Download Quesito 8 Quali sono i benefici dell`impiego di CVC rivestiti con

Quesito 8
Quali sono i benefici dell’impiego di CVC rivestiti con
eparina e/o impregnati con cloruro di benzalconio?
Ricerca effettuata l’8 aprile 2008
Strategia di ricerca
#10 Search #1 AND #9 AND #6 Limits: Publication Date from 2000
#9 Search #2 OR bonding OR bonded Limits: Publication Date from 2000
#7 Search ((#1) AND (#2)) AND (#6) Limits: Publication Date from 2000
#6 Search heparin OR benzalkonium chloride Limits: Publication Date from
2000
#2 Search coated OR coating OR impregnating OR impregnated Limits:
Publication Date from 2000
#1 Search central venous catheterization OR central venous catheter* OR cvc
OR cvcs Limits: Publication Date from 2000
05:16:11
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1: Am J Infect Control. 2008 Mar;36(2):104-17.
A systematic review comparing the relative effectiveness of antimicrobial-coated
catheters in intensive care units.
Ramritu P, Halton K, Collignon P, Cook D, Fraenkel D, Battistutta D, Whitby M,
Graves N.
The Centre for Healthcare Related Infection Surveillance & Prevention, Brisbane,
QLD, Australia.
BACKGROUND: Bloodstream infection related to a central venous catheter is a
substantial clinical and economic problem. To develop policy for managing the
risks of these infections, all available evidence for prevention strategies
should be synthesized and understood. METHODS: We evaluate evidence (1985-2006)
for short-term antimicrobial-coated central venous catheters in lowering rates
of
catheter-related bloodstream infection (CRBSI) in the adult intensive care unit.
Evidence was appraised for inclusion against predefined criteria. Data
extraction
was by 2 independent reviewers. Thirty-four studies were included in the review.
Antiseptic, antibiotic, and heparin-coated catheters were compared with uncoated
catheters and one another. Metaanalysis was used to generate summary relative
risks for CRBSI and catheter colonization by antimicrobial coating. RESULTS:
Externally impregnated chlorhexidine/silver sulfadiazine catheters reduce risk
of
CRBSI relative to uncoated catheters (RR, 0.66; 95% CI: 0.47-0.93). Minocycline
and rifampicin-coated catheters are significantly more effective relative to
CHG/SSD catheters (RR, 0.12; 95% CI: 0.02-0.67). The new generation
chlorhexidine/silver sulfadiazine catheters and silver, platinum, and
carbon-coated catheters showed nonsignificant reductions in risk of CRBSI
compared with uncoated catheters. CONCLUSION: Two decades of evidence describe
the effectiveness of antimicrobial catheters in preventing CRBSI and provide
useful information about which catheters are most effective. Questions
surrounding their routine use will require supplementation of this trial
evidence
with information from more diverse sources.
1
Publication Types:
Meta-Analysis
Research Support, Non-U.S. Gov't
PMID: 18313512 [PubMed - indexed for MEDLINE]
2: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005983.
Heparin-bonded catheters for prolonging the patency of central venous catheters
in children.
Shah PS, Shah N.
University of Toronto, Department of Paediatrics and Department of Health
Policy,
Management and Evaluation, Rm 775A, 600 University Avenue, Toronto, Ontario,
Canada, M5G 1XB. [email protected]
BACKGROUND: Central venous catheters (CVCs) are a mainstay in the management of
critically ill children. However, these catheters are associated with mechanical
and infectious complications which reduce their life span. Heparin bonding of
catheters has shown promise in animal studies and in adults. OBJECTIVES: The
primary objective was to determine the effect of heparin-bonded CVCs on the
duration of catheter patency in children. Secondary objectives were to determine
the effect of heparin-bonded catheters on catheter related thrombosis,
occlusion,
sepsis and side effects. SEARCH STRATEGY: We searched the Cochrane Peripheral
Vascular Diseases (PVD) Group Trials Register (inception to August 2007) which
contains trials identified through searches of MEDLINE (1966 to August 2007),
EMBASE (1980 to August 2007), CINAHL (1982 to August 2007), and hand searches
along with the Cochrane Central Register of Controlled Trials (CENTRAL) in The
Cochrane Library 2007, Issue 3. SELECTION CRITERIA: We included randomised and
quasi-randomised controlled trials of heparin-bonded catheters versus nonheparin
bonded catheters or antibiotic-impregnated catheters that reported on any of the
prespecified outcomes, without language restriction. DATA COLLECTION AND
ANALYSIS: Methodological quality of the trials was assessed using the
information
provided in the studies and by contacting authors. Data were extracted and the
effect size was estimated and reported as relative risk (RR), risk difference
(RD) or number needed to treat (NNT), as appropriate. MAIN RESULTS: Two eligible
studies reflecting 287 patients were included; both had good methodological
quality. There was no difference in the duration of catheter patency between
heparin bonded and non-heparin bonded catheters (median duration 7 days vs 6
days) reported in one study. There was no difference in the risk of catheter
related thrombosis (RR 0.71, 95% CI 0.44 to 1.15; RD -0.05, 95% CI 0.13 to 0.02;
I(2) = 79%). Data from one study revealed a statistically significant reduction
in the risk of catheter occlusion (RR 0.06, 95% CI 0.00 to 1.07; RD -0.08, 95%
CI
-0.13 to -0.02; NNT 13, 95% CI 8 to 50), catheter-related infections (RR 0.06,
95% CI 0.01 to 0.41; RD -0.17, 95% CI -0.25 to -0.10; NNT 6, 95% CI 4 to 10) and
catheter colonization (RR 0.21, 95% CI 0.06 to 0.71; RD -0.11, 95% CI -0.19 to
-0.04; NNT 9, 95% CI 5 to 25) in the heparin-bonded catheter group. AUTHORS'
CONCLUSIONS: Two eligible studies on the use of heparin-bonded catheters versus
placebo in children were identified. The use of heparin-bonded catheters is a
promising therapy but warrants further studies.
