This document discusses strategies for preventing catheter-related infections in hemodialysis patients. Central venous catheters are increasingly used for hemodialysis but carry a risk of infectious complications. Several preventive approaches are outlined, including universal precautions, sutureless securement devices, topical antiseptic ointments at exit sites, antimicrobial locking solutions, needleless connectors, and coated catheters. Proper hand hygiene and skin cleansing are also emphasized. Sutureless devices and antimicrobial locks may help reduce infections, but evidence on other strategies like chlorhexidine dressings is less clear. Overall prevention requires a multifaceted approach.
Catheter related infections- DR Nadia MohsenFarragBahbah
This document discusses catheter-related bloodstream infections (CRBSIs) in patients undergoing hemodialysis. It defines CRBSIs and describes the types of dialysis catheters and associated infection risks. Common causative organisms are gram-positive cocci like Staphylococcus aureus. The diagnostic approach involves clinical evaluation and blood cultures, with treatment tailored based on culture results. Management typically requires systemic antibiotics and often catheter removal, with options for catheter exchange or salvage with antibiotic locks in some cases.
Catheter related infections atmeda final (1)FarragBahbah
This document discusses catheter-related infections in hemodialysis patients. It covers definitions of different types of infections, pathogenesis, epidemiology, diagnosis, treatment, and prevention strategies. The most common causative pathogens are coagulase-negative staphylococci, S. aureus, enterococci, and Candida species. Antibiotic lock solutions can be used to reduce infections and allow catheter salvage in some cases. Strict adherence to infection control practices and prioritizing arteriovenous fistulas can help reduce catheter-related infections.
The document outlines CDC core interventions for preventing dialysis bloodstream infections, including catheter reduction, staff education, surveillance and feedback, hand hygiene observations, catheter/vascular access care observations, catheter hub disinfection, patient education, chlorhexidine for skin antisepsis, and antimicrobial ointment for hemodialysis catheter exit sites. It also provides definitions and treatment protocols for exit site infections, tunnel infections, and hemodialysis catheter-related bloodstream infections. Empiric antibiotic and antifungal regimens, treatment durations, and criteria for catheter salvage or removal are discussed in detail.
Catheter related _infections .. dr Osama ElshahatFarragBahbah
This document discusses catheter-related infections in hemodialysis patients. It covers definitions of different types of infections, including exit site infections, tunnel infections, and bloodstream infections. The most common causative pathogens are discussed. Risk factors for infections include the type and location of catheter, as well as patient factors like diabetes or recent hospitalization. Treatment involves antibiotics targeted to the pathogen along with catheter removal or salvage depending on the severity of infection. Antibiotic lock solutions may be used in some cases to reduce infections and allow catheter salvage. The document emphasizes preventing infections through strict adherence to infection control practices and policies.
This document discusses bacterial infection of tunneled hemodialysis catheters. It notes that while fistulas are preferred, many patients still initiate dialysis with catheters which have a high risk of infection. Catheter-related bloodstream infections can lead to serious complications and increased mortality. Common pathogens involved include Staphylococcus, Pseudomonas, and Candida. Prevention strategies include proper insertion technique, exit site care, and use of antimicrobial locks. Treatment of infections involves antibiotics tailored to the pathogen as well as potentially removing the catheter. Duration of treatment depends on the severity and type of infection.
Hemodialysis catheter related infection JAFAR ALSAID
The document discusses hemodialysis catheter-related infections. It notes that catheter infections are a major cause of morbidity and mortality for hemodialysis patients. It provides statistics on catheter use and infection rates. It then describes different types of catheter infections including exit site infections, tunnel infections, and bloodstream infections. Signs and symptoms of infections are outlined. The document proposes a strict infection control protocol for nurses to follow during catheter care and dialysis to help reduce infection rates. This includes recommendations for site cleaning, dressing changes, tubing changes, and staff education.
Infection control for_hemodialysis_facilitiesFarragBahbah
This document provides guidelines for infection control in hemodialysis facilities. It discusses that hemodialysis patients are at high risk for infections due to their medical treatment. Effective infection control programs can save money and improve patient care. The document outlines recommendations for cleaning and disinfecting equipment and surfaces, hand hygiene, patient immunizations, standard and transmission-based precautions, HBV isolation, respiratory hygiene, and vascular access infection prevention including catheter insertion guidelines.
Central line-associated bloodstream infections (CLABSI) develop within 48 hours of central line placement. Catheter-related bloodstream infections are attributed to an intravascular catheter. Risk factors include chronic illnesses, immune compromised states, and catheter characteristics. Symptoms include fever, inflammation at the insertion site, and sepsis. Diagnosis requires cultures of blood and the catheter tip. Treatment involves catheter removal and antibiotics based on identified pathogens. Antibiotic lock therapy can be used as an adjunct for some intraluminal infections when catheter removal is not possible.
Catheter related infections- DR Nadia MohsenFarragBahbah
This document discusses catheter-related bloodstream infections (CRBSIs) in patients undergoing hemodialysis. It defines CRBSIs and describes the types of dialysis catheters and associated infection risks. Common causative organisms are gram-positive cocci like Staphylococcus aureus. The diagnostic approach involves clinical evaluation and blood cultures, with treatment tailored based on culture results. Management typically requires systemic antibiotics and often catheter removal, with options for catheter exchange or salvage with antibiotic locks in some cases.
Catheter related infections atmeda final (1)FarragBahbah
This document discusses catheter-related infections in hemodialysis patients. It covers definitions of different types of infections, pathogenesis, epidemiology, diagnosis, treatment, and prevention strategies. The most common causative pathogens are coagulase-negative staphylococci, S. aureus, enterococci, and Candida species. Antibiotic lock solutions can be used to reduce infections and allow catheter salvage in some cases. Strict adherence to infection control practices and prioritizing arteriovenous fistulas can help reduce catheter-related infections.
The document outlines CDC core interventions for preventing dialysis bloodstream infections, including catheter reduction, staff education, surveillance and feedback, hand hygiene observations, catheter/vascular access care observations, catheter hub disinfection, patient education, chlorhexidine for skin antisepsis, and antimicrobial ointment for hemodialysis catheter exit sites. It also provides definitions and treatment protocols for exit site infections, tunnel infections, and hemodialysis catheter-related bloodstream infections. Empiric antibiotic and antifungal regimens, treatment durations, and criteria for catheter salvage or removal are discussed in detail.
