Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Abstract

The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections' prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2- adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.

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     Tsuji BT, Pogue JM, Zavascki AP, Paul M, Daikos GL, Forrest A, et al. International Consensus Guidelines for the Optimal Use of the Polymyxins: endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). Pharmacotherapy. 2019;39(1):10-39.

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     Khatib R, Clark JA, Briski LE, Wilson FM. Relevance of culturing Candida species from intravascular catheters. J Clin Microbiol. 1995;33(6):1635-1637.

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     Leenders NHJ, Oosterheert JJ, Ekkelenkamp MB, De Lange DW, Hoepelman AIM, Peters EJG. Candidemic complications in patients with intravascular catheters colonized with Candida species: an indication for preemptive antifungal therapy? Int J Infect Dis IJID. 2011;15(7):e453-e458.

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     Malanoski GJ, Samore MH, Pefanis A, Karchmer AW. Staphylococcus aureus catheter-associated bacteremia. Minimal effective therapy and unusual infectious complications associated with arterial sheath catheters. Arch Intern Med. 1995;155(11):1161-1166.

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     Stryjewski ME, Szczech LA, Benjamin DK, Inrig JK, Kanafani ZA, Engemann JJ, et al. Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis-dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia. Clin Infect Dis. 2007;44(2):190-196.

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     Kim S-H, Kim K-H, Kim H-B, Kim N-J, Kim E-C, Oh M, et al. Outcome of vancomycin treatment in patients with methicillin-susceptible Staphylococcus aureus bacteremia. Antimicrob Agents Chemother. 2008;52(1):192-197.

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     Comparative effectiveness of nafcillin or cefazolin versus vancomycin in methicillin-susceptible Staphylococcus aureus bacteremia · 2011

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     Leonard SN, Rybak MJ. Evaluation of vancomycin and daptomycin against methicillin-resistant Staphylococcus aureus and heterogeneously vancomycin-intermediate S. aureus in an in vitro pharmacokinetic/pharmacodynamic model with simulated endocardial vegetations. J Antimicrob Chemother. 2009;63(1):155-160.

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     Marco F, de la Mària CG, Armero Y, Amat E, Soy D, Moreno A, et al. Daptomycin is effective in treatment of experimental endocarditis due to methicillin-resistant and glycopeptide-intermediate Staphylococcus aureus. Antimicrob Agents Chemother. 2008;52(7):2538-2543.

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     Fowler VG, Boucher HW, Corey GR, Abrutyn E, Karchmer AW, Rupp ME, et al. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med. 2006;355(7):653-665.

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     Gasch O, Camoez M, Dominguez MA, Padilla B, Pintado V, Almirante B, et al. Predictive factors for mortality in patients with methicillin-resistant Staphylococcus aureus bloodstream infection: impact on outcome of host, microorganism and therapy. Clin Microbiol Infect. 2013;19(11):1049-1057.

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     Chaftari A-M, Hachem R, Mulanovich V, Chemaly RF, Adachi J, Jacobson K, et al. Efficacy and safety of daptomycin in the treatment of Gram-positive catheter-related bloodstream infections in cancer patients. Int J Antimicrob Agents. 2010;36(2):182-186.

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     Wilcox MH, Tack KJ, Bouza E, Herr DL, Ruf BR, Ijzerman MM, et al. Complicated skin and skin-structure infections and catheter-related bloodstream infections: noninferiority of linezolid in a phase 3 study. Clin Infect Dis. 2009;48(2):203-212.

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     Crowley AL, Peterson GE, Benjamin DK, Rimmer SH, Todd C, Cabell CH, et al. Venous thrombosis in patients with short- and long-term central venous catheter-associated Staphylococcus aureus bacteremia. Crit Care Med. 2008;36(2):385-390.

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     Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2008;133(6 Suppl):454S-545S.

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     Jones MA, Lee DY, Segall JA, Landry GJ, Liem TK, Mitchell EL, et al. Characterizing resolution of catheter-associated upper extremity deep venous thrombosis. J Vasc Surg. 2010;51(1):108-113.

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     Falagas ME, Vardakas KZ, Athanasiou S. Intravenous heparin in combination with antibiotics for the treatment of deep vein septic thrombophlebitis: a systematic review. Eur J Pharmacol. 2007;557(2–3):93-98.

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     Verghese A, Widrich WC, Arbeit RD. Central venous septic thrombophlebitis–the role of medical therapy. Medicine (Baltimore). 1985;64(6):394-400.