Publication Types:
Meta-Analysis
Review
PMID: 17943871 [PubMed - indexed for MEDLINE]
2
3: J Support Oncol. 2007 Jun;5(6):273-8.
Use of heparin-coated central venous lines to prevent catheter-related
bloodstream infection.
Abdelkefi A, Achour W, Ben Othman T, Ladeb S, Torjman L, Lakhal A, Ben Hassen A,
Hsairi M, Ben Abdeladhim A.
Centre National de Greffe de Moelle Osseuse, Tu- nis, Tunisia.
[email protected]
Bloodstream infections related to the use of central venous catheters are an
important cause of patient morbidity, mortality, and increased health care
costs.
Catheter-related infection may be due to fibrin deposition associated with
catheters. Interventions designed to decrease fibrin deposition have the
potential to reduce catheter-related infections. This study was a randomized,
controlled trial in which 246 patients with nontunneled central venous catheters
were randomly assigned to receive a heparin-coated catheter with 50 mL/d of
normal saline solution as a continuous infusion (heparin-coated group) or a
noncoated catheter with a continuous infusion of low-dose unfractionated heparin
(control group: continuous infusion of 100 U/kg/d). Catheter-related bloodstream
infection occurred in 2.5% (3/120 catheters) in the heparin-coated group (0.9
events per 1,000 days) and in 9.1% (11/120 catheters) in the control group (3.5
events per 1,000 days; P = 0.027). No other risk factors were found for the
development of catheter-related bloodstream infection. Six and seven patients
experienced severe bleeding in the heparin-coated and control groups,
respectively (P = 1.00).We did not observe heparin-induced thrombocytopenia. The
use of heparin-coated catheters can be a safe and effective approach to the
prevention of catheter-related bloodstream infection in patients with
hematooncologic disease.
Publication Types:
Randomized Controlled Trial
PMID: 17624052 [PubMed - indexed for MEDLINE]
4: Anaesth Intensive Care. 2006 Aug;34(4):481-4.
Effect of heparin-bonded central venous catheters on the incidence of
catheter-related thrombosis and infection in children and adults.
Long DA, Coulthard MG.
Royal Children's Hospital, Brisbane, Queensland, Australia.
The use of central venous catheters, while advantageous, is associated with a
range of complications including thrombosis and infection. These complications
can pose significant physical and financial costs to the patient and health care
system. A critical appraisal of the two randomized controlled trials examining
this topic in critically ill patients has shown that heparin-bonded central
venous catheters significantly reduced the incidence of catheter-related
thrombosis and infection in children and adults. These findings suggest that
heparin-bonded central venous catheters should be considered for routine use in
critically ill patients.
PMID: 16913346 [PubMed - indexed for MEDLINE]
5: Biomaterials. 2006 Oct;27(29):5107-17. Epub 2006 Jun 16.
Chronic performance of polyurethane catheters covalently coated with ATH
complex:
a rabbit jugular vein model.
3
Klement P, Du YJ, Berry LR, Tressel P, Chan AK.
Henderson Research Centre, McMaster University, Hamilton, Ont, Canada.
Covalent complexes of antithrombin (AT) and heparin (ATH) have superb
anticoagulant activity towards thrombin and factor Xa. Stability of polyurethane
central venous catheters covalently modified with radiolabeled ATH was studied
using a roller pump with saline or protease P-5147. Saline wash removed loosely
bound ATH molecules to decrease graft density from 26 to 12 pmol/cm2. However,
only slightly more ATH was removed by strong protease (from 12 to 7 pmol/cm2).
