gov (United States)

    Sambrook, Andrew J; Todd, Alistair

    2007-04-01

    Intravesical catheter knotting during micturating cystourethrography is a rare but recognized complication of the procedure. We were able to untangle a knot utilizing a fluoroscopically guided vascular guidewire. Following this success, a small study was performed using a model. Various types of guidewires and techniques were tested for different diameters of knots in order to predict the likelihood of success in this type of situation.

  18. Untangling of knotted urethral catheters

    Energy Technology Data Exchange (ETDEWEB)

    Sambrook, Andrew J. [Aberdeen Royal Infirmary, Department of Radiology, Aberdeen (United Kingdom); Todd, Alistair [Raigmore Hospital, Inverness (United Kingdom)

    2007-04-15

    Intravesical catheter knotting during micturating cystourethrography is a rare but recognized complication of the procedure. We were able to untangle a knot utilizing a fluoroscopically guided vascular guidewire. Following this success, a small study was performed using a model. Various types of guidewires and techniques were tested for different diameters of knots in order to predict the likelihood of success in this type of situation. (orig.)

  19. 导尿管相关尿路感染目标性监测结果分析%The analysis of the surveillance results of catheter-related urinary tract infection

    Institute of Scientific and Technical Information of China (English)

    骆安德

    2011-01-01

    目的:探讨开展导尿管相关尿路目标性监测是否降低尿路感染发生率,并分析其危险因素,为医院感染管理和控制提供科学的依据.方法:采用目标性监测方法,对2010年所有住院患者发生导尿管相关尿路感染情况进行调查.结果:926例留置尿管患者,发生尿路感染18例,感染率为1.94%,与去年相比感染率明显下降,监测发现感染与基础病、无菌操作、手卫生及导尿管留置时间有关;病原菌分布以大肠埃希菌为主,占20.00%,排在第1位,其次是金黄色葡萄球菌、粪肠球菌、白色念珠菌等.结论:通过目标性监测,发现了医院感染管理工作的各种问题和薄弱环节,通过针对性干预减少获得医院感染的危险因素,降低医院感染发生率.%Objective: To investigate the work of surveillance of catheter-related unnary tract on reducing the incidence rate of urinary tract infection. The analysis of risk factors of urinary tract infection were provided a timely scientific basis for the hospital infection management and control. Methods: The incidences of catheter-related urinary tract infection of all in-patients in 2010 were investigated objectively with monitoring method. Results: In 926 cases with detaining urine tube, 18 cases were infccled, the incidence was 1.94%, which dropped precipitously compared with last year. According to the surveillance resuhs. it was found that the infection rates were associated with basic disease, aseptic technique, hand hygiene and the lasting time of catheterization. The pathogen germs were large intestine Egypt primarily, which accounted for 20.00% as the first. The next was Staphylococcus aureus, Enteracoccus faecalis, Candida albicans and so on. Conclusion: The vast problems and weak link in the hospital infection management could be found by the objective surveillance method. Appropriate interference on reducing the risk factors of hospital infection, can effectively reduce the

  20. Cateter venoso profundo recoberto com antibiótico para reduzir infecção: estudo piloto Antibiotic coated catheter to decrease infection: pilot study

    Directory of Open Access Journals (Sweden)

    Pedro Kurtz

    2008-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A bacteremia associada a cateter venoso central (CVC aumenta a morbidade e mortalidade hospitalar em pacientes internados em unidade de terapia intensiva (UTI. Os cateteres recobertos com rifampicina e minociclina (RM reduzem a freqüência de colonização e bacteremia. No entanto, resultados de estudos recentes questionaram o seu impacto clínico. O objetivo deste estudo foi comparar a incidência de colonização e bacteremia associada à CVC recobertos com RM e não recobertos numa coorte de pacientes admitidos em UTI. METODO: Estudo prospectivo, controlado em UTI mista clínico-cirúrgica. Os pacientes receberam um CVC recobertos com RM ou não recoberto. Após remoção do CVC, foi feita cultura de ponta do cateter e hemoculturas foram coletadas. Avaliou-se a freqüência de colonização e bacteremia. RESULTADOS: Cento e vinte CVC foram inseridos e 100 puderam ser avaliados, 49 no grupo não recobertos e 51 no grupo recoberto. As características clínicas foram similares nos 2 grupos. Dois casos de bacteremia associada ao cateter (BAC (3,9% ocorreram em pacientes que receberam CVC recobertos com RM comparado a 5 (10,2% casos de BAC no grupo não recobertos (p = 0,26. Seis (11,8% cateteres recobertos foram colonizados, comparados a 14 (28,6% no grupo não recoberto (p = 0,036. A análise de Kaplan-Meier não demonstrou diferença no risco de colonização ou BAC entre os dois grupos estudados. A taxa de BAC foi de 4,7 por 1000 cateteres-dia no grupo com CVC recobertos e 11,4 por 1000 cateteres-dia no grupo que recebeu cateteres não recobertos (p = 0,45. CONCLUSÕES: Neste estudo piloto, demonstrou-se menor freqüência de colonização em cateteres recobertos com RM, quando comparados a cateteres não recobertos. A freqüência de BAC não foi diferente entre os dois grupos.BACKGROUND AND OBJECTIVES: Nosocomial catheter related bloodstream infections (CR-BSI increase morbidity and mortality in critically ill

  1. Position Control of Motion Compensation Cardiac Catheters

    Science.gov (United States)

    Kesner, Samuel B.; Howe, Robert D.

    2011-01-01

    Robotic catheters have the potential to revolutionize cardiac surgery by enabling minimally invasive structural repairs within the beating heart. This paper presents an actuated catheter system that compensates for the fast motion of cardiac tissue using 3D ultrasound image guidance. We describe the design and operation of the mechanical drive system and catheter module and analyze the catheter performance limitations of friction and backlash in detail. To mitigate these limitations, we propose and evaluate mechanical and control system compensation methods, including inverse and model-based backlash compensation, to improve the system performance. Finally, in vivo results are presented that demonstrate that the catheter can track the cardiac tissue motion with less than 1 mm RMS error. The ultimate goal of this research is to create a fast and dexterous robotic catheter system that can perform surgery on the delicate structures inside of the beating heart. PMID:21874124

  2. Analysis and prevention strategies of central venous catheter-related blood stream infection in the EICU patients%急诊重症患者中心静脉导管相关血流感染的分析及防控策略研究

    Institute of Scientific and Technical Information of China (English)

    闫泽晨; 王月芹; 周芮伊; 左书强; 裴辉; 王立萍; 刘丹丹; 王家祥; 兰超

    2015-01-01

    目的:探讨中心静脉导管相关血流感染( CVCRBSIs)在EICU的防控策略。方法选取2013-01~2014-06我院EICU中心静脉置管患者165例为研究对象,并应用我院信息管理系统监测统计CVCRBSIs的情况,并总结制定相关防治措施。结果选取的中心静脉置管患者发生中心静脉导管相关感染4例,其中CVCRBSIs 3例,感染率为1.82%;静脉炎1例,感染率为0.61%。结论建立基于感染监测软件的四级防控系统等措施能够切实有效控制CVCRBSIs的发生。%Objective To discuss the prevention and treatment strategy of the central venous catheter-related blood stream infections ( CVCRBSIs ) .Methods We collected 165 patients in Emergency Intensive Care Unit ( EICU ) who have been given the central venous catheter from the Infection Monitoring software,and in order to identify the the spectrum and current infection status and prevention strategies of central venous catheter.Results There were three CVCRBSIs in four catheter-related infections among the collected cases, infection rate was 1.82%.And there was one phlebitis, infection rates was 0.61%.Conclusion The establishment of Grade-4 monitoring system based on the Infection Monitoring software and many other methods can reduce the occurrence of the CVCRBSIs.

  3. Infecciones relacionadas con el catéter venoso central en pacientes con nutrición parenteral total Central venous catheters-related infections in patients with parenteral nutrition

    Directory of Open Access Journals (Sweden)

    R. Seisdedos Elcuaz

    2012-06-01

    related to central venous catheters (CVC are complications with a high prevalence and possible serious consequences. Administration of total parenteral nutrition (TPN is a risk factor, although the information available for these patients and conventional inpatient units is scarce. Objective: To determine the rate of catheter-related bacteremia (CRB in patients with TPN and to identify possible relationships with administration route or place of insertion, to determinate the current situation and identify possible preventive measures. Method: Prospective-observational study of 13 months. All adult patients who received TPN were included. Infection rate used was the CRB per 1,000 days of CVC. Results: 176 CVC were registered in 159 patients. In 47% of CVC, vein access was jugular vein, despite being a location of greatest risk of infection. In critically ill patients, which followed a zero bacteremia project, there was no cases of infection. In other patients, bacteremia rate was 13.10 per 1,000 days of CVC. The average time elapsed between catheter insertion and infection was 11 days (range: 4-22 and the most frequent species were S. epidermidis (38% and S. hominis (19%. Discussion: In our environment there is a high rate of BRC in non-critical patients, with a high proportion of CVC in locations with higher risk of infection, despite not having found in the sample a higher rate of infection depending on the access route. Place of insertion, operating room face ward, is related to a lower rate of BRC. Measures to standardize clinical practice may reduce its incidence. The zero bacteremia project is confirmed as a highly effective method.

