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LETTER TO THE EDITOR

Intravascular Catheter-Associated Infection

Critical Care and Anaesthesia; New Cross Hospital; Wolverhampton, United Kingdom; Nilesh.Parekh{at}rwh-tr.nhs.uk

To the Editor:

As physicians involved in the care of critically ill patients, we are always aware of the risk of nosocomial infections, particularly central venous catheter (CVC)-related sepsis. We read with great anticipation the recent paper by Zurcher et al. (1) on colonization and bloodstream infection with CVC. The authors have said the conclusions are based on limited data and suggested use of single-lumen catheters whenever feasible. However, our recent audit (Table 1) of 38 multilumen catheters in 31 critically ill patients carried out prospectively over 30 days shows that it may not be feasible to use single-lumen catheters in patients who are admitted to level 3 critical care facilities in a typical acute district general hospital in the United Kingdom.

The three most common reasons (95% of total) for insertion of CVC in our audit are listed in Table 2. In all of these situations, multilumen catheters are indicated. In 5%, CVC was primarily inserted for CVP assessment in perioperative care, however, anesthesiologists have preferred multilumen CVC, particularly if the patient is expected to receive postoperative ICU care. This will provide easy and rapid venous access for drugs, fluids, and supplemental nutrition, especially if peripheral venous access has been unreliable or difficult. We also found that up to 10% of CVC are inserted on the wards as part of resuscitation process. Once again multilumen catheters are used in anticipation that the patient will need CVP monitoring and drugs (e.g., amiodarone) that can be safely infused via CVC.

In our audit we encountered difficulties in reliable data capture on many confounding factors such as skills and performance of the operators, use of aseptic methods, and the number of punctures before successful placement. Considering that 71% lines were inserted either as an emergency or urgent, largely by trainee doctors under noticeable time pressure, we believe accounting for above mentioned confounding factors is vital, but we may not be able to capture these data consistently and reliably. Underpinning this, there is need for continuous education and more funding to develop a culture of real-time data collection in critical care medicine.

Reference

1. Zurcher M, Tramer MR, Walder B. Colonization and bloodstream infection with single-versus multi-lumen central venous catheters: a quantitative systematic review. Anesth Analg 2004;99:177–82.[Abstract/Free Full Text]

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