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     Malinoski DJ, Ewing T, Patel MS, Nguyen D, Le T, Cui E, et al. The natural history of upper extremity deep venous thromboses in critically ill surgical and trauma patients: what is the role of anticoagulation? J Trauma. 2011;71(2):316-321.

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     Visscher M, deCastro MV, Combs L, Perkins L, Winer J, Schwegman N, et al. Effect of chlorhexidine gluconate on the skin integrity at PICC line sites. J Perinatol. 2009;29(12):802-807.

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     Loewenthal M, Dobson P, Boyle M. Chlorhexidine 2% and choice of transparent dressing increase skin reactions at central venous catheter insertion sites. Am J Infect Control. 2016;44(12):1712-1714.

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     Breschan C, Platzer M, Jost R, Stettner H, Beyer A-S, Feigl G, et al. Consecutive, prospective case series of a new method for ultrasound-guided supraclavicular approach to the brachiocephalic vein in children. Br J Anaesth. 2011;106(5):732-737.

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     Breschan C, Platzer M, Jost R, Stettner H, Feigl G, Likar R. Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in infants: a retrospective analysis of a case series. Paediatr Anaesth. 2012;22(11):1062-1067.

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     Nardi N, Wodey E, Laviolle B, De La Brière F, Delahaye S, Engrand C, et al. Effectiveness and complications of ultrasound-guided subclavian vein cannulation in children and neonates. Anaesth Crit Care Pain Med. 2016;35(3):209-213.

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     Camkiran Firat A, Zeyneloglu P, Ozkan M, Pirat A. A randomized controlled comparison of the internal jugular vein and the subclavian vein as access sites for central venous catheterization in pediatric cardiac surgery. Pediatr Crit Care Med. 2016;17(9):e413-e419.

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     Karapinar B, Cura A. Complications of central venous catheterization in critically ill children. Pediatr Int. 2007;49(5):593-599.

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     Habas F, Baleine J, Milési C, Combes C, Didelot M-N, Romano-Bertrand S, et al. Supraclavicular catheterization of the brachiocephalic vein: a way to prevent or reduce catheter maintenance-related complications in children. Eur J Pediatr. 2018;177(3):451-459.

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     Lu W-H, Yao M-L, Hsieh K-S, Chiu P-C, Chen Y-Y, Lin C-C, et al. Supraclavicular versus infraclavicular subclavian vein catheterization in infants. J Chin Med Assoc JCMA. 2006;69(4):153-156.

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     Byon H-J, Lee G-W, Lee J-H, Park Y-H, Kim H-S, Kim C-S, et al. Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous catheterization in children’a randomized trial. Br J Anaesth. 2013;111(5):788-792.

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     Casado-Flores J, Barja J, Martino R, Serrano A, Valdivielso A. Complications of central venous catheterization in critically ill children. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2001;2(1):57-62.

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     Gray BW, Gonzalez R, Warrier KS, Stephens LA, Drongowski RA, Pipe SW, et al. Characterization of central venous catheter-associated deep venous thrombosis in infants. J Pediatr Surg. 2012;47(6):1159-1166.

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     Chauhan S, Saxena N, Mehrotra S, Rao BH, Sahu M. Femoral artery pressures are more reliable than radial artery pressures on initiation of cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2000;14(3):274-276.

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     Cho HJ, Lee SH, Jeong IS, Yoon NS, Ma JS, Ahn BH. Differences in perioperative femoral and radial arterial blood pressure in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass. J Pediatr (Rio J). 2018;94(1):76-81.

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     Shin YH, Kim HY, Kim YR, Yoon JS, Ko JS, Gwak MS, et al. The comparison of femoral and radial arterial blood pressures during pediatric liver transplantation. Transplant Proc. 2013;45(5):1924-1927.

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     Cetin S, Pirat A, Kundakci A, Camkiran A, Zeyneloglu P, Ozkan M, et al. Radial mean arterial pressure reliably reflects femoral mean arterial pressure in uncomplicated pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2014;28(1):76-83.

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     Brotschi B, Hug MI, Latal B, Neuhaus D, Buerki C, Kroiss S, et al. Incidence and predictors of indwelling arterial catheter-related thrombosis in children: arterial thrombosis in children. J Thromb Haemost. 2011;9(6):1157-1162.

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     Leyvi G, Taylor DG, Reith E, Wasnick JD. Utility of ultrasound-guided central venous cannulation in pediatric surgical patients: a clinical series. Paediatr Anaesth. 2005;15(11):953-958.