  4. Comparison between an Ascenda and a silicone catheter in intrathecal baclofen therapy in pediatric patients: analysis of complications.

    Science.gov (United States)

    Motta, Francesco; Antonello, Clara Eleonora

    2016-10-01

    OBJECTIVE In this single-center study the authors investigated the complications occurring before and after the introduction of the new Ascenda intrathecal catheter (Medtronic Inc.) in pediatric patients treated with intrathecal baclofen therapy (ITB) for spasticity and/or dystonia. METHODS This was a retrospective review of 508 children who had received ITB, 416 with silicone catheters in the 13 years between September 1998 and September 2011 and 92 with Ascenda catheters in the 3 years between September 2011 and August 2014. The authors evaluated major complications such as infections, CSF leaks treated, and problems related to the catheter or pump, and they compared the 2 groups of patients who had received either a silicone catheter or an Ascenda catheter implant. RESULTS One hundred twenty patients in the silicone group (29%) and 1 patient in the Ascenda group (1.1%; p < 0.001) had a major complication. In the silicone group 23 patients (5.5%) were affected by CSF leakage and 75 patients (18%) experienced 82 catheter-related events, such as occlusion, dislodgment, disconnection, or breakage, which required catheter replacement. In the Ascenda group, only 1 patient (1.1%) was affected by CSF leakage. CONCLUSIONS To the authors' knowledge, this study is the first in the literature to compare the performance of the new Ascenda catheter, introduced in 2011, with the traditional silicone catheter for intrathecal drug infusion. In their analysis, the authors found that the Ascenda catheter can reduce major complications related to the catheter after ITB pump implantation. Further investigation is necessary to expand on and confirm their results.

  5. A case of misplaced permacath dialysis catheter

    Directory of Open Access Journals (Sweden)

    Mohammed Arshad Ali

    2015-01-01

    Full Text Available Central venous placement using ultrasound has significantly reduced the complications associated with blind puncture. The central venous catheter can still get misplaced if it follows an anomalous route after appropriate puncture of desired vessel. We report a case of misplaced dialysis catheter into the accessory hemiazygos vein which resulted in a large hemothorax, and we recommend the routine use of a fluoroscope for placement of dialysis catheters so as to avoid serious complications.

  6. Accuracy of image-guided radiotherapy of prostate cancer based on the BeamCath urethral catheter technique

    DEFF Research Database (Denmark)

    Poulsen, Per Rugaard; Fokdal, Lars; Petersen, Jørgen B.B.;

    2007-01-01

    was 0.6 mm (LR), 2.4 mm (CC), and 2.8 mm (AP), while the prostate movement relative to external skin markers was considerably larger. Removal of the catheter resulted in a mean cranial prostate movement of 1.5mm relative to the pelvic bone. Caudal catheter displacements of 7-30 mm were observed in 5...

  7. Impact of different catheter lock strategies on bacterial colonization of permanent central venous hemodialysis catheters.

    Science.gov (United States)

    Erb, Stefan; Widmer, Andreas F; Tschudin-Sutter, Sarah; Neff, Ursula; Fischer, Manuela; Dickenmann, Michael; Grosse, Philipp

    2013-12-01

    Thirty-nine hemodialysis patients with permanent central venous catheters were analyzed for bacterial catheter colonization comparing different catheter-lock strategies. The closed needleless Tego connector with sodium chloride lock solution was significantly more frequently colonized with bacteria than the standard catheter caps with antimicrobially active citrate lock solution (odds ratio, 0.22 [95% confidence interval, 0.07-0.71]; P = .011).

  8. POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT OUTPATIENT UNITS

    Directory of Open Access Journals (Sweden)

    Icaro Boszczowski

    2014-01-01

    Full Text Available Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc in bone marrow transplant and hematology outpatients. Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units. Findings: 14 patients had B. multivorans (one patient had also B. cenopacia, six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology; in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30% were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication, no new cases occurred. Conclusions: This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A of multi-dose vials.

  9. Surveillance of bloodstream infections in pediatric cancer centers – what have we learned and how do we move on?

    Directory of Open Access Journals (Sweden)

    Simon, Arne

    2016-05-01

    Full Text Available Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI. Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients’ safety during intensive treatment. The great majority of all pediatric cancer patients (about 85% have a long-term central venous access catheter in use (type Broviac or Port; CVAD. Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD- BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined.

  10. Malposition of catheters during voiding cystourethrography

    Energy Technology Data Exchange (ETDEWEB)

    Rathaus, V.; Konen, O.; Shapiro, M. [Dept. of Diagnostic Imaging Sapir Medical Center, Kfar-Saba and Sackler Medical School, Tel Aviv University (Israel); Grunebaum, M. [Veteran Pediatric Radiologist, Kfar Saba (Israel)

    2001-04-01

    The aim of this study was to report catheter malposition during voiding cystourethrography. Eight hundred forty-three voiding cystourethrography (265 males and 578 females, aged 1 week to 12 years, mean age 2 years) were performed during a period of 4 years. The conventional standard procedure was applied. In 3 cases with passed history of urinary tract infection the catheter entered directly into the ureter. In all these cases the uretero-vesical reflux was present on the same side where the catheter entered. It appears that insertion of a catheter into the ureter is possible only in the presence of an anomaly or pathology at the vesicoureteric junction. (orig.)

  11. Klebsiella variicola is a frequent cause of bloodstream infection in the stockholm area, and associated with higher mortality compared to K. pneumoniae.

    Directory of Open Access Journals (Sweden)

    Makaoui Maatallah

    Full Text Available Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139 were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96, KpII (corresponding to K. quasipneumoniae, n = 9 and KpIII (corresponding to K. variicola, n = 34. Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%. Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%, whereas KpI isolates were associated with mortality in 13/96 cases (13.5%. This difference was significant both in univariate statistical analysis (P = 0.037 and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10-8.36. Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1, had a mucoid phenotype (n = 1 and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1. In conclusion, the results indicate higher mortality among patients infected with

  12. Klebsiella variicola is a frequent cause of bloodstream infection in the stockholm area, and associated with higher mortality compared to K. pneumoniae.

    Science.gov (United States)

    Maatallah, Makaoui; Vading, Malin; Kabir, Muhammad Humaun; Bakhrouf, Amina; Kalin, Mats; Nauclér, Pontus; Brisse, Sylvain; Giske, Christian G

    2014-01-01

    Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96), KpII (corresponding to K. quasipneumoniae, n = 9) and KpIII (corresponding to K. variicola, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10-8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1). In conclusion, the results indicate higher mortality among patients infected with

  13. Real-time x-ray fluoroscopy-based catheter detection and tracking for cardiac electrophysiology interventions

    Energy Technology Data Exchange (ETDEWEB)

    Ma Yingliang; Housden, R. James; Razavi, Reza; Rhode, Kawal S. [Division of Imaging Sciences and Biomedical Engineering, King' s College London, London SE1 7EH (United Kingdom); Gogin, Nicolas; Cathier, Pascal [Medisys Research Group, Philips Healthcare, Paris 92156 (France); Gijsbers, Geert [Interventional X-ray, Philips Healthcare, Best 5680 DA (Netherlands); Cooklin, Michael; O' Neill, Mark; Gill, Jaswinder; Rinaldi, C. Aldo [Department of Cardiology, Guys and St. Thomas' Hospitals NHS Foundation Trust, London SE1 7EH (United Kingdom)

    2013-07-15

    Purpose: X-ray fluoroscopically guided cardiac electrophysiology (EP) procedures are commonly carried out to treat patients with arrhythmias. X-ray images have poor soft tissue contrast and, for this reason, overlay of a three-dimensional (3D) roadmap derived from preprocedural volumetric images can be used to add anatomical information. It is useful to know the position of the catheter electrodes relative to the cardiac anatomy, for example, to record ablation therapy locations during atrial fibrillation therapy. Also, the electrode positions of the coronary sinus (CS) catheter or lasso catheter can be used for road map motion correction.Methods: In this paper, the authors present a novel unified computational framework for image-based catheter detection and tracking without any user interaction. The proposed framework includes fast blob detection, shape-constrained searching and model-based detection. In addition, catheter tracking methods were designed based on the customized catheter models input from the detection method. Three real-time detection and tracking methods are derived from the computational framework to detect or track the three most common types of catheters in EP procedures: the ablation catheter, the CS catheter, and the lasso catheter. Since the proposed methods use the same blob detection method to extract key information from x-ray images, the ablation, CS, and lasso catheters can be detected and tracked simultaneously in real-time.Results: The catheter detection methods were tested on 105 different clinical fluoroscopy sequences taken from 31 clinical procedures. Two-dimensional (2D) detection errors of 0.50 {+-} 0.29, 0.92 {+-} 0.61, and 0.63 {+-} 0.45 mm as well as success rates of 99.4%, 97.2%, and 88.9% were achieved for the CS catheter, ablation catheter, and lasso catheter, respectively. With the tracking method, accuracies were increased to 0.45 {+-} 0.28, 0.64 {+-} 0.37, and 0.53 {+-} 0.38 mm and success rates increased to 100%, 99

  14. Comparison of catheter-related infection risk in two different long-term venous devices in adult hematology-oncology patients Comparação do risco de infecção relacionada a cateteres entre dois tipos de dispositivos de longa permanência em pacientes onco-hematológicos

    Directory of Open Access Journals (Sweden)