Catheter related _infections .. dr Osama ElshahatFarragBahbah
This document discusses catheter-related infections in hemodialysis patients. It covers definitions of different types of infections, including exit site infections, tunnel infections, and bloodstream infections. The most common causative pathogens are discussed. Risk factors for infections include the type and location of catheter, as well as patient factors like diabetes or recent hospitalization. Treatment involves antibiotics targeted to the pathogen along with catheter removal or salvage depending on the severity of infection. Antibiotic lock solutions may be used in some cases to reduce infections and allow catheter salvage. The document emphasizes preventing infections through strict adherence to infection control practices and policies.
This document discusses bacterial infection of tunneled hemodialysis catheters. It notes that while fistulas are preferred, many patients still initiate dialysis with catheters which have a high risk of infection. Catheter-related bloodstream infections can lead to serious complications and increased mortality. Common pathogens involved include Staphylococcus, Pseudomonas, and Candida. Prevention strategies include proper insertion technique, exit site care, and use of antimicrobial locks. Treatment of infections involves antibiotics tailored to the pathogen as well as potentially removing the catheter. Duration of treatment depends on the severity and type of infection.
Hemodialysis catheter related infection JAFAR ALSAID
The document discusses hemodialysis catheter-related infections. It notes that catheter infections are a major cause of morbidity and mortality for hemodialysis patients. It provides statistics on catheter use and infection rates. It then describes different types of catheter infections including exit site infections, tunnel infections, and bloodstream infections. Signs and symptoms of infections are outlined. The document proposes a strict infection control protocol for nurses to follow during catheter care and dialysis to help reduce infection rates. This includes recommendations for site cleaning, dressing changes, tubing changes, and staff education.
Infection control for_hemodialysis_facilitiesFarragBahbah
This document provides guidelines for infection control in hemodialysis facilities. It discusses that hemodialysis patients are at high risk for infections due to their medical treatment. Effective infection control programs can save money and improve patient care. The document outlines recommendations for cleaning and disinfecting equipment and surfaces, hand hygiene, patient immunizations, standard and transmission-based precautions, HBV isolation, respiratory hygiene, and vascular access infection prevention including catheter insertion guidelines.
Central line-associated bloodstream infections (CLABSI) develop within 48 hours of central line placement. Catheter-related bloodstream infections are attributed to an intravascular catheter. Risk factors include chronic illnesses, immune compromised states, and catheter characteristics. Symptoms include fever, inflammation at the insertion site, and sepsis. Diagnosis requires cultures of blood and the catheter tip. Treatment involves catheter removal and antibiotics based on identified pathogens. Antibiotic lock therapy can be used as an adjunct for some intraluminal infections when catheter removal is not possible.
Vascular access care .. nephrology perspective - Dr. Tamer El saidMNDU net
This document discusses vascular access care from a nephrology perspective. It begins by noting the increasing number of ESRD patients requiring hemodialysis and the need for adequate vascular access to deliver treatment. It then describes the common types of vascular access and emphasizes the importance of planning, assessment, and surveillance to promote access patency and prevent complications like stenosis and infection. The document provides guidelines for physical examination, ultrasound, angiography, and other testing to monitor access and identify issues requiring intervention. The goal is early detection and treatment of problems to maximize vascular access lifespan and function.
This document discusses exit site infections in peritoneal dialysis patients. It defines acute and chronic exit site infections and notes that approximately one fifth of peritonitis episodes are associated with exit or tunnel infections. Exit site infections are commonly caused by Staphylococcus aureus or Gram-negative bacteria like Pseudomonas. Treatment depends on the severity and causative organism but may include antibiotics, changing the exit site dressing, or catheter removal in severe cases. Preventing exit site infections through good catheter care and possibly antibiotic prophylaxis can help reduce risks of peritonitis and catheter loss.
Dr tamer el said pd catheter insertionFarragBahbah
This document discusses peritoneal dialysis (PD) catheter insertion techniques and best practices. It covers:
1) Common catheter types including Tenckhoff catheters and extended catheters.
2) Key aspects of catheter placement including determining the insertion site to ensure proper pelvic placement of the catheter tip, using pre-operative marking, and fashioning the exit site for optimal visibility and reduced risk of complications.
3) Best practices for patient preparation prior to catheter insertion and performance of the insertion procedure to minimize risks of infection and mechanical complications.
4) Accepted methods for catheter placement including percutaneous, open surgical, and laparoscopic techniques. Placement should be done by those with appropriate expertise
This document discusses permanent vascular access for hemodialysis. It describes the formation and types of arteriovenous fistulae (AVF) and synthetic grafts. AVFs involve surgically connecting an artery and vein and are the preferred permanent access. Synthetic grafts are used when vessels are unsuitable for an AVF. Complications of access include stenosis, thrombosis, ischemia, pseudoaneurysms and infection. Care of the access involves monitoring for complications, proper needle placement and infection prevention.
This document outlines strategies to prevent central line-associated bloodstream infections (CLABSI) presented by Dr. Moustapha Ramadan, Head of the infection control office at Ibn Sina Hospital. It defines central line infections and risk factors such as host conditions, microbes, therapy factors, and catheter characteristics. Strategies discussed include education and training, infection control practices like hand hygiene and maximal barriers, appropriate catheter site care and dressings, and using antimicrobial catheters and locks in some cases. The goal is to standardize aseptic insertion and maintenance of intravascular catheters to reduce CLABSI rates.
Tunneled Hemodialysis Catheter-Related Infections
The document discusses tunneled hemodialysis catheter-related infections. Approximately 80% of patients initiate hemodialysis with a tunneled catheter which increases the risk of infection compared to fistulas or grafts. Gram-positive organisms cause most infections. Diagnosis involves clinical evaluation and blood cultures. Management depends on the infection type but may involve antibiotics and catheter salvage or removal. Prevention focuses on hand hygiene, care protocols, education, and in some cases antibiotic locks.
This document discusses different types of vascular access for hemodialysis, including arteriovenous fistulas, grafts, and catheters. It provides details on the anatomy of veins in the upper limbs that are used for access. Native fistulas have the highest patency rates and lowest infection risks compared to other options. Examination of vascular accesses involves inspection, palpation, and auscultation to evaluate for abnormalities. The conclusion recommends arteriovenous fistulas as the preferred long-term access due to lower complication rates.
