Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection: a randomized, controlled trial
The placement of small tubes (central vascular catheters) deep within the blood vessels has become a standard procedure in the practice of emergency and critical care medicine. The use of central vascular catheters allows physicians to directly monitor blood pressure in the vessels and chambers of the heart. Samples of blood are easily withdrawn and medications such as chemotherapeutic agents can be given. One of the most serious complication of their use, however, is the colonization of bacteria and other microorganisms along the course of the catheter from the skin through the underlying tissues and into the vessel system. A new device for controlling such infections, a small collagen (protein) cuff that is impregnated with silver ions, has been used to surround the catheter at a location just below the skin in the subcutaneous tissue. In an experimental evaluation of this device, nearly 35 percent of patients who had central vascular catheters without the use of the cuff had microbial infections develop along the course of their catheters, whereas only 7.7 percent of patients in whom the cuff was used developed similar colonization of their catheter tract. Similarly, 13.8 percent of the control group (no cuff) developed blood-stream infections, while none of the patients in whom the cuff was installed developed this serious complication. Surprisingly, 75 percent of catheter infections were caused by the fungus Candida albicans, perhaps because of the choice of antibiotic, a polyantibiotic ointment, which did protect against these infections. A cost analysis of the routine use of these cuffs in the intensive care unit suggests that the use of these cuffs at a cost of $34.00 each could save over $84,000 in the elimination of 22 cases of blood-stream infections. The cuff was found to be easily inserted and was not associated with any adverse effects.
Publication Name: JAMA, The Journal of the American Medical Association
Predicting death in patients hospitalized for community-acquired pneumonia
Community-acquired pneumonia, which develops in outpatients, accounts for nearly 1 million cases of pneumonia each year, resulting in approximately 50,000 deaths. A study was done with 245 patients who were hospitalized with community-acquired pneumonia to determine if any physical findings or laboratory results might be predictive of high risk of death. Of the 245 patients studied, 20 (8.2 percent) died. The three factors that were found to be predictive of death, when all three were present, included a respiratory rate of more than 30 breaths per minute (normal respiratory rate averages 12 to 14 breaths per minute), a diastolic blood pressure (the lower number in a reading) of less than 60, and a blood urea nitrogen (BUN) of greater than 7. The BUN is a measure of kidney function, and can be elevated when the patient is dehydrated. If all three of these abnormalities were present in one patient, that patient had a nine-fold greater risk of death from pneumonia than in the absence of those abnormalities. The fact that these three factors might be predictors of death is not surprising, because each represents a serious physical abnormality. A rapid respiratory rate can indicate a low level of oxygen in the blood, or a high level of acid, or both. A low diastolic blood pressure indicates dehydration and depression of heart function. An elevated BUN can result from both dehydration and low blood pressure. Targeting pneumonia patients with all three of these abnormalities for rapid and aggressive therapy might reduce mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters
Catheter-associated infections may not be prevented by routine replacement of central vascular catheters every three days. Central vascular catheters are used in critically ill patients to administer fluids, nutrition and drugs. Among 160 patients who were catheterized for more than three days, 35 underwent catheter replacement at a new site every three days, 40 underwent guide wire-assisted catheter exchange at the same site every three days, 41 underwent catheter replacement at a new site only when necessary and 44 underwent guide wire-assisted catheter exchange only when necessary. Patients in all four groups had similar rates of bloodstream infection and bacterial colonization of the catheter. However, those who underwent catheter replacement at a new site were more likely to experience mechanical complications.
Publication Name: The New England Journal of Medicine
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