Daily interruption of central venous catheters in critically ill ICU patients

Introduction

ICU patients require a central venous catheter (CVC) for solutions, and drug administration, transfusions of blood and blood products as well. The purpose of the study was to investigate the frequency of daily interruptions of CVC in critically ill patients. Catheter-related blood stream infections, especially due to Staphylococcus epidermidis, may be related to hand manipulation of the CVC during catheter interruptions.

Materials and methods

We included 20 critically ill patients having more than 14 days of hospitalization. We retrospectively recorded the number of catheter interruptions per 8-hour shift and then per 24 hours. We totally collected 500 catheter-days. Patients were grouped according to APACHE II score (group A ≥ 15 and group B < 15) on admission.

Results

The mean ICU stay was 26.4 ± 3.7 days. Illness severity on admission was SAPS II score 52.9 ± 0.4, APACHE II score 20.9 ± 0.2 and TISS 34.2 ± 0.2. Daily interruption is presented in Table 1.

Table 1

Group A had a statistically significant higher (P < 0.05) number of CVC interruptions per day. During the study we recorded 16 acquired positive blood cultures (eight Staphylococcus species, four S. epidermidis) and 13 positive catheter tips (four Staphylococcus species, two S. epidermidis). We confirmed five catheter-related infections (0.5% of catheter-days), which is within CDC guidelines.

Conclusions

Each patient is subjected to a significant number of CVC interruptions per day, which could be related to blood stream infections and specifically to S. epidermidis due to hand manipulations during CVC interruptions.