The document discusses complications that can arise with arteriovenous (AV) access for hemodialysis and their management. It covers types of complications such as hematomas, significant steal syndrome, non-maturing fistulas, venous outflow stenosis, aneurysmal degeneration, and central venous stenosis. It describes techniques for managing these complications, including balloon angioplasty, coil embolization, stent graft placement, and open surgery. The overall message is that timely intervention is important to address access complications in order to maintain patency and usability of AV access for hemodialysis.
Ventilator Associated Pneumonia (VAP) causes and preventive strategiesVeera Reddy Suravaram
Ventilator associated pnemonia is a cause of concern in today's medical practice due to wide spread of Gram negative pathogens in hospitals and lack of good hygienic practices due to high occupancy rate in ICUs.
Vascular access in hemodialysis chaken 2018CHAKEN MANIYAN
This document provides guidelines and information about vascular access for hemodialysis. It discusses:
- Types of vascular access including arteriovenous fistulas, grafts, and catheters. Fistulas have the lowest risk of complications but the highest risk of early failure.
- Evaluations for permanent access including history, physical exam, ultrasound of arteries and veins, and central vein evaluation.
- Placement of fistulas at least 6 months before starting dialysis to allow for maturation. Grafts can be placed 3-6 weeks before starting.
- Goals for types of access used - 50% of patients should have fistulas, 40% grafts, and no more than 10%
The document discusses central line-associated bloodstream infections (CLABSIs), including how they occur when bacteria grow in a central line and spread into the bloodstream. It provides details on risk factors, signs and symptoms, prevention methods like proper hand hygiene and dressing care, and personal protective equipment used by healthcare workers to prevent infection when handling central lines. The goal is to help reduce infections by carefully managing central lines and following infection control protocols.
- Short-term catheters should only be used for acute dialysis or limited hospital use. Non-cuffed femoral catheters are only for bed-bound patients.
- Long-term catheters should be used with a plan for permanent access and prefer those capable of high flow rates. Choice depends on local experience and goals.
- Long-term catheters should avoid the same side as a maturing arteriovenous access, if possible.
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
Vascular access for hemodialysis( AVF )Irfan Elahi
There are three main types of vascular access for hemodialysis: arteriovenous fistulae (AVF), arteriovenous grafts, and catheters. AVFs have the lowest rate of failures and complications and are the preferred type of access.
For an AVF to be suitable for cannulation and dialysis, it must undergo a maturation process where the fistula develops adequate blood flow, wall thickness and diameter. A properly matured fistula will have a minimum diameter of 6mm, be less than 6mm deep, have a blood flow over 600ml/min, and be evaluated at 4-6 weeks after creation.
The physical exam is the best tool to determine if an AV
Infective complications are common in peritoneal dialysis patients and include peritonitis and exit site/tunnel infections. Peritonitis presents with abdominal pain and cloudy dialysate fluid and is usually treated empirically with antibiotics covering common gram positive and negative organisms. Exit site/tunnel infections often precede peritonitis and require local antibiotic treatment. Prophylaxis including nasal mupirocin can reduce infection rates. Catheter removal may be needed for refractory, relapsing or fungal peritonitis.
The water to be used for the preparation of haemodialysis fluids needs treatment to achieve the appropriate quality. The water treatment is provided by a water pre-treatment system which may include various components such as sediment filters, water softeners, carbon tanks, micro-filters, ultraviolet disinfection units, reverse osmosis units, ultrafilters and storage tanks. The components of the system will be determined by the quality of feed water and the ability of the overall system to produce and maintain appropriate water quality.
This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
Using the Central Line Bundle
Hand Hygiene
Remove Unnecessary Lines
Use of Maximal Barrier Precautions
Chlorhexidine for Skin Antisepsis
Avoid femoral lines
Report CLABSI rates to the units
Celebrate success!!
The document provides guidance on evidence-based practices for preventing central line-associated bloodstream infections (CLABSI), including following maximal barrier precautions during insertion, using chlorhexidine for skin preparation, avoiding the femoral site when possible, maintaining daily review of line necessity, and adhering to proper insertion and care techniques. It emphasizes that bundling these prevention strategies can significantly reduce the incidence of CLABSI and related morbidity, mortality and costs. Proper technique and team communication are important to ensure safe central line insertion and management.
Vascular access care .. nephrology perspective - Dr. Tamer El saidMNDU net
This document discusses vascular access care from a nephrology perspective. It begins by noting the increasing number of ESRD patients requiring hemodialysis and the need for adequate vascular access to deliver treatment. It then describes the common types of vascular access and emphasizes the importance of planning, assessment, and surveillance to promote access patency and prevent complications like stenosis and infection. The document provides guidelines for physical examination, ultrasound, angiography, and other testing to monitor access and identify issues requiring intervention. The goal is early detection and treatment of problems to maximize vascular access lifespan and function.
This document discusses exit site infections in peritoneal dialysis patients. It defines acute and chronic exit site infections and notes that approximately one fifth of peritonitis episodes are associated with exit or tunnel infections. Exit site infections are commonly caused by Staphylococcus aureus or Gram-negative bacteria like Pseudomonas. Treatment depends on the severity and causative organism but may include antibiotics, changing the exit site dressing, or catheter removal in severe cases. Preventing exit site infections through good catheter care and possibly antibiotic prophylaxis can help reduce risks of peritonitis and catheter loss.
Dr tamer el said pd catheter insertionFarragBahbah
This document discusses peritoneal dialysis (PD) catheter insertion techniques and best practices. It covers:
1) Common catheter types including Tenckhoff catheters and extended catheters.
2) Key aspects of catheter placement including determining the insertion site to ensure proper pelvic placement of the catheter tip, using pre-operative marking, and fashioning the exit site for optimal visibility and reduced risk of complications.
3) Best practices for patient preparation prior to catheter insertion and performance of the insertion procedure to minimize risks of infection and mechanical complications.
