ABSTRACT
According to literary data the use of central venous catheters (CVC) is burdened with a significantly higher number of complications than a peripheral venous approach. The management of these complications is difficult and may increase the morbidity and even mortality of critically sick patients. This is why there is such emphasis on the prevention of these serious complications. Strict antiseptic procedures are an absolute must when handling such catheters. To prevent catheter sepsis, as well as any contamination and colonization of a central venous catheter, it is essential to insert such a catheter under aseptic conditions; it calls for handling in a sterile manner and the same applies to all tubing and other connecting systems and to the preparation of infusion liquids and drugs. Moreover, the site of insertion has to be correctly selected and the catheter left in place only for the absolutely necessary time. Most effective in the prevention of catheter infections are the so-called maximum barrier measures applied to the insertion of CVCs.
Subject(s)
Catheterization, Central Venous/adverse effects , Sepsis/prevention & control , Catheterization, Central Venous/methods , Catheters, Indwelling/adverse effects , Child , Humans , Sepsis/etiologyABSTRACT
INTRODUCTION: Besides their obvious advantages for the patient, central venous catheters (CVC) also carry the risk of possible infectious complications. The purpose of our investigation was to carry out a microbiological evaluation of a 5-year set of paediatric patients with indwelling CVCs. PATIENTS AND METHODS: In the group were 218 CVCs inserted to 165 children over a period of 5 years. There were 26 multi-lumen catheters (11.927 %) and 192 single-lumen catheters (88.073 %). The mean indwelling period was 10.1 days per 1 CVC. Blood for microbiology was removed by a physician from the CVC after disinfecting its opening under standard sterile conditions into a commercial sampling vessel HEMOD (Imuna, Sarisske Michalany, Slovak Republic) or into a vessel of an automated haemoculture system BactecPeds PLUS/F (Becton Dickinson and Comp., Spark,MA, USA). When removing the tip of the CVC we disinfected, before removing the CVC, the area around the insertion with isopropyl or ethyl alcohol. We released the fixed CVC and 1 minute after disinfection we pulled out the CVC and cut off the end or rather the tip of the catheter (approx. 1-3 cm of the tip) into a sterile test tube. To establish the diagnosis of infectious complications we used the 1995 Sirges-Serra classification and the CDC criteria. RESULTS: In 5 years (1995-1999) we had 71 infectious complications. There were 31 contaminated catheters, 27 cases of catheter sepsis and 11 cases of catheter bacteraemia. With 147 catheters (67.43%) there were no infectious complications. Dominant microbes were Staphylococcus epidermidis (32 cases - 11 from haemocultures and 21 from CVCs) and Candida spp. (30 cases, 17 from haemocultures and 13 from CVCs). Among the microbiological agents of catheter sepsis predominated Gram-negative bacteria. Out of the whole analysed group 41 children (24.8 %) died. CVC as the cause of death was demonstrated in 6 children (3.636 % of patients with CVC). CONCLUSIONS: Microbiological findings in our group are in line with literary data. To reduce the incidence of infectious complications it is important to limit sampling from CVC to a minimum. Insertion of CVCs under strict sterile conditions and aseptic handling of all entries into the central bloodstream reduces to a minimum the risk of infectious complications.