To
evaluate ATH-coated, heparin-coated, and uncoated catheters, a chronic rabbit
jugular vein model was developed with catheters maintained for up to 30-106
days.
Lumen occlusion was tested by drawing blood twice daily. Although unmodified or
heparin-coated catheters occluded within 5-7 days after insertion, all ATH
catheters remained patent throughout the experiment. Scanning electron
microscopy
(SEM) analysis of heparin and uncoated catheters revealed extensive thrombosis
(lumen+mural) while ATH catheters were unaffected. Visual observation showed
significant deposition of protein and cells on control and heparin-modified
catheters and, to a lesser degree, on ATH-coated surfaces. SEM showed no fibrin
inside or outside of ATH catheters, which remained patent in extended studies
out
to 106 days. Although atomic force microscopy showed ATH coatings to be rough,
6-fold higher anti-factor Xa activity likely contributed to increased patency.
Our data confirm that ATH-modified catheters are stable and have superior
potency
compared to heparin or control catheters.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 16781768 [PubMed - indexed for MEDLINE]
6: Ann Pharmacother. 2005 Oct;39(10):1617-20. Epub 2005 Sep 13.
Reliability of nesiritide infusion via non-primed tubing and heparin-coated
catheters.
Onat D, Stathopoulos J, Rose A, Newman K, Sciacca RR, Jorde UP, Colombo PC.
Department of Medicine, Columbia University, New York, NY 10032, USA.
BACKGROUND: Prescribing information for nesiritide mandates priming of
intravenous tubing prior to connecting to the patient's intravenous access
because the drug may adsorb to the line. As of this writing, no published study
has quantified the binding effect of nesiritide to intravenous tubing.
OBJECTIVE:
To investigate whether priming of peripheral intravenous tubing is necessary and
whether nesiritide can be reliably delivered through central intravenous lines,
including heparin-coated catheters, where priming cannot occur. METHODS: A
23.3-mL bolus of nesiritide followed by a 7-mL/h 2-hour infusion were run
through
(1) polyvinylchloride (PVC) peripheral intravenous tubing primed with
nesiritide,
(2) non-primed PVC peripheral intravenous tubing, (3) non-primed polyethylene
peripheral intravenous tubing, (4) non-primed PVC peripheral intravenous tubing
connected to a central intravenous polyurethane catheter, and (5) non-primed PVC
peripheral intravenous tubing connected to a heparin-coated pulmonary artery PVC
catheter. Nesiritide concentrations were measured in the intravenous bags and in
samples collected from the 5 intravenous settings. RESULTS: Priming of
4
intravenous tubing with nesiritide did not increase drug recovery: at least 94%
of the bolus dose and 96% of the total drug were recovered from all intravenous
sets. CONCLUSIONS: Infusion of nesiritide via non-primed peripheral and central
intravenous tubing, including heparin-coated pulmonary catheter, is reliable.
Changes in nesiritide labeling appear to be warranted.
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 16159995 [PubMed - indexed for MEDLINE]
7: Curr Opin Crit Care. 2005 Feb;11(1):87-93.
Extracorporeal membrane oxygenation.
Mielck F, Quintel M.
Anaesthesiologie II, Operative Intensivmedizin, Universitätsklinikum Göttingen,
Göttingen, Germany.
PURPOSE OF REVIEW: Extracorporeal membrane oxygenation (ECMO) has become a more
or less accepted standard in the algorithm of advanced acute respiratory
distress
syndrome therapy in adult patients when all other treatment options have failed.
This article reviews the current status of ECMO therapy with particular focus on
new technical developments and their potential implications for performance and
indications for ECMO therapy. RECENT FINDINGS: A recently published review on a
single-center experience in 255 adult ECMO patients identified using
multivariate
logistic regression analysis age, sex, initial pH 7.10 or lower and PaO2/FiO2
ratio, and days of mechanical ventilation before ECMO as a significant
predictors
of survival. Additionally, a careful cost-effectiveness study for neonatal ECMO
relating a 4-year base to the UK neonatal ECMO trial has clearly demonstrated
cost-effectiveness. SUMMARY: Over the years, the technique for ECMO therapy
underwent substantial changes in indications and the materials used. Impressive
technical progress has been made in pumps, oxygenators, and coating of
artificial
surfaces, leading to a higher biocompatibility and to a lower rate of
procedure-related complications. The potential of new inline pumps in
combination
with a decreasing rate of procedure-related complications might lead to a
re-evaluation of the role of extracorporeal lung support in acute respiratory
distress syndrome therapy. A very recent development is the use of spontaneous
arteriovenous devices for carbon dioxide removal, allowing significant reduction
of ventilator settings at decreased carbon dioxide partial pressures and at
increased pH values. Ongoing studies are looking at the potential of this
approach to reduce side effects of mechanical ventilation further.