4) Accepted methods for catheter placement including percutaneous, open surgical, and laparoscopic techniques. Placement should be done by those with appropriate expertise
This document discusses permanent vascular access for hemodialysis. It describes the formation and types of arteriovenous fistulae (AVF) and synthetic grafts. AVFs involve surgically connecting an artery and vein and are the preferred permanent access. Synthetic grafts are used when vessels are unsuitable for an AVF. Complications of access include stenosis, thrombosis, ischemia, pseudoaneurysms and infection. Care of the access involves monitoring for complications, proper needle placement and infection prevention.
This document outlines strategies to prevent central line-associated bloodstream infections (CLABSI) presented by Dr. Moustapha Ramadan, Head of the infection control office at Ibn Sina Hospital. It defines central line infections and risk factors such as host conditions, microbes, therapy factors, and catheter characteristics. Strategies discussed include education and training, infection control practices like hand hygiene and maximal barriers, appropriate catheter site care and dressings, and using antimicrobial catheters and locks in some cases. The goal is to standardize aseptic insertion and maintenance of intravascular catheters to reduce CLABSI rates.
Tunneled Hemodialysis Catheter-Related Infections
The document discusses tunneled hemodialysis catheter-related infections. Approximately 80% of patients initiate hemodialysis with a tunneled catheter which increases the risk of infection compared to fistulas or grafts. Gram-positive organisms cause most infections. Diagnosis involves clinical evaluation and blood cultures. Management depends on the infection type but may involve antibiotics and catheter salvage or removal. Prevention focuses on hand hygiene, care protocols, education, and in some cases antibiotic locks.
This document discusses different types of vascular access for hemodialysis, including arteriovenous fistulas, grafts, and catheters. It provides details on the anatomy of veins in the upper limbs that are used for access. Native fistulas have the highest patency rates and lowest infection risks compared to other options. Examination of vascular accesses involves inspection, palpation, and auscultation to evaluate for abnormalities. The conclusion recommends arteriovenous fistulas as the preferred long-term access due to lower complication rates.
The document discusses complications that can arise with arteriovenous (AV) access for hemodialysis and their management. It covers types of complications such as hematomas, significant steal syndrome, non-maturing fistulas, venous outflow stenosis, aneurysmal degeneration, and central venous stenosis. It describes techniques for managing these complications, including balloon angioplasty, coil embolization, stent graft placement, and open surgery. The overall message is that timely intervention is important to address access complications in order to maintain patency and usability of AV access for hemodialysis.
Ventilator Associated Pneumonia (VAP) causes and preventive strategiesVeera Reddy Suravaram
Ventilator associated pnemonia is a cause of concern in today's medical practice due to wide spread of Gram negative pathogens in hospitals and lack of good hygienic practices due to high occupancy rate in ICUs.
Vascular access in hemodialysis chaken 2018CHAKEN MANIYAN
This document provides guidelines and information about vascular access for hemodialysis. It discusses:
- Types of vascular access including arteriovenous fistulas, grafts, and catheters. Fistulas have the lowest risk of complications but the highest risk of early failure.
- Evaluations for permanent access including history, physical exam, ultrasound of arteries and veins, and central vein evaluation.
- Placement of fistulas at least 6 months before starting dialysis to allow for maturation. Grafts can be placed 3-6 weeks before starting.
- Goals for types of access used - 50% of patients should have fistulas, 40% grafts, and no more than 10%
The document discusses central line-associated bloodstream infections (CLABSIs), including how they occur when bacteria grow in a central line and spread into the bloodstream. It provides details on risk factors, signs and symptoms, prevention methods like proper hand hygiene and dressing care, and personal protective equipment used by healthcare workers to prevent infection when handling central lines. The goal is to help reduce infections by carefully managing central lines and following infection control protocols.
- Short-term catheters should only be used for acute dialysis or limited hospital use. Non-cuffed femoral catheters are only for bed-bound patients.
- Long-term catheters should be used with a plan for permanent access and prefer those capable of high flow rates. Choice depends on local experience and goals.
- Long-term catheters should avoid the same side as a maturing arteriovenous access, if possible.
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
Vascular access for hemodialysis( AVF )Irfan Elahi
There are three main types of vascular access for hemodialysis: arteriovenous fistulae (AVF), arteriovenous grafts, and catheters. AVFs have the lowest rate of failures and complications and are the preferred type of access.
For an AVF to be suitable for cannulation and dialysis, it must undergo a maturation process where the fistula develops adequate blood flow, wall thickness and diameter. A properly matured fistula will have a minimum diameter of 6mm, be less than 6mm deep, have a blood flow over 600ml/min, and be evaluated at 4-6 weeks after creation.
The physical exam is the best tool to determine if an AV
Infective complications are common in peritoneal dialysis patients and include peritonitis and exit site/tunnel infections. Peritonitis presents with abdominal pain and cloudy dialysate fluid and is usually treated empirically with antibiotics covering common gram positive and negative organisms. Exit site/tunnel infections often precede peritonitis and require local antibiotic treatment. Prophylaxis including nasal mupirocin can reduce infection rates. Catheter removal may be needed for refractory, relapsing or fungal peritonitis.
The water to be used for the preparation of haemodialysis fluids needs treatment to achieve the appropriate quality. The water treatment is provided by a water pre-treatment system which may include various components such as sediment filters, water softeners, carbon tanks, micro-filters, ultraviolet disinfection units, reverse osmosis units, ultrafilters and storage tanks. The components of the system will be determined by the quality of feed water and the ability of the overall system to produce and maintain appropriate water quality.
This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
Using the Central Line Bundle
Hand Hygiene
Remove Unnecessary Lines
Use of Maximal Barrier Precautions
Chlorhexidine for Skin Antisepsis
Avoid femoral lines
Report CLABSI rates to the units
Celebrate success!!
The document provides guidance on evidence-based practices for preventing central line-associated bloodstream infections (CLABSI), including following maximal barrier precautions during insertion, using chlorhexidine for skin preparation, avoiding the femoral site when possible, maintaining daily review of line necessity, and adhering to proper insertion and care techniques. It emphasizes that bundling these prevention strategies can significantly reduce the incidence of CLABSI and related morbidity, mortality and costs. Proper technique and team communication are important to ensure safe central line insertion and management.
1) Implementing a central line bundle that includes interventions related to catheter insertion, maintenance, and use can significantly reduce the risk of central line-associated bloodstream infections (CLABSIs).