    Luís Fernando Pracchia

    2004-01-01

    Full Text Available PURPOSE: Infection is the leading complication of long-term central venous catheters, and its incidence may vary according to catheter type. The objective of this study was to compare the frequency and probability of infection between two types of long-term intravenous devices. METHODS: Retrospective study in 96 onco-hematology patients with partially implanted catheters (n = 55 or completely implanted ones (n = 42. Demographic data and catheter care were similar in both groups. Infection incidence and infection-free survival were used for the comparison of the two devices. RESULTS: In a median follow-up time of 210 days, the catheter-related infection incidence was 0.2102/100 catheter-days for the partially implanted devices and 0.0045/100 catheter-days for the completely implanted devices; the infection incidence rate was 46.7 (CI 95% = 6.2 to 348.8. The 1-year first infection-free survival ratio was 45% versus 97%, and the 1-year removal due to infection-free survival ratio was 42% versus 97% for partially and totally implanted catheters, respectively (P OBJETIVO: Infecção é a principal complicação relacionada ao uso de cateteres venosos de longa permanência em pacientes oncológicos e sua incidência pode variar a depender do tipo de cateter utilizado. O objetivo deste estudo foi comparar a freqüência e risco de infecção entre dois tipos de dispositivos de longa permanência. MÉTODOS: Estudo retrospectivo com 96 pacientes onco-hematológicos portadores de cateteres parcialmente implantáveis (n=55 ou totalmente implantáveis (n=42. Dados demográficos e cuidados com o dispositivo foram similares entre os dois grupos. A comparação entre os dispositivos foi realizada através da avaliação da incidência de infecção e da sobrevida livre de infecção. RESULTADOS: Em uma mediana de acompanhamento de 210 dias, a incidência de infecção relacionada ao cateter foi de 0,2102/100 cateter-dias para os dispositivos parcialmente

  15. [Right ventricular perforation and cardiac tamponade caused by a central venous catheter].

    Science.gov (United States)

    Fukuda, H; Kasuda, H; Shimizu, R

    1993-02-01

    A 5 year old girl with ASD was scheduled for open heart surgery. A central venous catheter was placed via the right infraclavicular vein after induction of anesthesia. Thirty minutes after insertion of the catheter, a decrease in arterial pressure and pulse pressure, an increase in heart rate and central venous pressure were observed. Cardiac tamponade was revealed by rapid opening of the chest. Gushing blood out of a hole in the right ventricular free wall was confirmed by pericardiotomy. The hemodynamics were stabilized by blood transfusion and surgical closure of the hole on the ventricle. This perforation was thought to be caused by careless insertion of a relatively stiff central venous catheter.

  16. 重症监护病房老年患者导管相关性真菌感染高危因素研究%Risk Factors of Central Vein Catheter Related Fungal Infection in Elderly Patients in Intensive Care Units

    Institute of Scientific and Technical Information of China (English)

    高志凌; 俞兴群; 刘宝

    2012-01-01

    Objective To investigate the risk factors of elderly patients with central vein catheter related fungal infection in intensive care units, and to provide basis for earlier empirical antifungal treatment. Methods 47 elderly patients who admitted into ICU from August 2008 to August 2011 and who were diagnosed as central vein catheter related infection were retrospectively analyzed. All the patients were divided into fungal infection group and bacterial infection group, and the risk factors were analyzed. Results Compared with bacterial infection group, patients in fungal infection group had significantly longer catheter indwelling time, significantly more Candida parasitism and more application of broad - spectrum antibiotics ≥7 days, significantly higher APACHE II scores and significantly higher usage rate of antibacterial catheters ( P < 0. 05 ) . Multivariate logistic regression analysis showed that Candida parasitism, high APACHE II scores and application of broad - spectrum antibiotics ≥7 days were independent risk factors of central vein catheter related fungal infection. Conclusion Candida parasitism, high APACHE Ⅱ scores, using broad - spectrum antibiotics ≥ 7 days were independent risk factors of central vein catheter related fungi infection. This can guide the usage of central venous catheters and earlier empirical antifungal treatment.%目的 探讨重症监护病房(ICU)老年患者导管相关性真菌感染的危险因素,为早期经验性治疗提供依据.方法 回顾性调查2008年8月-2011年8月在我科住院并确诊为导管相关性血行性感染(CLABSI)的患者共47例,分为真菌感染组和细菌感染组,分析其危险因素.结果 真菌感染组较细菌感染组导管留置时间明显延长,念珠菌定植、应用广谱抗生素≥7 d患者明显增多,确诊感染当天急性生理与慢性健康状况评分Ⅱ(APACHEⅡ评分)明显升高,抗菌导管使用率明显升高,差异均有统计学意义(P<0.05).多因

  17. 医院获得性铜绿假单胞菌血流感染的临床分析%Clinical analysis of hospital-acquired bloodstream infections due to Pseudomonas aeruginosa

    Institute of Scientific and Technical Information of China (English)

    文亚坤; 曹萌; 邹琳; 俞森洋; 孙宝君

    2013-01-01

    bloodstream infections , 98. 0% of the patients had fever, 72. 5% with rigor, and 31. 4% with hematologic disease and low white blood cell counts and low neutrophilic granulocyte counts. Of the rest of the patients, there were 97. 1% of the patients with the white blood cell counts or/and the neutrophilic granulocyte counts elevated, 37. 3% with catheter-related bloodstream infections. There were 35. 3% of the patients complicated by septic shock, and the overall mortality rate was 29. 4%. The univariate analysis of the mortality-associated factors indicated that the mortality was correlated with the more than 70 years of age, diabetes mellitus, heart disease, pulmonary infection, blood ALB<30 g/L, blood HGB<90 g/L, invasive mechanical ventilation, hemodialysis, and the ICU stay. The logistic regression analysis indicated that the diabetes mellitus and blood HGB<90 g/L were related to the mortality. CONCLUSION The patients with hospital-acquired P. aeruginosa bloodstream infections are usually complicated by the fever, rigor, and the elevated white blood cell counts or/and neutrophilic granulocyte counts. The diabetes mellitus and blood HGB<90 g/L are the related factors for the mortality.

  18. SURVIVAL OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETERS: AN EVALUATION OF SURGICAL AND NON-SURGICAL FACTORS (SINGLE CENTER STUDY

    Directory of Open Access Journals (Sweden)

    A. Keshvari

    2006-06-01

    Full Text Available Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end-stage renal disease. The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. This study was conducted in order to evaluate the catheter survival and its related factors in Imam Khomeini Hospital. A total of 80 catheters were inserted into 69 patients (52 men and 28 women with end-stage chronic renal failure during a period of 84 months. Retrospectively the correlation between catheter survival (overall and event free with demographic factors (sex and age, surgical factors (surgeons and surgical methods, nephrologic factors (the causes of peritoneal dialysis selection and the history of hemodialysis and peritonitis factors (the history and number of peritonitis has been evaluated. The mean age of the patients was 48.35 years (16 to 79 years. The overall survival of catheters or the probability of having a functioning catheter after one, two and three years was 53%, 41%, 22%, respectively. The event free survival of the catheter or the probability of having a functioning catheter without any problems after one year was 14%. It has been found out that among all factors in this study only history of hemodialysis had statistically significant effect on the overall survival of continuous ambulatory peritoneal dialysis catheter (P = 0.04. It seems that the overall survival of catheters is better when CAPD is started before any other attempts for hemodialysis.

  19. Soft thrombus formation in radiofrequency catheter ablation

    NARCIS (Netherlands)

    Demolin, JM; Eick, OJ; Munch, K; Koullick, E; Nakagawa, H; Wittkampf, FHM

    2002-01-01

    During RF catheter ablation, local temperature elevation can result in coagulum formation on the ablation electrode, resulting in impedance rise. A recent study has also demonstrated the formation of a so-called soft thrombus during experimental ablations. This deposit poorly adhered to the catheter

  20. Catheter ablation of parahisian premature ventricular complex.

    Science.gov (United States)

    Kim, Jun; Kim, Jeong Su; Park, Yong Hyun; Kim, June Hong; Chun, Kook Jin

    2011-12-01

    Catheter ablation is performed in selected patients with a symptomatic premature ventricular complex (PVC) or PVC-induced cardiomyopathy. Ablation of PVC from the His region has a high risk of inducing a complete atrioventricular block. Here we report successful catheter ablation of a parahisian PVC in a 63-year-old man.

  1. Urethral catheters: can we reduce use?

    NARCIS (Netherlands)

    Broek, P.J. van den; Wille, J.C.; Benthem, B.H.B. van; Perenboom, R.J.M.; Akker-van Marle, M.E. van den; Nielen, A.M.A.

    2011-01-01

    Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. The efficacy of an intervention programme to improve adherence to recommenda

  2. Automated Pointing of Cardiac Imaging Catheters.

    Science.gov (United States)

    Loschak, Paul M; Brattain, Laura J; Howe, Robert D

    2013-12-31

    Intracardiac echocardiography (ICE) catheters enable high-quality ultrasound imaging within the heart, but their use in guiding procedures is limited due to the difficulty of manually pointing them at structures of interest. This paper presents the design and testing of a catheter steering model for robotic control of commercial ICE catheters. The four actuated degrees of freedom (4-DOF) are two catheter handle knobs to produce bi-directional bending in combination with rotation and translation of the handle. An extra degree of freedom in the system allows the imaging plane (dependent on orientation) to be directed at an object of interest. A closed form solution for forward and inverse kinematics enables control of the catheter tip position and the imaging plane orientation. The proposed algorithms were validated with a robotic test bed using electromagnetic sensor tracking of the catheter tip. The ability to automatically acquire imaging targets in the heart may improve the efficiency and effectiveness of intracardiac catheter interventions by allowing visualization of soft tissue structures that are not visible using standard fluoroscopic guidance. Although the system has been developed and tested for manipulating ICE catheters, the methods described here are applicable to any long thin tendon-driven tool (with single or bi-directional bending) requiring accurate tip position and orientation control.

