This is Part 3 of a 3-part series and will review flushing solutions and injection caps in addition to practice issues, standards, guidelines, and preventive strategies developed to prevent or decrease infections of central venous catheters.
The most frequent home parenteral nutrition complication is central venous catheter infection. The authors sought to determine the rate and types of bloodstream infections in a Canadian home parenteral nutrition program. Methods: Bloodstream infection was diagnosed if all following criteria were present: (1) one or more positive blood cultures were found, (2) antimicrobial therapy or catheter was removed, and (3) there were no other infections. Results: Between April 1, 1996, and April 30, 1997, 43 patients from the Home Parenteral Nutrition Program at Toronto General Hospital participated in a multicenter study in which a total of 355 patients receiving home infusion therapy for various reasons were enrolled. From these 43 patients, there were 37 infections in 19 home parenteral nutrition patients. The infection rate was 2.3 per 1000 catheter days. The common infecting organism was coagulase-negative Staphylococcus. Conclusion: In this prospective study involving patients receiving home parenteral nutrition, although the information is 10 years old, the infection rate of 2.3 per 1000 catheter days is lower than most recent studies involving patients receiving total parenteral nutrition in the hospital or at home with a similar common infecting organism of coagulase-negative Staphylococcus.
Peripherally inserted central catheters (PICCs) have become ubiquitous in the current management of chronic inpatient and outpatient conditions. Many hospitals have developed practice patterns that allow placement of PICC lines by teams of nurses at the bedside. This practice has led to a proliferation of these central venous access devices, and their use has expanded. One of the consequences of a nurse-based placement team is the decrease in physician involvement in decisions regarding the placement of PICC lines. In some settings, PICC placement can become so routine that the type of access needed or the other clinical conditions affecting an individual patient may be overlooked. One example of this problem is the situation in which a patient with chronic kidney disease or end-stage renal disease needs venous access for a nondialysis reason, such as antibiotics, cancer therapy, or total parenteral nutrition. The author discusses ramifications of this problem as well as ways to reduce the chances of mistakes.
Clinicians working in a facility specializing in cardiac care have probably seen patients with decompensated congestive heart failure (CHF) and renal failure. As a vascular access specialist, chances are that clinicians have recently been asked to provide vascular access for a relatively new treatment procedure called peripherally inserted veno-venous ultrafiltration or aquapheresis. This treatment, pioneered between 2002 and 2003, was designed for patients suffering from decompensated CHF, leading to acute fluid overload and renal failure. These patients no longer respond to the traditional diuretic and sodium-depleting therapies and often have no other treatment choices left. This article discusses the vascular access side of this treatment and the associated challenges.