2) Key elements of the bundle include using maximal sterile barriers during insertion, chlorhexidine skin antisepsis, sutureless securement devices, antimicrobial/antiseptic-impregnated catheters, proper hand hygiene and site care, and daily review of line necessity.
3) When all elements of the bundle are applied together, it results in better CLABSI prevention outcomes than when elements are used individually.
Evidence Based Practice: Assassination of Myths CAUTI (Catheter Associated Ur...man0032
Evidence Based Practice: Assassination of Myths CAUTI (Catheter Associated Urinary Tract Infections) reviews some of the myths healthcare teams use to perpetuate the need for indwelling urinary catheters (aka foleys) and replaces these myths with Evidence Based Practices. Citations and hyperlinks are included for all recommendations and are current as of Spring 2013. This presentation was presented to the Emory Healthcare system-wide CAUTI prevention retreat both in 2013 and 2014 and has been the basis for both entity and unit-based education to healthcare professionals.
The document discusses common errors in non-tunnelled hemodialysis catheter insertion and ways to prevent them. It notes that ultrasound guidance should be used for all insertions and specific sites like the femoral and internal jugular veins are preferable to the subclavian site. Common errors include failing to use ultrasound, not following infection control protocols, inserting guidewires too far, failing to replace catheters at new sites, and inadequate preparation. Adhering closely to insertion checklists and training can help reduce errors.
The document discusses urinary catheters and catheter-associated urinary tract infections (CAUTIs). It provides information on:
- The history and development of urinary catheters from the 1920s to present.
- Risk factors for bacteriuria associated with urinary catheters. Studies show rates of bacteriuria increase significantly within the first week of catheter placement.
- Core strategies and supplemental strategies recommended by healthcare organizations to prevent CAUTIs, such as only using catheters when necessary, maintaining a closed drainage system, and hand hygiene.
Catheter-related bloodstream infections (CR-BSI) are common, costly infections associated with central venous catheters. According to the document, CR-BSI occur in approximately 80,000 ICU patients per year in the US, costing $45,000 per episode and $2.3 billion annually. The median rate of CR-BSI in ICUs ranges from 1.8 to 5.2 per 1000 catheter days. Biofilm formation on intravascular catheters allows pathogens to survive and persist despite host defenses and antimicrobial treatment.
The document discusses catheter related infections in hemodialysis patients, including definitions, causes, treatment and prevention. It covers topics such as the pathogenesis of infections, common pathogens, diagnosing exit site infections, tunnel infections and bloodstream infections, and treatment approaches including antibiotic lock therapy and criteria for catheter removal or salvage.
The document provides information on catheter-related bloodstream infections (CR-BSIs) including what they are, where they come from, why proper central venous catheter (CVC) care and maintenance is crucial to prevent them, and recommendations from the CDC on prevention. CR-BSIs are associated with high morbidity, mortality, and costs. Adherence to best practices like aseptic technique during insertion and dressing changes, appropriate hand hygiene, and following policies on injection caps, flushing and medication administration can help reduce the risk of these infections.
Vascular graft infection do we need antimicrobial graftsuvcd
Vascular graft infections pose serious risks and costs. Preventing surgical site infections is a high priority. While various preventive measures have been attempted, graft infections still occur. New antimicrobial grafts containing combinations of agents like silver acetate and triclosan show promise in inhibiting early microbial colonization based on in vitro studies, but more research is needed to determine their efficacy in preventing infections in vivo. Antimicrobial grafts may help reduce the morbidity, mortality, and economic burden of vascular graft infections if shown to be effective through further investigation.
This document discusses guidelines for caring for patients with invasive central venous catheters (CVCs) in intensive care to reduce CVC-related infections. It describes different types of CVCs, challenges in intravenous therapy, and pathogenesis of CVC-related bloodstream infections. It emphasizes that implementing a CVC care bundle including hand hygiene, chlorhexidine skin antisepsis, maximal sterile barriers during insertion, and daily line necessity review can significantly reduce CVC-related bloodstream infection rates. Regular surveillance, case reviews, team meetings, and reporting are also important for prevention.
This document discusses strategies to improve patient outcomes related to vascular access at a hospital. It describes a Failure Mode Effects Analysis project led by various clinicians to review processes for central line care, education materials, supplies, and statistics on catheter-related infections. Areas of variation and practices not meeting best standards were identified. The team developed approaches to standardize line flushing, dressing changes, and evaluate practices to reduce risks of emboli, occlusion, extravasation, and infection.
This document discusses proper vascular access device care and prevention of catheter-related infections. It emphasizes that standardization of care practices like hand hygiene, maximal barrier precautions during insertion, and disinfecting catheter hubs can significantly reduce infections. It also explains the risks of biofilm formation on devices and how microbes within biofilms are highly resistant to antibiotics. Education of healthcare workers and patients on infection prevention is vital to improving outcomes.
Catheter-associated bloodstream infections (CABSIs) are caused by bacteria entering the bloodstream from intravenous catheters. They are the most common cause of hospital-acquired bloodstream infections and increase mortality, length of stay, and costs. CABSIs are usually diagnosed when the same bacteria is found in blood cultures and catheter samples. Treatment involves antibiotics and often removing the catheter, with guidelines recommending removal for more serious or drug-resistant infections. Prevention strategies center on proper catheter insertion and maintenance techniques.
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This study compared the efficacy of chlorhexidine-impregnated dressings to standard dressings in preventing central venous catheter-associated bloodstream infections in a pediatric intensive care unit. The randomized controlled study involved 100 patients, with 50 receiving chlorhexidine dressings and 50 receiving standard dressings. The rates of catheter colonization, local catheter infection, and catheter-related bloodstream infection were all lower in the chlorhexidine group compared to the standard group, though the differences were not statistically significant. The study concluded that chlorhexidine dressings may reduce infection risks and recommends their use in pediatric intensive care units.
This document discusses catheter-related bloodstream infections (CRBSIs). It defines CRBSIs and describes different catheter types. CRBSIs are caused by pathogens migrating from the skin insertion site into the catheter or through direct contact. Common pathogens include staphylococci and candida. The document recommends a bundle of strategies to prevent CRBSIs, including education and training, maximal sterile barrier precautions, chlorhexidine skin antisepsis, securement devices, and antimicrobial catheters when infection rates remain high despite other measures. Regular assessment and performance improvement initiatives can help increase adherence to guidelines.