Publication Types:
Review
PMID: 15659951 [PubMed - indexed for MEDLINE]
8: Oncologist. 2004;9(2):207-16.
Comment in:
Oncologist. 2004;9(5):594-5; author reply 596.
Thrombotic complications of central venous catheters in cancer patients.
Kuter DJ.
5
Hematology/Oncology Unit, Massachusetts General Hospital, Harvard Medical
School,
Boston, Massachusetts 02114, USA. [email protected]
Central venous catheters (CVCs), such as the tunneled catheters and the totally
implanted ports, play a major role in general medicine and oncology. Aside from
the complications (pneumothorax, hemorrhage) associated with their initial
insertion, all of these CVCs are associated with the long-term risks of
infection
and thrombosis. Despite routine flushing with heparin or saline, 41% of CVCs
result in thrombosis of the blood vessel, and this markedly increases the risk
of
infection. Only one-third of these clots are symptomatic. Within days of
insertion, almost all CVCs are coated with a fibrin sheath, and within 30 days,
most CVC-related thrombi arise. Aside from reducing the function of the
catheter,
these CVC-related thrombi can cause postphlebitic syndrome in 15%-30% of cases
and pulmonary embolism in 11% (only half of which are symptomatic). Risk factors
for CVC thrombosis include the type of malignancy, type of chemotherapy, type of
CVC, and locations of insertion site and catheter tip, but not inherited
thrombophilic risk factors. Efforts to reduce CVC thrombosis with systemic
prophylactic anticoagulation with low-molecular-weight heparin have failed.
Low-dose warfarin prophylaxis remains controversial; all studies are flawed,
with
older studies, but not newer ones, showing benefit. Currently, less than 10% of
patients with CVCs receive any systemic prophylaxis. Although its general use
cannot be recommended, low-dose warfarin may be a low-risk treatment in patients
with good nutrition and adequate hepatic function. Clearly, additional studies
are required to substantiate the prophylactic use of low-dose warfarin. Newer
anticoagulant treatments, such as pentasaccharide and direct thrombin
inhibitors,
need to be explored to address this major medical problem.
Publication Types:
Historical Article
Review
PMID: 15047925 [PubMed - indexed for MEDLINE]
9: Intensive Care Med. 2004 Apr;30(4):633-8. Epub 2004 Jan 13.
Evaluation of a triple-lumen central venous heparin-coated catheter versus a
catheter coated with chlorhexidine and silver sulfadiazine in critically ill
patients.
Carrasco MN, Bueno A, de las Cuevas C, Jimenez S, Salinas I, Sartorius A, Recio
T, Generelo M, Ruiz-Ocaña F.
Intensive Care Unit, Hospital Universitario de la Princesa, Diego de León 62,
28006 Madrid, Spain. [email protected]
OBJECTIVE: To compare the incidence of catheter colonization and catheterrelated
bloodstream infections between heparin-coated catheters and those coated with a
synergistic combination of chlorhexidine and silver sulfadiazine. DESIGN:
Randomized, controlled clinical trial. SETTING: A 20-bed medical-surgical
intensive care unit. PATIENTS: A total of 180 patients requiring the insertion
of
a trilumen central venous catheter. INTERVENTIONS. Patients were randomized to
receive either a trilumen heparin or chlorhexidine and silver sulfadiazinecoated
catheter. MEASUREMENTS: Catheter colonization was defined by a semiquantitative
6
catheter tip culture yielding 15 or more colony-forming units or quantitative
culture of 1,000 or more colony-forming units/ml. Catheter-related bloodstream
infection as the isolation of the same microorganism from a peripheral blood
culture and catheter tip. RESULTS: A total of 260 catheters were cultured. Out
of
132 heparin-coated catheters, 29 were colonized and out of 128 chlorhexidine and
silver sulfadiazine-coated catheters, 13 were colonized ( p=0.03), relative risk
RR=2.16 (1.18-3.97). This represents an incidence of 23.5 and 11.5 episodes of
catheter colonization per 1,000 catheter-days, respectively ( p=0.0059), RR=2.04
(1.05-3.84). Microorganisms isolated in catheter colonization from heparincoated
catheters were gram-positive cocci 23, gram-negative bacilli 7, and Candida spp
4. In chlorhexidine and silver sulfadiazine-coated catheters were gram-positive
cocci 6 and gram-negative bacilli 11 ( p=0.009). The incidence of
catheter-related bloodstream infections per 1,000 catheter-days was 3.24 in
heparin-coated catheters and 2.6 in chlorhexidine and silver sulfadiazine-coated
catheters ( p=0.79), RR=1.22 (0.27-5.43). CONCLUSIONS: In critically ill
patients
the use of trilumen central venous catheters coated with chlorhexidine and
silver
sulfadiazine reduced the risk of catheter colonization due to prevention of
gram-positive cocci and Candida spp.