  3. Attitudes Towards Catheter Ablation for Atrial Fibrillation

    DEFF Research Database (Denmark)

    Vadmann, Henrik; Pedersen, Susanne S; Nielsen, Jens Cosedis;

    2015-01-01

    BACKGROUND: Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians´ attitudes towards catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish...

  4. The changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report.

    Science.gov (United States)

    Vasconcelos, Ana Tereza R; Barth, Afonso L; Zavascki, Alexandre P; Gales, Ana C; Levin, Anna S; Lucarevschi, Bianca R; Cabral, Blenda G; Brasiliense, Danielle M; Rossi, Flavia; Furtado, Guilherme H C; Carneiro, Irna Carla R S; da Silva, Juliana O; Ribeiro, Julival; Lima, Karla V B; Correa, Luci; Britto, Maria H; Silva, Mariama T; da Conceição, Marília L; Moreira, Marina; Martino, Marinês D V; de Freitas, Marise R; Oliveira, Maura S; Dalben, Mirian F; Guzman, Ricardo D; Cayô, Rodrigo; Morais, Rosângela; Santos, Sânia A; Martins, Willames M B S

    2015-12-01

    We evaluated the epidemiology of Acinetobacter spp. recovered from patients diagnosed with bloodstream infections in 9 tertiary hospitals located in all Brazilian geographic regions between April and August 2014. Although OXA-23-producing Acinetobacter baumannii clones were disseminated in most hospitals, it was observed for the first time the spread of OXA-72 among clonally related A. baumannii isolated from distinct hospitals. Interestingly, Acinetobacter pittii was the most frequent species found in a Northern region hospital. Contrasting with the multisusceptible profile displayed by A. pittii isolates, the tetracyclines and polymyxins were the only antimicrobials active against all A. baumannii isolates.

  5. Concentration of erythrocyte-based magnetic carriers in the bloodstream

    Energy Technology Data Exchange (ETDEWEB)

    Danilov, Y.N.; Il' ina, M.B.; Makharudov, S.Y.; Orekhov, A.N.; Rodchenko, S.A.; Samokhin, G.P.

    1986-04-01

    The writers postulated that magnetic erythrocytes (ME), injected into the bloodstream, may be concentrated in an assigned region of the vascular bed with the aid of the field of a permanent magnet. To test this hypothesis, erythrocytes ''loaded'' with colloidal magnetite were used, and concentrated in experiments in vitro and in vivo. For the experiments in vivo ME were labeled with sodium pertechnetate (Na /SUP 99n/ TcO4) was estimated in ME with a Rackgamma 1270 counter by determining radioactivity in the ME suspension and in the supernatant. For the experiment in vivo, a midline laparotomy was performed on a dog weighing 14 kg under intravenous hexobarbital anesthesia. The distribution of ME was recorded by means of a gamma-camera.

  6. Mortality in enterococcal bloodstream infections increases with inappropriate antimicrobial therapy

    DEFF Research Database (Denmark)

    Suppli, M.; Aabenhus, R.; Harboe, Z.B.;

    2010-01-01

    Enterococcus species are common in nosocomial bloodstream infections and their incidence is rising. Although well recognized in several serious bacterial infections, the influence of appropriate antimicrobial therapy in enterococcal bacteraemia has not been fully settled. The aim of the study...... in Denmark. Patients with growth of non-enterococcus co-pathogens apart from the enterococcal bacteraemia were also included, as were patients with repeated enterococcal bacteraemia. Time to appropriate antimicrobial therapy was counted from the first episode. Appropriate antibiotic therapy was defined...... as any therapy with documented clinical effect, in vitro activity and a minimum treatment length of 6 days. Multivariate regression models were built to determine the independent risk factors for mortality. We included 196 patients with enterococcal bacteraemia. Appropriate antibiotics for at least 6...

  7. Risk factors of the central-vein catheter related infection and advancement in nursing%中心静脉导管相关性感染危险因素及临床护理进展

    Institute of Scientific and Technical Information of China (English)

    杨屹珺

    2010-01-01

    @@ 中心静脉导管(central venous catheter,CVC)是临床上抢救危重患者的必要通道,广泛用于输液、输血、药物治疗、肠道外营养、中心静脉压检测、血液透析和心血管疾病的介入治疗等.

  8. Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Msangi Viola

    2007-05-01

    Full Text Available Abstract Background Bloodstream infection is a common cause of hospitalization, morbidity and death in children. The impact of antimicrobial resistance and HIV infection on outcome is not firmly established. Methods We assessed the incidence of bloodstream infection and risk factors for fatal outcome in a prospective cohort study of 1828 consecutive admissions of children aged zero to seven years with signs of systemic infection. Blood was obtained for culture, malaria microscopy, HIV antibody test and, when necessary, HIV PCR. We recorded data on clinical features, underlying diseases, antimicrobial drug use and patients' outcome. Results The incidence of laboratory-confirmed bloodstream infection was 13.9% (255/1828 of admissions, despite two thirds of the study population having received antimicrobial therapy prior to blood culture. The most frequent isolates were klebsiella, salmonellae, Escherichia coli, enterococci and Staphylococcus aureus. Furthermore, 21.6% had malaria and 16.8% HIV infection. One third (34.9% of the children with laboratory-confirmed bloodstream infection died. The mortality rate from Gram-negative bloodstream infection (43.5% was more than double that of malaria (20.2% and Gram-positive bloodstream infection (16.7%. Significant risk factors for death by logistic regression modeling were inappropriate treatment due to antimicrobial resistance, HIV infection, other underlying infectious diseases, malnutrition and bloodstream infection caused by Enterobacteriaceae, other Gram-negatives and candida. Conclusion Bloodstream infection was less common than malaria, but caused more deaths. The frequent use of antimicrobials prior to blood culture may have hampered the detection of organisms susceptible to commonly used antimicrobials, including pneumococci, and thus the study probably underestimates the incidence of bloodstream infection. The finding that antimicrobial resistance, HIV-infection and malnutrition predict fatal

  9. Vascular collateralization along ventriculoperitoneal shunt catheters in moyamoya disease.

    Science.gov (United States)

    Singla, Amit; Lin, Ning; Ho, Allen L; Scott, R Michael; Smith, Edward R

    2013-06-01

    vascularization is interrupted when shunt catheters are removed and replaced. A knowledge of the existence of shunt-related collaterals in patients with moyamoya may aid the surgeon in planning shunt revisions and considering, for example, a new entry point for a ventricular catheter, rather than replacing an existing one, to minimize the risk of jeopardizing existing collaterals.

  10. Unusual migration of pulmonary artery catheter

    Directory of Open Access Journals (Sweden)

    Sanjay Kuravinakop

    2007-01-01

    Full Text Available Pulmonary artery catheter is widely used in intensive care. Distal migration of the catheter is a know complication. Diagnosis of such a migration is made by both clinical criteria and radiographs. A 55 year old septic lady was admitted to the intensive care unit. Pulmonary artery catheter introduced for cardiac output monitoring migrated from right lung to left lung. Diagnosis was made following a chest radiograph the following day of insertion with the clinical criteria remaining unaltered. Migration of pulmonary artery catheter can occur not only distally but from one lung to another. Clinical criteria alone cannot rule out migration. Chest radiographs form an important part in monitoring the position of the pulmonary artery catheter.

  11. Central venous catheters: detection of catheter complications and therapeutical options; Zentralvenoese Katheter: Diagnostik von Komplikationen und therapeutische Optionen

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, B.; Beck, A. [Universitaetsmedizin Charite, Berlin (Germany). Klinik fuer Strahlenheilkunde; Wagner, H.J. [Vivantes-Kliniken, Friedrichshain und Am Urban, Berlin (Germany). Radiologie; Vivantes-Kliniken, Hellersdorf und Prenzlauer Berg (Germany). Radiologie

    2008-06-15

    For modern medicine central venous catheters play an important role for diagnostic and therapeutic options. Catheter implantation, complication detection and therapy of catheter complications are an increasing demand for the radiologist. The review article provides an overview of different catheter types, their indications, advantages and disadvantages. Catheter malpositions are usually detectable in conventional X-ray. Most malpositions are correctable using interventional-radiological techniques. In addition therapeutical options for thrombotic complications (venous thrombosis, catheter occlusion, fibrin sheath) are discussed. In case of an infectious catheter complication, usually a catheter extraction and re-implantation is necessary.