Healthcare-associated infections affect millions of hospital patients each year, causing prolonged hospital stays, increased costs, and preventable deaths. Urinary tract infections are the most common type of healthcare-associated infection, with catheter-associated UTIs accounting for the majority. Inserting and leaving urinary catheters in place when not medically necessary can increase infection risks. Proper training of staff, following guidelines for catheter insertion and maintenance, and removing catheters as soon as possible can help reduce unnecessary catheter use and prevent catheter-associated UTIs.
3. central line associated blood stream infectionChartwellPA
There are two terms used to describe central line infections: central line-associated bloodstream infections (CLABSI) and catheter-related bloodstream infections (CRBSI). CLABSI is defined as a bloodstream infection where the patient had a central line within 48 hours before onset. CRBSI requires lab testing to confirm the catheter as the infection source. Central lines are essential for patient care but can lead to costly and life-threatening infections if not properly inserted and maintained. Adhering to evidence-based practices like maximum barrier precautions and chlorhexidine skin antisepsis can significantly reduce central line infection rates.
Similar to 09.30 10.00 maurizio gallieni - publiceren (20)
This document summarizes research on complications from intraosseous vascular access. It finds that serious complications are rare, with osteomyelitis occurring in only a few isolated case reports since 1985. Other rare complications include compartment syndrome (18 cases reported), fractures (3 cases), skin necrosis (2 cases), and suspected air embolism (2 cases). The document concludes that with proper technique and monitoring, complications can be avoided, and intraosseous access has been shown to decrease time to vascular access and speed delivery of lifesaving medications.
This document discusses accuracy and cost-effectiveness in diagnosing catheter-related bloodstream infections (CRBSI). It covers several topics:
1. Comparing roll plate (Maki) culture to sonication culture methods for diagnosing CRBSI, concluding that roll plate remains the preferred method.
2. Exploring the strengths and limitations of differential time to positivity (DTTP) as an in vivo diagnostic method for CRBSI. DTTP has good sensitivity and specificity but sample collection requirements limit its practicality.
3. Evaluating the potential role of surveillance surface cultures in anticipating catheter tip colonization, finding that positive previous surface cultures accurately predicted all subsequent CR
This document discusses central line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs). It provides definitions of CLABSI and CRBSI from the CDC and notes the key differences. It also discusses various prevention strategies matched to the different sources of organisms that can cause infections, including the skin, infusate, and catheter hub manipulation. The document emphasizes the importance of a multidisciplinary approach involving education and training as well as monitoring and surveillance to effectively reduce CLABSIs.
The document summarizes a literature review of 45 studies on peripheral venous catheter (PVC) infections. The review found reported PVC infection rates ranging from 0.1 to 0.4 bloodstream infections per 100 devices/1000 device days. Colonization of PVC tips with skin organisms was found in 5-25% of catheters upon removal and in 11.25-20.72% of studied catheters. Rates of phlebitis/thrombophlebitis ranged widely from 2-80% across studies. An estimated 165,000 patients in the US experience PVC-related bloodstream infections annually, despite PVCs having the lowest reported infection rates of all intravascular devices.
This study examined the use of prefilled saline syringes compared to manually filled syringes for flushing and locking implanted port devices in cancer patients. The study retrospectively analyzed 801 implanted ports, with 303 patients using manually filled syringes and 498 using prefilled saline syringes. The primary outcome was the incidence of catheter-related bloodstream infections requiring port removal. The study found a significantly lower rate of CRBSI in the prefilled saline syringe group compared to the manually filled syringe group. Further controlled studies are needed to confirm these results and examine additional benefits of using prefilled saline syringes.
The document summarizes initiatives at Sutter Roseville Medical Center to reduce central line-associated bloodstream infections (CLABSIs). It describes the hospital's transition from primarily using peripheral IVs and centrally inserted central catheters to now preferring peripherally inserted central catheters (PICCs) placed by ultrasound guidance in the basilic vein, with the goal of reducing CLABSIs. It also outlines enhancements to the hospital's central line bundle, including the addition of maximal barrier precautions and chlorhexidine preparations, to strengthen infection prevention practices for central line insertion and maintenance.
The document compares guidelines from different organizations (RCN, INS, CDC) on various elements of vascular access device (VAD) insertion and maintenance to prevent infection. It discusses recommendations around education and training of healthcare personnel, hand hygiene techniques, use of barrier precautions like masks and gowns, appropriate skin preparation, and securing dressing regimens. The guidelines generally agree but some organizations provide more detailed or stringent recommendations for certain elements like use of maximal sterile barrier precautions during all central line insertions and exchanges. Comparing standards across multiple oversight groups can help clarify best practices.
This document discusses factors that increase the risk of central venous catheter infection related to exit site selection. It identifies moisture, warmth, hair distribution, and poor dressing adherence as increasing contamination risk. The groin is considered very high risk due to these factors. The neck and chest areas are also relatively high risk, especially higher on the neck. More stable, dry sites like the base of the neck and upper arm are lower risk. Proper skin antisepsis and securement are important to prevent bacterial colonization and infection.
This document summarizes evidence from multiple studies on the use of antimicrobial-coated central venous catheters. It finds that silver alloy and iontophoretic coatings are associated with lower rates of bloodstream infection compared to standard catheters, with silver alloy coatings showing a 58% lower rate. Miconazole/rifampin coatings are also effective at reducing colonization compared to standard and benzalkonium chloride coatings. However, the duration of activity of miconazole/rifampin appears to be greater than chlorhexidine/silver sulfadiazine coatings based on studies of catheter cultures. Cost-effectiveness analyses also indicate that antimicrobial coatings can reduce infection
The document discusses proper maintenance of central line exit sites to prevent catheter-related bloodstream infections (CRBSIs). It recommends:
1) Using 2% chlorhexidine for skin antisepsis before insertion and during dressing changes due to its broad-spectrum antimicrobial activity.
2) Covering the exit site with a semipermeable transparent dressing or gauze/tapes, changing every 2-7 days depending on the dressing.