Publication Types:
Clinical Trial
Comparative Study
Randomized Controlled Trial
PMID: 14722639 [PubMed - indexed for MEDLINE]
10: J Hosp Infect. 2003 Jun;54(2):163-4.
Comment on:
J Hosp Infect. 2003 Jan;53(1):46-57.
Heparin-bonded lines reduce hospital-acquired bacteraemia.
Gilbert R, Howard R, Mok Q.
Publication Types:
Comment
Letter
PMID: 12818593 [PubMed - indexed for MEDLINE]
11: Hamostaseologie. 2002 Dec;22(4):161-6.
[Prevention of catheter-induced thromboses by low molecular weight heparins]
[Article in German]
Lersch Ch.
II. Medizinische Klinik und Poliklinik der Technischen Universität München,
Klinikum rechts der Isar, Ismaninger Strasse 22, 81675 München.
[email protected]
Infections and thromboses are the most frequent complications of central venous
catheters (cvc). The use of a special material (i. e. polyurethane, silicone)
and
type (i. e. Hickman) small in diameter, the avoidance of any infection as well
as
the optimal position of the cvc tip in the lower part of the vena cava superior
7
and a short period of catheterisation will be effective in decreasing the number
of thromboses, whereas other thrombogenic factors (i. e. malignant disease), the
patient's age, additional chemo- and/ or radiotherapy cannot practically be
influenced. Coated cvc, oral anticoagulants, acetylsalicylic acid, and low dose
urokinase, unfractionated and predominantly low molecular weight heparins (LMWH)
are in use to avoid thromboses. Our outpatients with progressed gastrointestinal
malignancies, port systems, and systemic chemotherapy consequently receive a
prophylaxis with LMWH for at least 90 days according to the beneficial results
published in three studies. Additional antitumoral effects of LMWH are presently
evaluated and will favour consequent LMWH prophylaxis in patients with advanced
malignancies and permanent catheters.
Publication Types:
English Abstract
Review
PMID: 12540975 [PubMed - indexed for MEDLINE]
12: Circ J. 2003 Jan;67(1):96-8.
Acute pulmonary thromboembolism induced by prophylactic heparin use and a
heparin-coated catheter: a case of heparin-induced thrombocytopenia and
thrombosis syndrome.
Nasuno A, Matsubara T, Hori T, Higuchi K, Tsuchida K, Mezaki T, Tanaka T,
Hanzawa
K, Moro H, Hayashi J, Tanaka K, Fuse I, Aizawa Y.
First Department of Internal Medicine, Niigata University Medical Hospital,
Japan.
Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) is a
potentially
life-threatening side effect of heparin therapy, triggered by an immune
response,
and has been reported to be related not only to the therapeutic use of heparin
but also to heparin-coated catheters. A 45-year-old woman with intrapelvic
malignancy developed an acute pulmonary thromboembolism (PE) after hysterectomy
despite prophylactic heparin use. Subsequent large doses of heparin for
treatment
of the PE exacerbated the thrombocytopenia and, moreover, a large thrombus
formed
around the heparin-coated central venous catheter. Anti-heparin-platelet factor
4
complex antibody and heparin-induced platelet aggregation assay were positive,
so
the diagnosis was HITTS, and heparin was replaced by argatroban after carrying
out thrombectomy. This therapy was successful, and the patient made favorable
progress.
Publication Types:
Case Reports
PMID: 12520161 [PubMed - indexed for MEDLINE]
13: Comp Med. 2002 Jun;52(3):243-8.
Effect of covalently bound heparin coating on patency and biocompatibility of
long-term indwelling catheters in the rat jugular vein.
Foley PL, Barthel CH, Brausa HR.
Center for Comparative Medicine, University of Virginia, Charlottesville 22908,
8
USA.
Many physiologic and pharmacologic studies require long-term vascular access for
repeated substance infusion and/or blood sample collection. The study reported
here was undertaken to determine whether a functionally active heparin coating
would improve long-term patency of venous catheters in rats. Uncoated or coated
catheters were surgically placed in the jugular vein, and patency was evaluated
twice weekly for a total of 30 days. Culturing of blood and catheters, and
histologic examination were performed for all rats. All heparin-coated catheters
remained patent for the study duration, with patency defined as ability to
infuse
saline and withdraw a blood sample. Median patency for uncoated catheters was
17.5 days, with a range of three to 30 days. Histologic evaluation of vessels
revealed more advanced and severe lesions in rats with uncoated, compared with
coated catheters. Furthermore, uncoated catheters had increased association with
bacteremia (3/8), compared with coated (0/9) catheters. Taken together, these
results indicate that coating catheters with covalently bound heparin molecules
can significantly prolong patency and cause less pathologic damage to the
catheterized vessel.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 12102570 [PubMed - indexed for MEDLINE]
14: J Chemother. 2001 Nov;13 Spec No 1(1):234-8.