  12. Application and effect of FOCUS-PDCA methodology on the control of catheter-related blood stream infection%FOCUS-PDCA 方法学在控制 CRBSI 过程中的应用及效果

    Institute of Scientific and Technical Information of China (English)

    封卫征; 朱金京

    2014-01-01

    Objective To evaluate the effect of FOCUS-PDCA program(find,organize,clarify,understand,se-lect,plan,do,check,act )on the prevention and control of catheter-related blood stream infection (CRBSI)in an intensive care unit(ICU).Methods Process of central venous catheterization and nursing care were analyzed by u-sing FOCUS-PDCA program,and the causes for CRBSI were found out ;a continuous quality improvement (CQI) team was established to provide training for ICU nurses,and the process was improved and supervised,virtuous cir-cle was created.Results Incidence of CRBSI decreased from 8.29‰ before FOCUS-PDCA intervention(January-December,2010)to 3.20‰ after FOCUS-PDCA intervention(January 2011 -December 2012),the difference was significant (χ2 =14.6,P <0.001).Conclusion FOCUS-PDCA program is effective for controlling the incidence of CRBSI.%目的:探讨运用 FOCUS-PDCA 程序预防控制重症监护室(ICU)导管相关血流感染(CRBSI)的效果。方法运用 FOCUS-PDCA 程序分析中心静脉置管以及护理操作流程中的各个环节,明确 CRBSI 发生的具体原因;成立持续质量控制(CQI)小组并对 ICU 护士进行培训,对操作流程进行改进和监督,形成良性循环。结果运用 FOCUS-PDCA 程序干预前(2010年1-12月),ICU 的 CRBSI 发病率为8.29‰;经干预后(2011年1月-2012年12月),CRBSI 的发病率降至3.20‰,差异具有统计学意义(χ2=14.6,P <0.001)。结论运用 FOCUS-PDCA程序控制 CRBSI 的发病率是有效的。

  13. Improved ex vivo blood compatibility of central venous catheter with noble metal alloy coating.

    Science.gov (United States)

    Vafa Homann, Manijeh; Johansson, Dorota; Wallen, Håkan; Sanchez, Javier

    2016-10-01

    Central line associated bloodstream infections (CLABSIs) are a serious cause of morbidity and mortality induced by the use of central venous catheters (CVCs). Nobel metal alloy (NMA) coating is an advanced surface modification that prevents microbial adhesion and growth on catheters and thereby reduces the risk of infection. In vitro microbiological analyses have shown up to 90% reduction in microbial adhesion on coated CVC compared to uncoated ones. This study aimed to assess the blood compatibility of NMA-coated CVC according to ISO 10993-4. Hemolysis, thrombin-antithrombin (TAT) complex, platelet counts, fibrin deposition, and C3a and SC5b-9 complement activation were analyzed in human blood exposed to the NMA-coated and control CVCs using a Chandler-loop model. NMA-coated CVC did not induce hemolysis and fell in the "nonhemolytic" category according to ASTM F756-00. Significantly lower amounts of TAT were generated and less fibrin was deposited on NMA-coated CVC than on uncoated ones. Slightly higher platelet counts and lower complement markers were observed for NMA-coated CVC compared to uncoated ones. These data suggest that the NMA-coated CVC has better ex vivo blood compatibility compared to uncoated CVC. © 2015 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1359-1365, 2016.

  14. Evaluation of an intravenous catheter for use in the horse.

    Science.gov (United States)

    Gulick, B A; Meagher, D M

    1981-02-01

    A commercially available polyvinyl chloride intravenous catheter was studied in 9 horses for 3 to 10 days to evaluate the catheter's suitability for use in the horse, to develop a new insertion technique, and to establish a protocol for catheter care. Seven of the animals were clinically normal horses receiving parenteral nutrition; one was a horse with hypocalcemia receiving frequent intravenous injections of calcium gluconate, and one was a clinically normal horse receiving no infusions. The catheter dressings were changed every 48 hours, and an aspirate from the catheter and the catheter tip was cultured at the time of catheter removal. One catheter became infected following a break in the protocol. It was concluded that the polyvinyl catheter is suitable for use in the horse and that the proposed protocol for catheter insertion and maintenance may reduce the likelihood of complications such as catheter sepsis, thrombophlebitis, and embolism.

  15. Clinical investigation of catheter-related infections in two central venous cathers%两种中心静脉导管相关性感染的临床观察

    Institute of Scientific and Technical Information of China (English)

    高立平

    2012-01-01

    目的 评价抗感染中心静脉导管在减少重症监护病房(ICU)患者导管相关性感染(CRI)中的作用.方法 将248例在ICU留置中心静脉导管的患者随机分成普通中心静脉导管组(对照组120例)和抗感染中心静脉导管组(抗感染组128例),观察两组CRI的发生率和病原菌分布情况.结果 抗感染组的CRI发生率明显低于对照组(6.3%vs14.2%),差异有统计学意义(P<0.05).CRI的病原菌为金黄色葡萄球菌、鲍曼不动杆菌、阴沟肠杆菌、肠球菌、肺炎克雷伯菌和白色念珠菌,但两组患者CRI病原菌分布比较,差异无统计学意义(P>0.05).结论 抗感染中心静脉导管可明显降低ICU患者CRI的发生率.%Objective To evaluate the effect of reducing intravenous catheter-ralated infection (CRT) using antiseptic impregnated central venous catheter in patients in intensive care unit (ICU). Methods 248 patients treated in ICU who needed intravascular catheterization were randomly divided into the control group (120 cases, treated with ordinary central venous catheter) and the antiseptic group (128 cases, treated with antiseptic impregnated central venous catheter). The incidence of CRI and pathogenic distribution were observed. Results The incidence of CRI in the antiseptic group was significantly lower than that of the control group (6.3% vs 14.2%, P<0.05). The pathogens of CRI were Staphytococcus aureus, Acmetabactor baumarwiii, E. Cloacae, entemcoccus, Klebsiella pneumonias and Candida albicans. Pathogenic distribution between the two groups showed no statistically significant difference (PX).O5). Conclusion Antiseptic impregnated central venous catheter can obviously reduce the incidence of CRI in patients in ICU.

  16. The decline of typhoid and the rise of non-typhoid salmonellae and fungal infections in a changing HIV landscape: bloodstream infection trends over 15 years in southern Vietnam.

    Science.gov (United States)

    Nga, Tran Vu Thieu; Parry, Christopher M; Le, Thuy; Lan, Nguyen Phu Huong; Diep, To Song; Campbell, James I; Hoang, Nguyen Van Minh; Dung, Le Thi; Wain, John; Dolecek, Christiane; Farrar, Jeremy J; Chau, Nguyen Van Vinh; Hien, Tran Tinh; Day, Jeremy N; Baker, Stephen

    2012-01-01

    The etiological spectrum of bloodstream infections is variable between industrialized and developing countries and even within a defined location over time. We investigated trends in bloodstream infections at an infectious disease hospital in Ho Chi Minh City, Vietnam, from 1994-2008. Amongst 66,111 blood cultures performed, a clinically relevant pathogen was isolated in 7645 episodes (positivity rate; 116/1000 cultures). Salmonella Typhi was the predominant pathogen until 2002; however, a considerable annual decline in the proportion of S. Typhi was observed (OR 0.6993, 95% CI [0.6885, 0.7103], pSalmonella (NTS), Cryptococcus neoformans and Penicillium marneffei, concurrent with increasing HIV prevalence. These data document a substantial longitudinal shift in bloodstream infection etiology in southern Vietnam. We propose such changes are related to increasing economic prosperity and HIV prevalence, and this pattern marks a substantial change in the epidemiology of invasive salmonellosis in Southeast Asia.

  17. Taurolidine in Pediatric Home Parenteral Nutrition Patients.

    Science.gov (United States)

    Hulshof, Emma Claire; Hanff, Lidwien Marieke; Olieman, Joanne; de Vette, Susanna; Driessen, Gert-Jan; Meeussen, Conny; Escher, Johanna Caroline

    2017-02-01

    To reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients, the use of taurolidine was introduced in the Sophia Children's Hospital in 2011. This introduction led to a reduction in catheter-related bloodstream infections: 12.7/1000 catheter days before the use of taurolidine, compared with 4.3/1000 catheter days afterwards (n = 7) [relative risk = 0.36, 95% confidence interval: 0.20-0.65 (P = 0.018)].

