RESUMO
BACKGROUND: Central line-associated bloodstream infection (CLABSI) is a known complication of central line use. Salvage of infected central lines with ethanol lock therapy (ELT) with systemic antimicrobials may be an alternative treatment option in children. METHODS: Retrospective review was performed in children with CLASBI who underwent short-dwell ELT (70% ethanol, 4- to 25-hour dwell times ≤3 days) with systemic antimicrobials from January 1, 2007 to July 15, 2009. RESULTS: A total of 59 patients, aged 2 months to 19 years (mean ± SD = 6.3 ± 6.1 years) with 80 episodes of CLABSI were included. The CLABSI eradication rate was 86% (69/80 episodes; 95% confidence interval [CI] 78%, 94%), significantly greater than 50% (Z = 2.35, P < .05), the estimated clearance rate of CLABSI eradication using systemic antimicrobials alone. Overall central line retention was 78% (60/77 episodes, 95% CI 69%, 87%). ELT was well tolerated. CONCLUSIONS: These findings suggest the potential benefit of short-dwell ELT combined with systemic antimicrobials in CLABSI treatment. Randomized controlled trials are needed.
Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Infecção Hospitalar/prevenção & controle , Etanol/administração & dosagem , Adolescente , Anti-Infecciosos/administração & dosagem , Bacteriemia/tratamento farmacológico , Cateterismo Venoso Central/instrumentação , Criança , Pré-Escolar , Contaminação de Equipamentos/prevenção & controle , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
In the health care community, nurses are important agents of change and vehicles for improvements in clinical practice and policy. Pediatric nurses empowered with the tools of evidence-based practice and clinical expertise collaborated in 2007 with other health care professionals to make changes in clinical practice for pediatric patients with vascular access devices (VADs). Nurses recognized that there was a need for a change in the heparinization policy for children with short- and long-term VADs. Data were methodically collected over a 1-year period on 500 VAD. Data collection demonstrated a range of VAD volumes that did not exceed 2 mL. The group analysis of the results gave support for changes in the volumes needed for heparinization. Establishment of appropriate heparin dosing based on scientific data led to a decrease in heparin used to maintain pediatric VAD patency and aided in lowering the risk of side effects in patients.