3) Securing the catheter with sutureless devices instead of sutures to avoid inflammation and heavy skin colonization. Proper exit site care is important for multi-faceted CRBSI prevention bundles.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
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The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
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2. Disclosure
Director, Nephrology and Dialysis Unit
San Carlo Borromeo Hospital, Milano, Italy
President Elect, the Vascular Access Society
Coordinating Editor – the Journal of Vascular Access
Consultant, NICAST (dialysis grafts), Israel
3. the
Vascular
Access
Society
http://www.vas2013.org/
http://www.vascularaccesssociety.com/
4. Background
• Central
venous
catheters
(CVCs)
are
increasingly
used
as
vascular
access
for
hemodialysis,
but
infec=ous
complica=ons
remain
a
major
clinical
problem.
• Catheter-‐related
bloodstream
infec=ons
affect
survival,
hospitaliza=on,
mortality,
and
the
overall
cost
of
care,
poin=ng
out
the
importance
of
preven=on.
5. Ideal
Dialysis
Catheter
• Easy
to
insert
and
remove
• Inexpensive
• Free
of
infec&on
• Free
of
fibrin
sheath
(“invisible
to
body”)
• Does
not
cause
venous
thrombosis
or
stenosis
• Delivers
high
flow
(>400
ml/min)
reliably
• Durable
• Does
not
presently
exist
Scott Trerotola - Radiology 2000; 215:651-658
7. Risk of CVC-related infection in
hemodialysis
Mayo
Clinics
Proceedings
September
2006
8. Risk of CVC-related infection in
hemodialysis (16 studies)
HD CVC non tunneled 4.8/1000 catheter days
HD CVC tunneled 1.6/1000 catheter days
9. Risk of CVC-related infection in
hemodialysis
Beathard GA, Urbanes A. Infection associated with tunneled
hemodialysis catheters. Semin Dial. 2008;21(6):528-38.
13. Temporary vs tunnelled catheters
• If
temporary
access
is
needed
for
dialysis,
a
tunneled
cuffed
catheter
is
preferable
to
a
non-‐cuffed
catheter,
even
in
the
ICU
seRng,
if
the
catheter
is
expected
to
stay
in
place
for
>
3
weeks
17. FaUori
di
rischio
• Inesperienza
dell’operatore
• Colonizzazione
baUerica
del
sito
di
inserzione
• Colonizzazione
baUerica
del
catetere
• Frequen=
manipolazioni
del
catetere
• Rapporto
infermiere-‐paziente
• Tipo
di
catetere
• U=lizzo
della
nutrizione
parenterale
• CaraUeris=che
del
paziente
• Contaminazione
del
materiale
• Scarsa
cura
del
catetere
come
mancata
compliace
alle
linee
guida
(Queensland
Goverment)
18. Pa&ent’s
skin
cleansing
Use a 2% chlorhexidine wash for daily skin
cleansing to reduce CRBSI. Category II
Bleasdale SC, et al. Effectiveness of chlorhexidine bathing to reduce catheter-
associated bloodstream infections in medical intensive care unit patients.
Arch Intern Med 2007; 167:2073–9.
No published data have addressed this same question in studies
with hemodialysis patients
20. Preven&on
of
catheter
related
infec&ons
in
hemodialysis
• Preven&ve
approaches
– Universal
precau&ons
– Sutureless
aGachment
devices
– Topical
ointments
and
dressings
– Locking
solu&ons
– Needle
free
connectors
– Coated
catheters
21. Sutureless attachment devices
Catheter Securement Devices
Use a sutureless securement device to reduce the risk of
infection for intravascular catheters *. Category II
* Yamamoto AJ, Solomon JA, Soulen MC, et al. Sutureless securement
device reduces complications of peripherally inserted central venous
catheters. J Vasc Interv Radiol 2002; 13:77–81.
24. Sutureless attachment devices
72 dialysis patients with cuffed tunneled CVC.
Study group (n=36): CVC secured with a sutureless
StatLock attachment device.
Control group (n=36): CVC secured with sutures.
Mean use of the tunneled CVC: 42 ± 7 days (until use
of the AV fistula).
Results:
No infections in both groups
Four local irritations at the CVC entry site were seen
only in the control group
Teichgräber et al. JVA 2011;12:17-20
25. Preven&on
of
catheter
related
infec&ons
in
hemodialysis
• Preven&ve
approaches
– Universal
precau&ons
– Sutureless
aGachment
devices
– Topical
ointments
and
dressings
– Locking
solu&ons
– Needle
free
connectors
– Coated
catheters
26. Topical ointments
• Do
not
use
topical
an=bio=c
ointment
or
creams
on
inser=on
sites,
except
for
dialysis
catheters,
because
of
their
poten=al
to
promote
fungal
infec=ons
and
an=microbial
resistance.
Category
IB
27. Topical ointments
• Use
povidone
iodine
an=sep=c
ointment
or
bacitracin/gramicidin/
polymyxin
B
ointment
at
the
hemodialysis
catheter
exit
site
a]er
catheter
inser=on
and
at
the
end
of
each
dialysis
session
only
if
this
ointment
does
not
interact
with
the
material
of
the
hemodialysis
catheter
per
manufacturer’s
recommenda=on.
Category
IB
28. Posi&on
statement
of
European
Renal
Best
Prac&ce
(ERBP)
Use of antibiotic ointments at the exit site
Vanholder et al. NDT Plus 2010; 3: 234–246
29. Topical ointments and dressings
• Chlorhexidine-‐impregnated
dressings
and
sponges
are
available,
but
the
evidence
of
their
efficacy
in
preven=ng
infec=on
(as
compared
to
appropriate
skin
cleansing
with
2%
chlorhexidine
in
alcohol
solu=ons)
is
not
convincing.
An
RCT
in
pa=ents
on
hemodialysis
with
CVCs
did
not
show
that
these
dressings
(BIOPATCH)
conferred
any
addi=onal
benefit.
Camins, BC et al. A crossover intervention trial evaluating the efficacy of a
chlorhexidine-impregnated sponge in reducing catheter-related bloodstream
infections among patients undergoing hemodialysis. Infect. Control Hosp.
Epidemiol. 2010; 31: 1118–1123.
Betjes Nat Rev Nephrol 2011; 7: 257–265
31. Topical ointments and dressings
Camins, BC et al. A crossover intervention trial evaluating the efficacy of a
chlorhexidine-impregnated sponge in reducing catheter-related bloodstream
infections among patients undergoing hemodialysis. Infect. Control Hosp.