  18. Risk factors for bloodstream infections in 66 patients in ICU%ICU 66例血流感染患者危险因素分析

    Institute of Scientific and Technical Information of China (English)

    姚彬; 习慧明

    2012-01-01

    OBJECTIVE To investigate the risk factors for bloodstream infections in the intensive care unit (ICU), to analyze the distribution of pathogens and their drug resistance so as to provide basis for the prevention and treatment of bloodstream infections and reduce the incidence of bloodstream infections and the mortality. METHODS Totally 66 patients with bloodstream infections were investigated retrospectively in the ICU of Beijing Haidian Hospital between 2009 and 2011, the risk factors for bloodstream infections, the distribution of pathogens, and the drug resistance characteristics were analyzed. RESULTS A total of 70 strains of pathogens were isolated from 66 patients with bloodstream infections, including 32 (45. 7%) strains of gram-negative bacteria,28 (40. 0%) strains of gram-positive bacteria, and 10 (14.3%) strains of fungi; the main pathogens causing bloodstream infections were coagulase-negative Staphylococci (25. 7%), Acinetobacter baumannii (12.9%), Yeast (12. 9%), Burkholderia cepacia (10.0%), Enterococcus feces (8.6%), and Escherichia coli (8. 6%). Those patients with the bloodstream infections had poor prognosis and the mortality rate was high, up to 69. 23%. The chronic underlying disease, low immunity, invasive operation,and the abuse of antibiotics were risk factors of bloodstream infections. CONCLUSION The distribution of the gram-negative bacteria is as basically same as the gram-positive bacteria in the pathogens causing blood stream infections in the ICU during the three years. A. baumannii is the main species of gram-negative bacteria, and coagulase-negative Staphylococci was the predominant species of gram-positive bacteria. The strict aseptic operation, careful nursing of catheter, intensifying the blood culture, and reasonable use of antibiotics are the effective measures to prevent and treat the bloodstream infections.%目的 了解重症监护病房(ICU)血流感染的危险因素、病原菌分布特点及其耐药性,为更好地预防

  19. Peripherally inserted central venous catheter safety in burn care: a single-center retrospective cohort review.

    Science.gov (United States)

    Austin, Ryan E; Shahrokhi, Shahriar; Bolourani, Siavash; Jeschke, Marc G

    2015-01-01

    The use of peripherally inserted central catheter (PICC) line for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC-associated complication rates with the existing literature in both the critical care and burn settings. The methodology involved is a single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008 and 2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and three cases of central line-associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days (range 1 to 49 days). We suggest that PICC line-associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to central venous catheter-associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant and potentially fatal risks.

  20. Radiologic placement of tunneled central venous catheter

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Seong Tae; Yang, Po Song; Yang, Dong Hunn; Kim, Ki Tae; Kim, Choon Yul; Shinn, Kyung Sub [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of); Yun, Eun Joo [Korea Veterans Hospital, Seoul (Korea, Republic of)

    1996-01-01

    To evaluate the efficacy and safety of fluoroscopy-guided, radiologic placement of a tunneled central venous catheter into the superior vena cava (SVC). Thirty five patients underwent tunneled central venous catheter placement to facilitate long-term chemotherapy. They included 33 leukemic patients, one colon cancer patient, and one multiple myeloma patient. After confirming central venous patency with a injection of contrast media via the peripheral cephalic or basilic vein in the wrist joint, the subclavian vein was punctured under fluoroscopic guidance. A 7F double lumen TPN catheter was placed into the SVC through a subcutaneous tunnel in the anterior chest wall. Catheter placements were successful in all patients. The mean procedure time was 17.2minutes, mean fluooscopy time was 1.3minutes, mean number of punctures was 1.4, and mean volume of injhected contrast media was 43.5cc. Only two of all leukemic patients developed mild hematomas at the puncture site, but these soon resolved themselves. None of the patients developed pneumothorax or hemothorax. But late complications included local infection in two patients (6%) and thrombotic occlusion of the catheter in one (3%). The occluded catheter was successfully recanalized with Urokinase infusion. Fluoroscopy-guided, radiologic placement of a tunneled central venous catheter is an easy and safe method, and useful for patients requiring long-term venous access.

  1. [Updating enteral feeding by catheter].

    Science.gov (United States)

    Rodríguez, T; Planas, M

    2005-12-01

    Intestinal nutrition can be administered orally or by means of a catheter; the latter method is the focus of this article. The authors' objective is to provide up-to-date information in a succinct manner about the enteral feeding technique. The authors hope health professionals know the advantages as well as the inconveniences of the latest intestinal nutrition advances regarding access ways and the means to administer these. Intestinal nutrition formulas will not be dealt with in this article. However, a health professional should know that there is a wide variety of diets available depending on the complexity of macronutrients included in a diet, the quantity of proteins in a mixture, and that these are designed, in addition to feeding, to treat the specific pathological process a patient suffers from, such as diabetes of cancer.

  2. 水胶体敷料预防PICC患者机械性静脉炎效果的meta分析%A system review of the effects of hydrocolloid dressing in preventing Peripherally Inserted Central Catheter-related mechanical phlebitis:meta-analysis

    Institute of Scientific and Technical Information of China (English)

    黎贵; 张淑香; 徐波

    2014-01-01

    目的:系统评价水胶体敷料对于PICC患者机械性静脉炎的预防效果。方法:计算机检索Cochrane Database of Systematic Reviews、JBI Database of Systematic Review、EMBase、PubMed、中国生物医学文献数据库、万方数据库和中国学术期刊全文数据库中关于水胶体敷料对于预防PICC患者机械性静脉炎效果的随机对照试验(RCT)和半随机对照试验(q-RCT),同时筛检纳入文献的参考文献。由2名研究者对文献质量进行严格评价和资料提取,对符合质量标准的RCT进行meta分析。结果:共纳入9篇文献,meta分析的结果显示水胶体敷料能降低PICC患者机械性静脉炎的发生率。结论:水胶体敷料的使用对于预防PICC机械性静脉炎的发生具有显著效果,具有一定临床推广意义。%Objective:To systematically evaluate the effects of hydrocolloid dressing in preventing Peripherally Inserted Central Catheter-related mechanical phlebitis. Methods:The authors searched the Cochrane Database of Systematic Reviews, JBI Database of Systematic Review, EMBase, PubMed, CBMdisc, Wanfang Data and CNKI to collect randomized controlled trials (RCTs) and quasi-Randomized Controlled Trials (q-RCTs) which studied the effects of hydrocolloid dressing in preventing Peripherally Inserted Central Catheter-related mechanical phlebitis. The quality of RCTs and q-RCT were critically appraised and data were extracted by 2 reviewers independently. Meta-analyses were conducted for the eligible RCTs. Results:9 RCTs were included. The meta-analysis had showed that hydrocolloid dressing could decrease the rate of Peripherally Inserted Central Catheter-related mechanical phlebitis significantly. Conclusion:Hydrocolloid dressing was effective to prevent Peripherally Inserted Central Catheter-related mechanical phlebitis.

  3. Improving patient safety during insertion of peripheral venous catheters: an observational intervention study

    Directory of Open Access Journals (Sweden)

    Kampf, Günter

    2013-11-01

    Full Text Available [english] Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps.Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology. A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback, followed by a second observation period. During the last observation week, participants evaluated the intervention.Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test. Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after. Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68

  4. Risk factors for the appearance of central venous catheters colonization

    Directory of Open Access Journals (Sweden)

    Mioljević Vesna

    2007-01-01

    Full Text Available Introduction/Aim. Intravascular device placement (IVD is a part of everyday medical practice, however, its application is associated with a high risk of onset of nosocomial infections (NI and increased mortality and morbidity. Nosocomial blood infections (NBIs account for 10% of all the registered NI. NBIs are more frequent in patients with a placed IVD and it present an important risk factor for the onset of NBI, i.e. catheter-associated NBIs (CANBIs. Pathogenesis of CANBIs is complex and conditioned by the presence of different characteristics related to a catheter, patient and a specific causative organism. The most common CRBSI causes include coagulase-negative staphylococcus, S. aureus, Enterobacter spp, Candida spp, Klebsiella spp, Pseudomonas spp. and Enterococcus spp. Methods. All the patients hospitalized at the Intensive Care Department of the Clinic of Digestive Diseases over the period January 1, 2004-September 1, 2004 were retrospectively analyzed. The study included 107 patients in whom central venous catheter (CVC was placed for more than 48 h. All the causes isolated from a CVC segment were recorded. Culture, isolation and identification of the causative organisms were performed using standard microbiological methods in the Bacteriological Laboratory within the Emergency Center, Clinical Center of Serbia. Catheter segment samples (tip of the CVC 3-5 cm long were analyzed. Based on the insight into medical documentation, patients’ examination and medical staff interview, catheter and patient-related characteristics were recorded. Results. A total of 107 CVCs were analyzed, out of which 56 (52% were sterile while 51 (48% were colonized. The results of our study evidenced that total parenteral nutrition (TPN (p < 0.05, number of catheterization days (p < 0.05, and central venous pressure measurement (p < 0.05 were significantly associated with CVC colonization. In this study, no statistically significant difference in catheter

  5. Cryoballoon Catheter Ablation in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cevher Ozcan

    2011-01-01

    Full Text Available Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

  6. Percutaneous catheter dilatation of carotid stenoses

    Energy Technology Data Exchange (ETDEWEB)

    Mathias, K.; Mittermayer, C.; Ensinger, H.; Neff, W.

    1980-09-01

    Thirty-one carotid artery stenoses were produced in thirty dogs by three different techniques. Twenty-three of these could be cured by transfemoral percutaneous catheter dilatation. High grade tight stenoses may present resistance which cannot be overcome by the catheter. Histological examination of the dilated vessels showed circumscribed changes in the vessel wall, with destruction of elastic membranes. From our experience of catheter dilatation of pelvic and lower limb arteries and of renal arteries, we consider it feasible to use this technique in selected patients with carotid stenosis.

  7. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    Science.gov (United States)

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients.

