WhatsNewinthe2011GuidelineforPreventingCatheter.pptVIP

Prevention and Management of Catheter Related Infections What’s New in the 2011 Guideline for Preventing Catheter Related BSI? Naomi P. O’Grady, MD Critical Care Medicine Department National Institutes of Health I have no disclosures. Objectives Highlight some areas of controversy, including catheter site selection, antimicrobial locks, and chlorhexidine impregnated sponge dressings Discuss the recommendations in the updated guideline Outline some of the data to support the new recommendations Site Selection Old Recommendation Use a subclavian site (rather than a jugular or a femoral site) in adult patients to minimize infection risk for non-tunneled CVC placement Site Selection Rather than focus on one specific site to select, we now focus on one specific site to avoid. Avoid the femoral vein for central venous access in adults Femoral site associated with greater risk of infection and DVT Catheter Complications Randomized patients to femoral (145) vs subclavian (144) 8 ICU’s; 3 years Mechanical complications similar in both groups Infection and thrombosis higher in femoral group Femoral vs Jugular Catheterization 375 patients in each arm over a 3 year period Primary endpoint was colonization on removal Insertion complications, CR-BSI, and thrombosis were secondary endpoints Mechanical Complications Jugular catheters: longer insertion times, more failed attempts and more crossover Arterial punctures no different (5.1% vs 3.6%), although hematoma formation higher in jugular 2 patients required intubation in jugular group 1 patient required vascular surgery for carotid artery insertion 1 patient with acute leg ischemia required limb amputation Old Recommendation Disinfect clean skin with an appropriate antiseptic. A chlorhexidine-based preparation with 2% is preferred. Alternatively, tincture of iodine, an iodophor, or 70% alcohol could be used. New Recommendation Disinfect clean skin with an appropriate antiseptic. A chlorhexidine-based pr