The prevention of central venous catheter-related sepsis.
Elliott TS.
University Hospital Birmingham NHS Trust, UK.
[email protected]
Intravascular catheters continue to be a major source of sepsis which range from
localised inflammation at the site of insertion to septicaemia. There are two
main approaches which have been taken in an attempt to prevent these infections.
These can be divided into the patient and the catheter. Approaches for
prevention
with patients include improved aseptic techniques, appropriate choice of
antiseptic skin preparations, use of semi-occlusive dressings and cleaning
schedules when using the devices. Catheters have also been developed to reduce
the incidence of these infections. These include the production of polymers with
smooth, anti-adhesive coatings, eg Hydromer, and more recently the introduction
of devices which are either coated with antiseptics or antimicrobials. The
antimicrobial coatings include antibiotics such as rifampicin and doxycycline or
antiseptics, for example benzalkonium chloride or chlorhexidine. The efficacy of
these approaches will be reviewed based on both laboratory and clinical studies.
The treatment of intravascular catheter-related sepsis depends primarily on
establishing the diagnosis. When the diagnosis has been made treatment ranges
from the use of antimicrobials alone to removal of the device. More recent
approaches have included the use of antibiotic locks within the catheters.
Treatment schedules will also be reviewed.
Publication Types:
Review
PMID: 11936372 [PubMed - indexed for MEDLINE]
15: Cancer. 2002 Jan 1;94(1):245-51.
Catheter-related infection and thrombosis of the internal jugular vein in
hematologic-oncologic patients undergoing chemotherapy: a prospective comparison
9
of silver-coated and uncoated catheters.
Harter C, Salwender HJ, Bach A, Egerer G, Goldschmidt H, Ho AD.
Department of Internal Medicine V, University of Heidelberg, Heidelberg,
Germany.
[email protected]
BACKGROUND: Catheter-related venous thrombosis is one of the most frequent
complications of central venous catheters (CVCs). This complication occurs in 440% of patients with hematologic malignancies receiving conventional
chemotherapy
after placement of CVCs. METHODS: The objective of this prospective study was to
assess whether a silver-coated CVC poses an additional risk in the development
of
catheter-related thrombosis in hematologic-oncologic patients. Patients were
randomized to receive either silver-coated polyurethane catheters (BactiGuard;
Metacot, Stockholm, Sweden) or uncoated standard polyurethane catheters
(Cavatheter, Fresenius AG, Bad Homburg, Germany) for central venous access.
Silver-coated catheters (n = 120) and standard catheters (n = 113) were inserted
into the jugular vein in 233 consecutive patients. Variables that may be
significant for the development of thrombosis were comparable in the two groups.
After removal of the CVC, the patency of both jugularian veins internal as well
as external was assessed with real-time ultrasound (Sonolayer-SAL-35A; Toshiba,
Tokyo, Japan). RESULTS: Four of 233 patients (1.5%) were found to have venous
thrombosis. Incomplete occlusion of the internal jugular vein occurred in 2
patients (0.75%, parietal thrombosis), and complete thrombosis, although
clinically silent, was found in 2 patients (0.75%). There was no difference
between patients with silver-coated and uncoated CVCs. CONCLUSIONS: The authors
concluded that this novel silver-coated CVC does not cause a higher rate of
central venous thrombosis compared with standard CVCs. The low overall incidence
of central venous thrombosis might be attributed to the routine application of
low-dose heparin in our patients during chemotherapeutic treatment. Copyright
2002 American Cancer Society.
Publication Types:
Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 11815983 [PubMed - indexed for MEDLINE]
16: J Chemother. 2001 Dec;13(6):595-606.
Efficacy of antiadhesive, antibiotic and antiseptic coatings in preventing
catheter-related infections: review.
Donelli G, Francolini I.
Laboratorio di Ultrastrutture, Istituto Superiore di Sanità, Rome, Italy.
[email protected]
In recent years, central venous catheters (CVCs) are increasingly used in
clinical practice. However, complications such as local or systemic infections
are frequent for both temporary and indwelling vascular catheters. Annually, in
the United States of America there are more than 200,000 cases of nosocomial
bloodstream infections (BSIs), of which 90% are related to the use of an
intravascular device. These infections are associated with increased morbidity
and mortality, prolonged hospitalization and growing medical costs.
Technological
treatments of polymer surfaces including coating the catheter with antimicrobial
substances may be promising tools for prevention of catheter-associated
infections. A large number of surface-treated central venous catheters are now
10
commercially available. In this paper the features and the clinical efficacy of
different antimicrobial coatings are reviewed.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 11806619 [PubMed - indexed for MEDLINE]
17: Acta Neurochir (Wien). 2000;142(12):1377-83.