  8. 恶性肿瘤中心静脉置管后并发血栓相关因素分析%Related Factors of Central Venous Catheter-associated Thrombosis in Cancer

    Institute of Scientific and Technical Information of China (English)

    谢勋鹏; 陈萍; 朱红军; 陆宏宾; 张莉莉; 王明伟; 范红菊

    2015-01-01

    Objective To investigate the risk factors of thrombosis fol owing central venous catheter (CVC) in cancer patients. Methods CVC - associated thrombosis was investigated in 702 patients receiving placement of CVC. Results There were 23 CVC-associated thrombosis among 702 patients. Patients with adanced cancer,chemotherapy,and increase of blood d-dimer were the important risk factors for CVC-associated thrombosis. Conclusion Adanced tumors fol owing central venous catheter prone to deep vein thrombosis. Patients with high risk of blood clots after central venous catheter should give preventive intervention.%目的探讨肿瘤患者进行置入中心静脉导管后深静脉血栓发生情况及相关危险因素。方法对702例行中心静脉置管的恶性肿瘤患者,对其性别、年龄、原发疾病、置管部位、血红蛋白和D-二聚体水平与血栓发生情况进行回顾性分析。结果23例发生深静脉血栓栓塞(VTE),中心静脉置管后深静脉血栓发生与肿瘤分期、治疗及患者血液D-二聚体水平相关。结论晚期肿瘤患者中心静脉置管易发生深静脉血栓,对于有血栓高危的肿瘤患者中心静脉置管后需预防性干预。

  9. Periinterventional prophylactic antibiotics in radiological port catheter implantation; Periinterventionelle prophylaktische Antibiotikagabe bei der radiologischen Portkatheterimplantation

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, B.; Teichgraeber, U.; Werk, M. [Charite, Universitaetsmedizin Berlin (Germany). Klinik fuer Strahlenheilkunde; Wagner, H.J. [Vivantes Klinikum im Friedrichshain und am Urban (Germany). Inst. fuer Radiologie

    2007-08-15

    Purpose: To evaluate whether catheter-related infections after radiologically placed port catheters can be reduced by single-shot periinterventional antibiosis. Materials and Method: Between January and September 2002, 164 consecutive patients with indication for central venous port catheter implantation were included in the present study. During implantation the interventional radiologist was responsible for deciding whether to administer a prophylactic single-shot antibiosis. The prophylactic antibiosis entailed intravenous administration of ampicillin and sulbactam (3 g Unacid, Pfizer) or 100 mg ciprofloxacine (Ciprobay, Bayer) in the case of an allergy history to penicillins. Catheter-related infection was defined as a local or systemic infection necessitating port catheter extraction. Results: Indication for port catheter implantation was a malignant disease requiring chemotherapy in 158 cases. The port catheter (Chemosite [Tyco Healthcare] [n = 123], low-profile [Arrow International] [n = 35], other port system [n = 6]) was implanted via sonographically guided puncture of the right jugular vein in 139 patients, via the left jugular vein in 24 cases and via the right subclavian vein in one patient. 75 patients received periinterventional prophylactic antibiosis (Unacid [n = 63] Ciprobay [n = 12]) and 89 patients did not receive antibiosis. The prophylactic antibiosis caused a minor allergic reaction in one patient that improved with antihistamic and corticoid medication. A total of 7 ports, 6 without prophylactic antibiosis versus one with periinterventional prophylaxis, were extracted due to infectious complications. Conclusion: Single-shot periinterventional prophylactic antibiosis can reduce early and late infectious complications after radiological-interventional placement of central venous port catheters. (orig.)

  10. THE KISSING BALLOON TECHNIQUE WITH 2 OVER-THE-WIRE BALLOON CATHETERS THROUGH A SINGLE 8-FRENCH GUIDING CATHETER

    NARCIS (Netherlands)

    DENHEIJER, P; BERNINK, PJLM; VANDIJK, RB; TWISK, SPM; LIE, KI

    1991-01-01

    Some of the newer over-the-wire coronary angioplasty catheters have shaft sizes of 3.0 French (F) or less. The inner diameter of modern 8-F guiding catheters is large enough to accommodate two of such balloon catheters. We report a kissing balloon procedure with two over-the-wire catheters through a

  11. Evaluation of the usefulness of coronary catheters and 4 Fr insertion sets for transradial access coronarography in comparison with catheters and 5 Fr sets

    Science.gov (United States)

    Chodór, Piotr; Sulik-Gajda, Sylwia; Ramus, Nela; Kowalczyk, Jacek; Honisz, Grzegorz; Wilczek, Krzysztof; Średniawa, Beata; Kalarus, Zbigniew

    2013-01-01

    Introduction Application of transradial arterial access during coronarography, besides pain, means faster patient mobilization and fewer complications. During those procedures, vascular sheaths and 5/6 Fr catheters, and lately 4 Fr catheters, are used. Aim To assess the usefulness of 4 Fr catheters and sheaths in comparison to 5 Fr in diagnostic coronarography. Material and methods In the period from 5.12.2010 to 27.02.2012, a group of patients who had coronarography with a 4 Fr catheter (n = 20) and a 5 Fr catheter (n = 20) were studied. Technical issues and potential problems related to the use of each catheter were analyzed. Morphology, biochemical parameters, and local complications were analyzed. The assessment included pain intensification during catheter removal and insertion in the VAS/numerical (0–10)/verbal scales and the quality of image obtained during the coronarography. Results All the angiograms obtained during all the interventions were of diagnostic value and in invasive cardiologists’ opinions, they did not differ statistically in clarity. Moreover, there were no statistically significant differences in radiation/fluoroscopy time, amount of contrast medium, or morphological and biochemical parameters. The size of hematomas in the 4 Fr group was 17.55 ±14.6 cm2, and in the 5 Fr group 31.07 ±32.11 cm2, p = 0.12. The average intensity of pain felt during the intervention/at the time of its removal and insertion in the numerical scale was in the 4 Fr group 0.65 ±0.93/0.55 ±0.94 and in the 5 Fr group 1.88 ±1.64/1.42 ±1.61, p < 0.05. Conclusions Application of 4 Fr catheters allows one to perform a diagnostic procedure with a small number of local and hemorrhagic complications comparable with 5 Fr catheters. Due to reduced pain, it is appropriate to continue studies with the use of 4 Fr catheters and sheaths. PMID:24570748

  12. Using urokinase to restore patency in double lumen catheters.

    Science.gov (United States)

    Northsea, C

    1994-08-01

    All hemodialysis patients with temporary or permanent double lumen catheters are at risk for catheter occlusion. Clinical outcomes and cost-effectiveness of using urokinase, a thrombolytic agent, to declot occluded double lumen dialysis catheters were evaluated for 2 years. Patency was restored in 95 of 102 catheters. These data support the use of urokinase to safely and effectively restore patency, thereby extending the length of time a catheter can be used for dialysis.

  13. Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives

    Science.gov (United States)

    Meddings, Jennifer; Reichert, Heidi; Greene, M Todd; Safdar, Nasia; Krein, Sarah L; Olmsted, Russell N; Watson, Sam R; Edson, Barbara; Albert Lesher, Mariana; Saint, Sanjay

    2017-01-01

    Background The Agency for Healthcare Research and Quality (AHRQ) has funded national collaboratives using the Comprehensive Unit-based Safety Program to reduce rates of two catheter-associated infections—central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI), using evidence-based intervention bundles to improve technical aspects of care and socioadaptive approaches to foster a culture of safety. Objective Examine the association between hospital units' results for the Hospital Survey on Patient Safety Culture (HSOPS) and catheter-associated infection rates. Methods We analysed data from two prospective cohort studies from acute-care intensive care units (ICUs) and non-ICUs participating in the AHRQ CLABSI and CAUTI collaboratives. National Healthcare Safety Network catheter-associated infections per 1000 catheter-days were collected at baseline and quarterly postimplementation. The HSOPS was collected at baseline and again 1 year later. Infection rates were modelled using multilevel negative binomial models as a function of HSOPS components over time, adjusted for hospital-level characteristics. Results 1821 units from 1079 hospitals (CLABSI) and 1576 units from 949 hospitals (CAUTI) were included. Among responding units, infection rates declined over the project periods (by 47% for CLABSI, by 23% for CAUTI, unadjusted). No significant associations were found between CLABSI or CAUTI rates and HSOPS measures at baseline or over time. Conclusions We found no association between results of the HSOPS and catheter-associated infection rates when measured at baseline and postintervention in two successful large national collaboratives focused on prevention of CLABSI and CAUTI. These results suggest that it may be possible to improve CLABSI and CAUTI rates without making significant changes in safety culture, particularly as measured by instruments like HSOPS. PMID:27222593

  14. Catheter-Associated Urinary Tract Infections

    Science.gov (United States)

    ... Submit Button Frequently Asked Questions about Catheter-associated Urinary Tract Infections Recommend on Facebook Tweet Share Compartir What is ... an incision above the pubis. What is a urinary tract infection? A urinary tract infection (UTI) is an infection ...

  15. Bloodstream Infections in a Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mehmet Sah Ižpek

    2016-09-01

    Full Text Available Aim: To determine the pattern of bloodstream infections (BSIs and antimicrobial susceptibility of pathogens in a neonatal intensive care unit (NICU.Material and Method: Positive hemoculture of neonates diagnosed with nosocomial sepsis from March 2011 to March 2014 in the NICU of Diyarbakir Maternity and Children%u2019s Hospital, in the southeastern region of Anatolia, Turkey, were retrospectively reviewed. Results: A total of 148 pathogens were isolated in 142 neonates. The most common microorganisms isolated were Klebsiella pneumoniae (40.5% and Acinetobacter baumannii (29.7% which was a result of a hospital outbreak. Multi-drug resistant (MDR strains accounted for 20.0% of K. pneumoniae isolates and 93.2% of A. baumannii isolates. The sepsis-attributable mortality rate was higher in cases infected with MDR strains than in cases infected without MDR strains or Candida spp (24% vs. 9.7%, p=0.032. Discussion: In our unit, BSIs were more often caused by Gram negative bacteria. BSIs caused by MDR strains were associated with a higher rate of sepsis-attributable mortality.

