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Chapter 20 : Preventive Strategies for Intravascular Catheter-Related Infections

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Abstract:

Millions of intravascular catheters are purchased each year by hospitals and clinics, placing many patients at risk for serious catheter-related infections. This chapter summarizes the rapidly expanding body of literature concerning prevention of intravascular catheter-related infections in the hope of reducing the risk posed to present and future patients. Prophylaxis with vancomycin or teicoplanin during central venous catheter insertion does not reduce the incidence of catheter-related bloodstream infection. The addition of prophylactic vancomycin to flush solutions or total parenteral nutrition solutions significantly reduces the incidence of catheter-related bloodstream infection; however, use of systemic antimicrobial agents to prevent intravascular catheter-related infections is not recommended. Administering very low doses of warfarin reduces thrombosis due to long-term central venous catheters. Use of prophylactic heparin by bolus infusion or when it is added to intravenous solutions does not significantly reduce the risk of central venous catheter-related bloodstream infection. Prophylactic heparin significantly reduces the incidence of catheter-related central venous thrombosis in patients with central venous and pulmonary artery catheters. A number of different strategies can be used to prevent serious intravascular catheter-related infections.

Citation: Mermel L. 2000. Preventive Strategies for Intravascular Catheter-Related Infections, p 407-425. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch20

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Figure 1

The I System hub designed to prevent catheter-related bloodstream infection.

Citation: Mermel L. 2000. Preventive Strategies for Intravascular Catheter-Related Infections, p 407-425. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch20
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Image of Figure 2
Figure 2

The Segur Lock hub designed to prevent catheter-related bloodstream infection.

Citation: Mermel L. 2000. Preventive Strategies for Intravascular Catheter-Related Infections, p 407-425. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch20
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Tables

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Table 1

Efficacy of systemic antimicrobial prophylaxis during central venous catheter insertion in prevention of catheter-related infections

Citation: Mermel L. 2000. Preventive Strategies for Intravascular Catheter-Related Infections, p 407-425. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch20
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Table 2

The efficacy of chlorhexidine-containing cutaneous antiseptics in the prevention of central venous, pulmonary artery, and peripheral arterial catheter-related infections

Citation: Mermel L. 2000. Preventive Strategies for Intravascular Catheter-Related Infections, p 407-425. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch20
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Table 3

Risk of central venous, pulmonary artery, and peripheral arterial catheter infection with use of gauze and transparent dressings

Citation: Mermel L. 2000. Preventive Strategies for Intravascular Catheter-Related Infections, p 407-425. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch20
Generic image for table
Table 4

Efficacy of the chlorhexidine-silver sulfadiazine-impregnatcd central venous catheters in the prevention of catheter-related infections

Citation: Mermel L. 2000. Preventive Strategies for Intravascular Catheter-Related Infections, p 407-425. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch20
Generic image for table
Table 5

Recommendations for the prevention of intravascular catheter-related infections

Citation: Mermel L. 2000. Preventive Strategies for Intravascular Catheter-Related Infections, p 407-425. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch20

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