Prevention and treatment of central line infections is a core competency in critical care. Prevention is the true key here. Achieving zero central line infections is an unreachable goal, but with diligence the rate can be pushed close to zero.
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The IBCC chapter is located here.
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Nice overview. We use a lot of tunneled CVC. Never seen any evidence that it reduces CLABSI. Whats your take on the use? Aware of any evidence?
Love the show. Thomas.
I don’t know, sorry. Haven’t seen or read about these.
Great post, as always. Thanks.
Good read and maybe an addition to the post:
the new ASA Practice Guidelines for Central Venous Access 2020: An Updated Report on Central Venous Access:
https://doi.org/10.1097/ALN.0000000000002864
Very useful podcast and chapter as usual. You recommend to convert a CVL to a PICC for long-term access when possible. It would be important to clarify what you mean by “long-term.” Requiring 6 -8 weeks of antibiotics to be finished at home or long term TPN definitely require a PICC. However, a prolonged 2 week ICU stay, not necessarily. Here are some reasons that I would be cautious about converting CVL to PICC as a standard practice unless they truly need several more weeks of IV access. (a) I can’t find any solid data that PICCs are associated with… Read more »
1) You’re right, there is a playoff between central line infections with CVCs vs. DVTs with PICC.
2) I think the best approach here may be to stop treating most PICC associated DVTs with systemic anticoagulation. These seem to be pretty benign. I think the main problem with PICC-associated DVTs is that we insist on anticoagulation, and the anticoagulation hurts people. OHSU recently published a series demonstrating that it’s often safe to just pull out the PICC line without any anticoagulation and closely observe patients (https://www.ncbi.nlm.nih.gov/pubmed/30673943).
Should lines be removed if you have positive cultures with a likely alternative source of infection such as an underlying pneumonia? What about removal of peripheral lines? Should peripheral lines be removed?
Very informative post, thank you. What is your take on Acridine-orange leucocyte cytospin (AOLC) test for diagnosing CVC infection?
Thank you for the awesome review. My hospital is considering implementing IV bags hanging for over 24 hrs must be exchanged q24hrs in central venous access systems in effort to prevent increased line infection. I found a small study that showed no difference after 96hrs. Aware of any stronger evidence? I feel like this will lead to excess waste, increased shortages, and increased opportunity for line infections. Thanks so much.
Mianecki TB, Peterson EL. PMID: 33935250