  16. Systemic effects of locally injected platelet rich plasma in a rat model: an analysis on muscle and bloodstream.

    Science.gov (United States)

    Borrione, P; Grasso, L; Racca, S; Abbadessa, G; Carriero, V; Fagnani, F; Quaranta, F; Pigozzi, F

    2015-01-01

    Abundant evidence suggests that growth factors, contained in platelets alpha granules, may play a key role in the early stages of the muscle healing process with particular regard to the inflammatory phase. Although the contents of the platelet-rich plasma preparations have been extensively studied, the biological mechanisms involved as well as the systemic effects and the related potential doping implications of this approach are still largely unknown. The aim of the present study was to investigate whether local platelet-rich plasma administration may modify the levels of specific cytokines and growth factors both in treated muscle and bloodstream in rats. An additional aim was to investigate more deeply whether the local platelet-rich plasma administration may exert systemic effects by analyzing contralateral lesioned but untreated muscles. The results showed that platelet-rich plasma treatment induced a modification of certain cytokines and growth factor levels in muscle but not in the bloodstream, suggesting that local platelet-rich plasma treatment influenced directly or, more plausibly, indirectly the synthesis or recruitment of cytokines and growth factors at the site of injury. Moreover, the observed modifications of cytokine and growth factor levels in contralateral injured but not treated muscles, strongly suggested a systemic effect of locally injected platelet-rich plasma.

  17. Clonal distribution of bone sialoprotein-binding protein gene among Staphylococcus aureus isolates associated with bloodstream infections.

    Science.gov (United States)

    Wiśniewska, Katarzyna; Piórkowska, Anna; Kasprzyk, Joanna; Bronk, Marek; Świeć, Krystyna

    2014-11-01

    Staphylococcus aureus is a leading cause of bloodstream infections (BSI) and diseases that may be caused by hematogenous spread. The staphylococcal adhesin, for which the association with the infections emerging as a complication of septicemia has been well documented, is a bone sialoprotein-binding protein (Bbp). The aim of the study was to assess the prevalence of a bbp gene in S. aureus bloodstream isolates associated with BSI and to investigate to what degree the distribution of this gene is linked to the clonality of the population. Spa typing, used in order to explore the genetic population structure of the isolates, yielded 29 types. Six spa clusters and seven singletons were identified. The most frequent was spa clonal complex CC021 associated with MLST CC30 (38%). The bbp gene was found in 47% of isolates. Almost all isolates (95%) clustered in spa clonal complex CC021 were positive for this gene. All isolates carrying the bbp gene were sensitive to methicillin, and if clustered in the spa CC021, belonged to agr group III. Our study shows that Bbp is not strictly associated with BSI. However, one may conclude that for clonally related S. aureus strains most commonly causing BSI, the risk of Bbp-mediated complications of septicemia is expected to be higher than for other strains.

  18. Percutaneous versus laparoscopic placement of peritoneal dialysis catheters: Simplicity and favorable outcome

    Directory of Open Access Journals (Sweden)

    Abdulla K Al-Hwiesh

    2014-01-01

    Full Text Available Implantation of peritoneal dialysis (PD catheters via the laparoscopic technique is expanding, but none of the studies concerning this technique have compared its outcome with the percutaneous insertion done by the nephrologist. We compared the technical survival and outcome of 52 PD catheters placed in 43 patients with end-stage renal disease (ESRD in our center from March 2006 to October 2007. Of these, 27 PD catheters were inserted percutaneously by a nephrologist (group 1 and 25 were placed by a surgeon using the conventional laparoscopic technique (group 2. Very obese patients, those with previous abdominal surgery, and those who refused local anesthesia were excluded from the study. All catheters were evaluated for mechanical and infectious complications and the overall technique survival was analyzed. The incidence of complications in PD catheters did not largely differ between the two groups. Early catheter-related infection episodes (within two weeks of catheter placement occurred in three of 22 (13.6% patients in group 1, versus three of 21 (14.3% patients in group 2 (P >0.05. The incidence of exit site leak was higher in group 2 (19.0% compared to (4.5% group 1 (P 0.05. We conclude that in our study, the percutaneous bedside placements of PD catheters done by nephrologists were comparable with the laparoscopic insertions performed by surgeons where the high-risk patients were avoided, and the former provided a safer and more reliable access that allowed a rapid initiation of PD.

  19. Placement of an implantable port catheter in the biliary stent: an experimental study in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Gi Young; Lee, Im Sick; Choi, Won Chan [Asan Medical Center, Seoul (Korea, Republic of)

    2004-04-01

    To investigate the feasibility of port catheter placement following a biliary stent placement. We employed 14 mongrel dogs as test subject and after the puncture of their gaIl bladders using sonographic guidance, a 10-mm in diameter metallic stent was placed at the common duct. In 12 dogs, a 6.3 F port catheter was placed into the duodenum through the common duct and a port was secured at the subcutaneous space following stent placement. As a control group, an 8.5 F drain tube was placed into the gallbladder without port catheter placement in the remaining two dogs. Irrigation of the bile duct was performed every week by injection of saline into the port, and the port catheter was replaced three weeks later in two dogs. Information relating to the success of the procedure, complications and the five-week follow-up cholangiographic findings were obtained. Placement of a biliary stent and a port catheter was technically successful in 13 (93%) dogs, while stent migration (n=3), gallbladder rupture (n=1) and death (n=5) due to subcutaneous abscess and peritonitis also occurred. The follow-up was achieved in eight dogs (seven dogs with a port catheter placement and one dog with a drain tube placement). Irrigation of the bile duct and port catheter replacement were successfully achieved without any complications. Cholangiograms obtained five weeks after stent placement showed diffuse biliary dilation with granulation tissue formation. However, focal biliary stricture was seen in one dog with stent placement alone. Placement of a port catheter following biliary stent placement seems to be feasible. However, further investigation is necessary to reduce the current complications.

  20. Clinical and molecular characteristics of bloodstream infections caused by Candida albicans in children from 2003 to 2011.

    Science.gov (United States)

    Tsai, M-H; Wang, S-H; Hsu, J-F; Lin, L-C; Chu, S-M; Huang, H-R; Chiang, M-C; Fu, R-H; Lu, J-J; Huang, Y-C

    2015-11-01

    We investigated the clinical and molecular characteristics of Candida albicans bloodstream infection (BSI) in children from a tertiary-level medical centre in Taiwan over a 9-year period from January 2003 to December 2011. We performed multilocus sequence typing (MLST) to investigate the genetic relatedness of these C. albicans BSI isolates. A total of 79 episodes of C. albicans BSI in 76 paediatric patients were identified, including 41 (51.9%) from the paediatric intensive care unit, 24 (30.4%) from the neonatal intensive care unit and 14 (17.7%) from general wards. More than half (59.5%) of these patients had underlying chronic co-morbidities, and the majority (94.9%) had a catheter or some other artificial device. All the isolates were susceptible to the antifungal agents tested. Only 32.9% (26/79) received effective antifungal agents within 24 h of onset of candidaemia. Twenty-five (31.6%) patients had persistent candidaemia (>3 days after the start of antifungal treatment) and candidaemia-attributable mortality rate was 22.8% (18/79). The 72 isolates available for MLST yielded 53 unique diploid sequence types (DSTs). Forty-five DSTs were singletons and eight DSTs were shared by 27 (37.5%) isolates. Seventy-one (98.6%) isolates were clustered within previously known clades. Based on the definition of two or more strains with shared DST occurring within a period of 90 days, 10.1% of the infections were categorized as nosocomial clusters, most commonly identified in the intensive care units. Although cluster-associated candidaemia was not associated with a higher mortality rate, none of the clusters were identified by the hospital infection control team.

  1. The Use of a Low-Concentration Heparin Solution to Extend the Life of Central Venous Catheters in the African Green Monkeys (Chlorocebus aethiops)

    Science.gov (United States)

    2006-11-28

    rhesus macaques developed catheter-related septice- mia, and antibiotic therapy and catheter removal was required to resolve the bacteremia.2 Materials ...the internal jugular vein from the remainder of the vascular bundle. A trocar was used to cre- ate a subcutaneous tunnel from the cervical surgery...site, over the right shoulder, to a point in the center of the back, where a small incision was made to expose the trocar tip. The catheter was

  2. Clinical characteristics and risk factors of symptomatic central venous catheter-related deep vein thrombosis in children%儿童中心静脉置管相关症状型深静脉血栓形成的临床特点和影响因素

    Institute of Scientific and Technical Information of China (English)

    裴亮; 杨雨航; 杨妮; 文广富; 许巍; 刘春峰

    2016-01-01

    Objective To investigate the clinical features and risk factors in children with symptomatic central venous catheter-related deep vein thrombosis,and to provide guidence for clinical therapy.Methods The clinical data of 105 children with central venous catheter were retrospectively analyzed.According to the thrombosis or not,these children were classified into two groups:thrombosis group and non-thrombosis group.The risk factors influencing symptomatic central venous catheter-related deep vein thrombosis forming were identified by Logis