Epidemiol. 2010; 31: 1118–1123.
32. Preven&on
of
catheter
related
infec&ons
in
hemodialysis
• Preven&ve
approaches
– Universal
precau&ons
– Sutureless
aGachment
devices
– Topical
ointments
and
dressings
– Locking
solu&ons
– Needle
free
connectors
– Coated
catheters
33. Antimicrobial lock
• Use
prophylac=c
an=microbial
lock
solu=on
in
pa=ents
with
long
term
catheters
who
have
a
history
of
mul=ple
CRBSI
despite
op=mal
maximal
adherence
to
asep=c
technique.
Category
II
34. Antimicrobial lock
Antimicrobial lock solutions
substantially reduce the risk of
CRBSI (relative risk 0.23).
Labriola
L
et
al.
Preven=ng
haemodialysis
catheter
related
bacteraemia
with
an
an=microbial
lock
solu=on:
a
meta-‐analysis
of
prospec=ve
randomized
trials.
Nephrol
Dial
Transplant
2008;
23:1666–1672
Rabindranath, K. S. et al. Systematic review of antimicrobials for the
prevention of haemodialysis catheter-related infections. Nephrol. Dial.
Transplant 2009; 24: 3763–3774
Jaffer Y et al. A meta-analysis of hemodialysis catheter locking solutions in the
prevention of catheter-related infection. Am J Kidney Dis 2008; 51:233-241
36. European
Renal
Best
Prac&ce
(ERBP)
Vanholder et al. NDT Plus 2010; 3: 234–246
37. Preven&on
of
catheter
related
infec&ons
in
hemodialysis
• Preven&ve
approaches
– Universal
precau&ons
– Sutureless
aGachment
devices
– Topical
ointments
and
dressings
– Locking
solu&ons
– Needle
free
connectors
– Coated
catheters
38. Needle
free
connectors
A
needle
free
connector
creates
a
mechanically
and
microbiologically
closed
system
when
aUached
to
the
hub
of
a
catheter,
elimina=ng
open
catheter
hubs
and
lowering
the
chance
of
contamina=on
and
infec=on
39. Needle
free
connectors
One FDA approved device
• No clear evidence of a benefit (possible benefit: in
patients with mulfunctioning catheters, needing line
inversions?)
• No recommendations in guidelines
40. Preven&on
of
catheter
related
infec&ons
in
hemodialysis
• Preven&ve
approaches
– Universal
precau&ons
– Sutureless
aGachment
devices
– Topical
ointments
and
dressings
– Locking
solu&ons
– Needle
free
connectors
– Coated
catheters
42. Silvergard
Trial
–
the
only
available
RCT
in
dialysis
• RCT,
adequate
number
of
pa=ents
(n=100)
• Two
groups
with
same
CVC
(one
silver
coated)
• All
CVC
in
the
right
internal
jugular
vein
• Follow-‐up
with
venography
(evalua=on
of
thrombosis
and
infec=on)
• Colture
of
CVC
=p
upon
removal
Trerotola et al, Radiology 1998;207:491-496
43. Silvergard
trial
-‐
Results
• No
significant
difference
in
the
number
of
infec&ons
– (indeed,
infec=on/coloniza=on
more
common
in
the
silver
coated
group,
p=NS)
• 4%
vein
thrombosis
/
stenosis
• 2
pa=ents
with
permanent
skin
lesions
in
the
silver
coated
group
Trerotola et al, Radiology 1998;207:491-496
44. Heparin
Coa&ng
and
Silver
Ion
Anµbial
Sleeve
«The xxx Heparin Coated and Silver Ion
Antimicrobial Dialysis Catheter is the first
chronic catheter to provide dual protection
against clotting and microbial
colonization»
45. Heparin
Coa&ng
and
Silver
Ion
Anµbial
Sleeve
The antimicrobial silver ions in the sleeve work to
reduce the colonization of clinically relevant
microbes on the external surface of the catheter
in the subcutaneous tunnel tract.
The unique silver-polymer system delivers a
controlled release of silver ions, which have been
tested against a broad spectrum of recent clinical
isolates and is specifically designed for the
dialysis catheter environment.
46. From
the
manufacturer
web-‐site:
Is
there
a
clinical
study
to
show
efficacy
of
the
xxx
–
Heparin
Coated
and
Silver
Ion
Anµbial
Dialysis
Catheter?
The silver ion sleeve was tested against recent
clinical isolates including S. Aureus, coagulase-
negative Staphylococcus, C. Albicans and E. Coli.
In vitro testing demonstrated a statistically significant
reduction of microbial colonization by 99.2%–
99.999%.
In vivo testing resulted in a statistically significant
reduction of microbial colonization by 99.7%–
99.999% in Staphylococcus aureus.
47. Poten&al
problems
of
coated
CVCs
– Coa=ng
has
been
used
mainly
in
short-‐term
catheters
– Coa=ng
usaully
limited
to
the
external
surface
(beUer
protec=on
from
skin
bacteria,
not
from
intraluminal
contamina=on)
– Higher
cost:
cost-‐effec=veness
should
be
demonstrated
– Possibility
of
allergies
or
induc=on
of
an=bio=c
resistance
• Anaphylaxis
to
chlorhexidine-‐impregnated
central
venous
catheter.
(Kluger,
Anaesth
Intensive
Care
2003)
– Transient
an=microbic
effect
(days
to
week?)
– No
RCT
avalable,
besides
Silvergard
trial.
48. Conclusions
• Various
interven=ons
aimed
at
reducing
the
incidence
of
CRBSI
are
available.
Preven=on
of
intraluminal
contamina=on
of
the
CVC
is
pivotal
and
of
proven
efficacy,
as
are
strict
asep=c
CVC
inser=on
and
handling
protocols,
use
of
chlorhexidine
in
alcohol
solu=ons
for
skin
cleansing,
topical
applica=on
of
an=microbial
ointments,
and
an=microbial
lock
solu=ons.
51. the
Journal
of
Vascular
Access
Volunteers to participate as
reviewers and subsequently
as Editorial Board members
are welcome
Home page:
http://www.vascular-access.info/
Article submission:
http://www.editorialmanager.com/jva/