Review of central-line-related sepsis in neurointensive care patients

Introduction

Central venous catheterisation is a core component of intensive care management. Despite advances in medicine, central venous catheters are associated with infection rates ranging between 2.5 and 70% [1, 2]. There is, however, little isolated information regarding rates of central line sepsis in neurointensive patients. Microbiology results from the 3 months preceding this study identified six line-related infections. Following implementation of a new evidence-based medicine technique for central lines, this study set out to review central line sepsis in patients at Walton Neurological ITU.

Methods

Eighty-seven patients were identified by the study criteria as suitable for inclusion, of which information on 65 patients was obtained. Baseline demographical information was collected on patient sex, age, catheter insertion site and procedural complications. Analysis was then carried out to review the rates of line sepsis in this neurologically compromised group of patients, along with identifying any obvious trends in central venous insertion.

Results

A total of 69.2% (n = 45) of the cohort of 65 patients had a central line in situ. Of these, 47% (n = 29) were femoral, 24% (n = 15) were internal jugular, 23% (n = 14) were subclavian whilst 6% (n = 4) were unknown (site not mentioned in records). In total, 4.8% (n = 3) had reported line infections, two of which were coagulase-negative staphylococcus grown from femoral lines while one patient was reported to have grown Candida albicans from their internal jugular central line site.

Conclusion

Despite best practice evidence favouring cervical lines, the study found that femoral line insertion was more appropriate in this subset of patients with unstable head injuries. In addition, this study highlighted a 50% reduction in central line sepsis in the 3 months following our central line insertion and maintenance policies. Furthermore, early resiting on day 3 in the case of femoral lines resulted in a reduction in contaminated central lines.