External ventricular drainage catheters: effect of surface heparinization on
bacterial colonization and infection.
Lundberg F, Wady L, Söderström S, Siesjö P, Larm O, Ljungh A.
Department of Infectious Diseases and Medical Microbiology, Lund University
Hospital, Sweden.
Surface heparinization of central venous catheters has earlier been shown to
reduce the frequency of bacterial colonization and septicaemia. The present
study
was undertaken to investigate the benefit of surface heparinization of external
ventricular drainage (EVD) catheters in relation to bacterial colonization, as
measured by bacterial growth and examination by a 16S-rRNA PCR assay, of
catheters and of samples of cerebrospinal fluid (CSF). Ninety-eight heparinized
and one hundred unheparinized EVD catheters from the same batch of catheters
were
used. Twenty point five percent of the heparinized and 22.8% (p = 0.63) of the
unheparinized EVD catheters were colonized with bacteria. Culture of CSF, which
is the definition of clinical infection in this study, yielded growth in 10.3%
of
patients with heparinized and in 6.3% (p = 0.18) of those with unheparinized
catheters. PCR examination yielded positive signal in 31.3% of patients with
heparinized catheters and in 37.7% (p = 0.061) of patients without (CSF and
catheters). In the subgroup of patients with subarachnoid haemorrhages, there
was
a tendency, though not statistically significant, towards a lowered frequency of
colonization with 23.1% for heparinized and 33.3% (p = 0.31) for unheparinized
catheters. PCR examination did not contribute any further to the diagnostic
procedure in the patients concerned. The EVD catheters are skin-penetrating
devices and contamination from the skin flora is common. Skin cultures, obtained
after skin disinfection and insertion of catheters, showed growth of bacteria in
62% of the patients.
Publication Types:
Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 11214632 [PubMed - indexed for MEDLINE]
18: Chemotherapy. 2001 Jan-Feb;47(1):50-5.
Efficacy of a benzalkonium chloride-impregnated central venous catheter to
prevent catheter-associated infection in cancer patients.
Jaeger K, Osthaus A, Heine J, Ruschulte H, Kuhlmann C, Weissbrodt H, Ganser A,
Karthaus M.
Department of Anesthesiology, Hannover Medical School, Hannover, Germany.
BACKGROUND: This study was performed to determine the efficacy of a benzalkonium
11
chloride-impregnated central venous catheter (CVC) in preventing catheterrelated
infection in patients suffering from malignant diseases and undergoing
chemotherapy. METHODS: A randomized, prospective clinical trial was carried out
to compare the incidence of catheter-related colonization and catheter-related
bacteremia using an antiseptic-impregnated CVC (n = 25) with that using a
standard triple-lumen CVC (n = 25). RESULTS: All patients were treated with
intensive chemotherapy for acute leukemia (n = 28), lymphoma (n = 17) or solid
tumors (n = 5). Both study groups presented with similar data in regards to age,
insertion site, duration of catheterization and neutropenia period during
catheterization, demonstrating a comparable risk for catheter-related
colonization. Suspicion of infection led to explantation in 14 versus 15 cases.
Catheter-related colonization was proven in 4 cases (16%) and catheter-related
bacteremia was observed only once (4%) in both groups. Statistical testing
showed
no significant differences between the study and control group. CONCLUSIONS: The
rate of catheter-related colonization was lower than suspected in this high-risk
patient group. The use of benzalkonium chloride-impregnated CVC failed to
decrease the incidence of catheter-related colonization and bacteremia in
patients with a high risk of infectious complications. Copyright 1999 S. Karger
AG, Basel
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 11125233 [PubMed - indexed for MEDLINE]
19: Eur J Anaesthesiol. 2000 Nov;17(11):680-7.
A central venous catheter coated with benzalkonium chloride for the prevention
of
catheter-related microbial colonization.
Moss HA, Tebbs SE, Faroqui MH, Herbst T, Isaac JL, Brown J, Elliott TS.
Departments of Clinical Microbiology and Anaesthetics and Intensive Care, Queen
Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston,
Birmingham, B15 2TH, UK.
In an attempt to overcome infections associated with central venous catheters, a
new antiseptic central venous catheter coated with benzalkonium chloride on the
internal and external surfaces has been developed and evaluated in a clinical
trial. Patients (235) randomly received either a triple-lumen central venous
catheter coated with benzalkonium chloride (117) or a polyurethane nonantiseptic
catheter (118). The incidence of microbial colonization of both catheters and
retained antiseptic activity of the benzalkonium chloride device following
removal were determined. The benzalkonium chloride resulted in a significant
reduction of the incidence of microbial colonization on both the internal and
external catheter surfaces. The reduction in colonization was detected at both
the intradermal (21 benzalkonium chloride catheters vs. 38 controls, P = 0.0016)
and distal segments of the antiseptic-coated catheters. Following catheter
removal retained activity was demonstrated in benzalkonium chloride catheters
which had been in place for up to 12 days. No patients developed adverse
reactions to the benzalkonium chloride catheters. The findings demonstrate that
the benzalkonium chloride catheter significantly reduced the incidence of
catheter-associated colonization.
