Intravascular Catheter Infections

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Intravascular Catheter Infections

• Chris Culpepper
• David Allison

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Overview

• Intravascular catheters provide necessary
  vascular access in patients who require both
  short-term and long-term medical therapy
• Short-term therapy utilizes peripheral IV access
• Long-term therapy can utilize either peripheral
  vs. central IV access

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Overview

• Types of Catheters
• Peripheral Venous Catheter
• Peripheral Arterial Catheter
• Midline Catheter
• Nontunneled CVC
• Pulmonary Artery Catheter
• PICC
• Tunneled Catheter
• Totally Implantable
• Umbilical Catheter

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PICC vs. Port

• PICC PORT

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PICC Line - Introduction

• What is it?
• Peripherally Inserted Central Catheterization
• ENTRY SITE Inserted into basilic, cephalic, or
  brachial veins and enter the SVC
• LENGTH 20 cm or longer, depending on patient
  size
• COMMENTS Requires catheter site care Lower
  rates of infection (0.4 - 2.4) Can remain for
  weeks to a year with proper maintenance
• Guidelines for the prevention of intravascular
  catheter-related infections. OGrady et al.
  Pediatrics. Vol110, Num 5, Nov 2002

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Totally Implantable - Introduction

• Port-a-cath
• ENTRY Tunneled beneath skin and have devices
  subcutaneous port accessed with a needle
  implanted in subclavian or internal jugular vein
• LENGTH 8 cm or longer
• COMMENTS Lowest risk for catheter-related
  bloodstream infection (CRBSI) (0.05 - 0.18)
  improved patient self-image no need for local
  catheter site care can remain for years surgery
  required for catheter removal
• Guidelines for the prevention of intravascular
  catheter-related infections. OGrady et al.
  Pediatrics. Vol110, Num 5, Nov 2002

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Complication

• Infection, Infection, Infection!!
• The use of either peripheral or central IV access
  puts patients at increased risk for local or
  systemic infections, including
• Local site infection, CRBSI, septic
  thrombophlebitis, endocarditis, and other
  metastatic infections (lung abscess, brain
  abscess, osteomyelitis, etc.)
• Guidelines for the prevention of intravascular
  catheter-related infections. OGrady et al.
  Pediatrics. Vol110, Num 5, Nov 2002

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Infection Pathways

• Migration of skin organisms
• Contamination of catheter hub intraluminal
  infection
• Hematogenous seeding

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Prevention of Infection

• Materials Teflon, Silicone, and Polyethylene are
  more resistant to attachment of microorganisms
• Sterile technique when placing catheters
• Catheter site Femoral more prone to infections
• Catheter securement (Tegaderm less prone to
  infection than sutures)
• Systemic prophylactic antibiotics
• Regular catheter exchanges not helpful at
  reducing infection rates
• Impregnated Catheters
• - Chlorhexidine/Silver Sulfadiazone
• - Minocycline/Rifamptin (best)
• - Platinum/Silver
• Guidelines for the prevention of intravascular
  catheter-related infections. OGrady et al.
  Pediatrics. Vol110, Num 5, Nov 2002

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Catheter-related Infection

• Most Common Pathogens isolated from catheter
  related bloodstream infections
• Coagulase-negative staph 37
• S. aureus 13
• Enterococcus 13
• Gram-negative Rods 14
• E. coli 2
• Enterobacter 5
• P. aeruginosa 4
• K. pneumoniae 3
• Candida species 8
• Guidelines for the prevention of intravascular
  catheter-related infections. OGrady et al.
  Pediatrics. Vol110, Num 5, Nov 2002

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Special Circumstances

• Gynocologic oncology patients have a much higher
  rate of infection from PICC lines versus
  subcutaneous ports (29 vs 9.8)
• Malfunction and complication requiring removal
  also favored subcutaneous ports
• Complications of indwelling venous access devices
  in patients with gynecologic malignancies. Estes
  et al. Gynecologic Oncology, Dec 2003 pp 591-595

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Treatment Regimens
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Medications

• Coag-negative Staph or Staph Aureus
• MSSA - Nafcillin or Oxacillin
• MRSA Vanc, Clinda, Linezolid
• E. faecalis/ E. faecium
• Amp/Gent
• If Amp resistant - Vanc/Gent
• If Vanc resistant - Linezolid or Quin/
  Dalf
•  E. coli and Klebsiella - Third-generation Csp
• Guidelines for the Management of Intravascular
  Catheter-Related Infections Clinical Infectious
  Disease Vol 32,Number 9, May 2001

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Medications

• P. aeruginosa - Third- or fourth- generation Csp
  or carbapenem or antipseudomonal ß-lactam (Tic,
  Pip, Mez) aminoglycoside
• Enterobacter - Carbapenem
• C. albicans or Candida - AmB or fluconazole
• Guidelines for the Management of Intravascular
  Catheter-Related Infections Clinical Infectious
  Disease Vol 32,Number 9, May 2001