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Sunday, April 23, 2017

Central venous Line/ Catheter Related Infections In ICU Setting.



Introduction:

Majority of patients in ICU have central venous lines placed in order to provide fluids and medicines. They may be life saving but at the same time these can result in serious blood stream infections. These catheter related blood infections are reported to occur in about 3 to 8% of inserted catheters and are the number one cause of nosocomial infections in ICU settings.

A few Definitions:
1. A central venous catheter or a central venous line is a catheter whose tip resides in a central vein.


                                                       An Adult Central venous catheter 
2. Catheter related blood stream infections refer to an infection that is attributed to an intravenous catheter by quantitative culture of the catheter tip or by difference in growth between catheter and peripheral venipuncture blood culture specimens.

3. Central line associated blood infections is defined as an infection that appears in the presence of a central venous catheter or within 48 hours of removal of a central venous line and which cannot be attributed to an infection unrelated to the catheter.

Risk factors:
The risk factors for these central venous line related blood infections include :
  • Patient’s severity of illness
  • Compromised immune system
  • Presence of a distant skin infection
  • Site of the catheter with greatest chances of infection with groin insertions.
  • If aseptic techniques are not proper;y used while insertion of the catheter.
Background Information:
Addressing the issue of central venous line associated blood infections is challenging. Different countries and organizations have setup different guidelines to prevent these infections. These include:
  • Hand hygiene and decontamination with antiseptic soaps or alcohol based gels before catheter insertion.
  • Antiseptic care during insertion, maintenance and replacement of these intravascular central catheters.
  • Use of maximum sterile barrier precautions like cap, mask, sterile gloves and gown while inserting central venous catheters.
  • Proper education and training for the staff involved in taking care of patients with central venous lines in ICU.
  • Catheter material is also very important to take into consideration for prevention of these infections. The material should be biostable and biocompatible. Also the catheter should be flexible, resistant, not altered by drugs, as radio opaque as possible and thin walled with a high internal to external diameter ratio.
  • The subclavian vein should be the insertion point of choice.
  • It is important to remove the central venous catheters as soon as they are no longer needed. The longer they are in place there are increased chances for infection.
  • Although routine antibiotic prophylaxis is not recommended it can be used for high risk patients with central venous lines.
The microorganisms that are most commonly involved in these infections include:
  • Staphylococci ( Both Staphylococcus aureus and the coagulase negative staphylococci)
  • Enterococci
  • Aerobic gram negative bacilli
  • Yeasts.
Diagnosis: The diagnosis of catheter related blood stream infection is made if a patient with an intravascular central line develops the clinical or the laboratory criteria of the systemic inflammatory response syndrome . these include:
  • A temperature < 36 C or > 38 C
  • Heart rate >90/minute
  • Respiratory rate >20/ minute
  • Peripheral white blood cell count <4000/microliter or > 12,000/microliter.

Catheter-related bloodstream infection remains the most serious complication of central venous access and a leading cause of nosocomial infection in the ICU. It is important to take appropriate measure to prevent it.

4 comments:


  1. I feel so excited today because it's just a year since I got my breakthrough from Herpes.I was diagnosed of HSV1 on the 12/4/2015 and latter i got affected with the HSV2. That was my 2nd outbreak after i lost my ex fiance that got me affected with the virus. I was so scared when he died and what i heard about the Herpes virus as he's deathly and such has no cure. I feel so pity and and a disgrace to my personality,in my career and my family to have been in with the deathly sickness, and that would makes my love ones siblings stay far from me. I was going to my regular church activities when i begin to hear testimonies of how people get cure online, i never gave it a thought till my cousin Stephanie who was affected with HIV told me, Lenny you need not to worry cos i met i man today online , i traditional herbal healer whom two of her friends confirmed he cure them with his herbal herbs that i should give it a try. I saw the interest in her and she did contact the herbal doctor again in my present, luckily for me he picked and show up himself, behold he was at about to attain to some patients that have came back with appreciation of how he cure them from Cancer, HIV, and off much too the herpes he cured an 18 years old daughter.
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  2. I'M Kelly FROM KENTUCKY.
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