RT Book, Section
A1 Conly, J. M.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2291204
T1 Chapter 50. Infectious Complications of Intravascular Access Devices
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accesssurgery.mhmedical.com/content.aspx?aid=2291204
RD 2023/05/31
AB Intravascular  access  device–associated  infections  may  be  either  local  or  bacteremic,  and  the  risk  of  developing  an  infection  varies  with  the  patient  population,  the  type  of  device,  the  microbe,  and  the  patient-microbe-device  interaction.The  status  of  all  indwelling  vascular  access  devices  should  be  reviewed  daily  by  the  critical  care  team,  with  attention  to  the  duration  of  placement,  appearance  of  the  exit  site,  and  continued  clinical  indication  for  the  intravascular  device.Central  venous  catheters  account  for  over  90%  of  all  intravascular  device–related  bacteremias.Most  intravascular  device–related  bacteremias  are  caused  by  endogenous  skin  flora  at  the  catheter  insertion  site  that  migrate  along  the  transcutaneous  portion  of  the  catheter  with  subsequent  colonization  of  the  catheter  tip.Coagulase-negative  staphylococci  and  Staphylococcus  aureus  account  for  just  over  50%  of  all  intravascular  device–related  bacteremias,  followed  in  frequency  by  gram-negative  bacilli  and  yeast.Diagnosis  of  intravascular  device–related  infection,  either  local  or  bacteremic,  is  best  approached  using  a  combination  of  clinical  and  laboratory  criteria.Although  treatment  of  central  line  infections  due  to  coagulase-negative  staphylococci  may  be  successful  without  catheter  removal,  infections  caused  by  S.  aureus  necessitate  catheter  removal.Central  intravascular  catheter  infections  are  essentially  preventable  infections.  Successful  prevention  entails  attention  to  a  careful  needs  assessment  for  the  device,  careful  site  selection,  maximal  barrier  precautions  and  aseptic  technique  on  insertion,  insertion  by  the  most  skilled  operators,  rigorous  catheter-site  care,  and  interrupting  the  integrity  of  the  system  as  little  as  possible.