Publication Types:
Clinical Trial
Comparative Study
Randomized Controlled Trial
12
Research Support, Non-U.S. Gov't
PMID: 11029566 [PubMed - indexed for MEDLINE]
20: Crit Care Med. 2000 Sep;28(9):3366-7.
Comment on:
Crit Care Med. 2000 Sep;28(9):3332-8.
Antimicrobial catheters: value and safety.
Farr BM.
Publication Types:
Comment
Editorial
PMID: 11009013 [PubMed - indexed for MEDLINE]
21: Crit Care Med. 2000 Sep;28(9):3332-8.
Comment in:
Crit Care Med. 2000 Sep;28(9):3366-7.
Prevention of nosocomial bloodstream infections: effectiveness of
antimicrobial-impregnated and heparin-bonded central venous catheters.
Marin MG, Lee JC, Skurnick JH.
Department of Medicine, University of Medicine and Dentistry of New Jersey--New
Jersey Medical School, Newark, USA.
OBJECTIVES: To examine the effectiveness of antimicrobial-impregnated and
heparin-bonded catheters relative to standard central venous catheters in
lessening catheter-related bloodstream infections. DATA SOURCES: Articles were
identified by computer-assisted searching. STUDY SELECTION: Studies were
eliminated from further consideration if they did not contain original data
relevant to lessening catheter-related bloodstream infections, were
nonrandomized
or uncontrolled, described subjects <17 yrs of age, or used animal subjects.
DATA
ABSTRACTION: From each eligible article, we abstracted the following: a)
citation; b) type of control; c) study setting; d) type of experimental
catheter;
e) catheter-specific complications; f) total numbers of patients and catheters;
g) number of experimental catheters used that resulted in a catheter-related
bloodstream infection; h) number of control catheters used that resulted in a
catheter-related bloodstream infection; i) number of experimental catheters used
without catheter-related bloodstream infections; and j) number of control
catheters used without infections. We also recorded the duration of catheter use
and the types of microbes cultured in association with the catheters and with
catheter-related bloodstream infections. DATA SYNTHESIS: Eleven eligible studies
were identified. Using meta-analysis, we showed that antimicrobial-impregnated
and heparin-bonded central venous catheters significantly decreased
catheter-related bloodstream infections by 2.32% (95% confidence interval, 1.04%
to 3.61%). CONCLUSIONS: The modest additional cost for the use of these
catheters
relative to the considerable cost of treating even a single bloodstream
infection
makes their use cost-effective.
Publication Types:
Meta-Analysis
13
PMID: 11008998 [PubMed - indexed for MEDLINE]
22: Intensive Care Med. 2000 Jul;26(7):967-72.
Heparin-bonded central venous lines reduce thrombotic and infective
complications
in critically ill children.
Pierce CM, Wade A, Mok Q.
Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children,
London, UK. [email protected]
OBJECTIVE: To determine whether heparin bonding reduces the incidence of
catheter-related thrombosis and infection in critically ill children. DESIGN: A
prospective double-blind randomized controlled study. SETTING: A tertiary
paediatric intensive care unit. PATIENTS: Two hundred and nine patients, 123
males and 86 females, aged 0-16 years, admitted to the intensive care unit and
needing a central venous line (CVL), were randomized to receive either a
heparin-bonded (HB, n = 102) or a non-heparin-bonded line (NHB, n = 107). Nine
patients were excluded owing to incomplete data. INTERVENTION: HB or NHB CVL.
MEASUREMENTS: Blood cultures were carried out on insertion of the line and every
3 days thereafter. Ultrasound was performed within the first 3 days and every 3
days thereafter. On removal the line was sent for culture. Results: The two
groups were comparable for age, sex, severity of illness and length of time that
the catheter was in situ. Proportional hazards modelling showed that heparin
bonding was associated with a significant reduction in infections (hazard ratio
0.11, P < 0.00005). The incidence of infection was 4% and 33% in HB and NHB
CVLs,
respectively (4/97 vs. 34/103, P < 0.0005). The incidence of thrombosis was 0%
and 8% in HB and NHB CVLs, respectively (0/97 vs. 8/103, P = 0.006). The number
of HB CVLs which would need to be used to avoid one episode of infection or
thrombosis was 3 and 13, respectively. CONCLUSION: Our study shows a significant
reduction in the incidence of infection and thrombosis associated with the use
of
HB CVLs.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 10990114 [PubMed - indexed for MEDLINE]
14