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     RECANVA collaborative study, Oulego-Erroz I, González-Cortes R, García-Soler P, Balaguer-Gargallo M, Frías-Pérez M, et al. Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children. Intensive Care Med. 2018;44(1):61-72.

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     Lau CSM, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. 2016;80(2):178-184.

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     Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig PLJ, Easley KA, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit*. Crit Care Med. 2009;37(3):1090-1096.

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     Anantasit N, Cheeptinnakorntaworn P, Khositseth A, Lertbunrian R, Chantra M. Ultrasound versus traditional palpation to guide radial artery cannulation in critically ill children: a randomized trial. J Ultrasound Med. 2017;36(12):2495-2501.

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     Aouad-Maroun M, Raphael CK, Sayyid SK, Farah F, Akl EA. Ultrasound-guided arterial cannulation for paediatrics. Cochrane Database Syst Rev. 2016;9:CD011364.

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     Siddik-Sayyid SM, Aouad MT, Ibrahim MH, Taha SK, Nawfal MF, Tfaili YJ, et al. Femoral arterial cannulation performed by residents: a comparison between ultrasound-guided and palpation technique in infants and children undergoing cardiac surgery. Pediatr Anesth. 2016;26(8):823-830.

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     Gilbert RE, Mok Q, Dwan K, Harron K, Moitt T, Millar M, et al. Impregnated central venous catheters for prevention of bloodstream infection in children (the CATCH trial): a randomised controlled trial. Lancet. 2016;387(10029):1732-1742.

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249. 249.

     Weber JM, Sheridan RL, Fagan S, Ryan CM, Pasternack MS, Tompkins RG. Incidence of catheter-associated bloodstream infection after introduction of minocycline and rifampin antimicrobial-coated catheters in a pediatric burn population. J Burn Care Res. 2012;33(4):539-543.

     Not in our library10.1097/bcr.0b013e31823c4cd5

250. 250.

     Chelliah A, Heydon KH, Zaoutis TE, Rettig SL, Dominguez TE, Lin R, et al. Observational trial of antibiotic-coated central venous catheters in critically ill pediatric patients. Pediatr Infect Dis J. 2007;26(9):816-820.

     Not in our library10.1097/inf.0b013e318123e8bf

251. 251.

     Cox EG, Knoderer CA, Jennings A, Brown JW, Rodefeld MD, Walker SG, et al. A randomized, controlled trial of catheter-related infectious event rates using antibiotic-impregnated catheters versus conventional catheters in pediatric cardiovascular surgery patients. J Pediatr Infect Dis Soc. 2013;2(1):67-70.

     Not in our library10.1093/jpids/pis066

252. 252.

     Biasucci DG, Pittiruti M, Taddei A, Picconi E, Pizza A, Celentano D, et al. Targeting zero catheter-related bloodstream infections in pediatric intensive care unit: a retrospective matched case-control study. J Vasc Access. 2018;19(2):119-124.

     Not in our library10.5301/jva.5000797

253. 253.

     Düzkaya DS, Sahiner NC, Uysal G, Yakut T, Çitak A. Chlorhexidine-impregnated dressings and prevention of catheter-associated bloodstream infections in a pediatric intensive care unit. Crit Care Nurse. 2016;36(6):e1-e7.

     Not in our library10.4037/ccn2016561

254. 254.

     Gerçeker GÖ, Yardımcı F, Aydınok Y. Randomized controlled trial of care bundles with chlorhexidine dressing and advanced dressings to prevent catheter-related bloodstream infections in pediatric hematology-oncology patients. Eur J Oncol Nurs. 2017;28:14-20.

     Not in our library10.1016/j.ejon.2017.02.008

255. 255.

     Garland JS, Alex CP, Mueller CD, Otten D, Shivpuri C, Harris MC, et al. A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics. 2001;107(6):1431-1436.

     Not in our library10.1542/peds.107.6.1431

256. 256.

     Hatler C, Buckwald L, Salas-Allison Z, Murphy-Taylor C. Evaluating central venous catheter care in a pediatric intensive care unit. Am J Crit Care. 2009;18(6):514-520.

     Not in our library10.4037/ajcc2009168

257. 257.

     Onder AM, Chandar J, Coakley S, Francoeur D, Abitbol C, Zilleruelo G. Controlling exit site infections: does it decrease the incidence of catheter-related bacteremia in children on chronic hemodialysis? Hemodial Int Int Symp Home Hemodial. 2009;13(1):11-18.

     Not in our library10.1111/j.1542-4758.2009.00348.x

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.