Central venous catheter sepsis with weekly catheter change in paediatric burn patients: an analysis of 221 catheters.
To document the risk of catheter sepsis associated with central venous catheter changes every 7 days in paediatric burn patients, and analysis of data collected prospectively on 234 such catheters was performed. During an 18-month period there were 301 acutely burned children admitted to a regional paediatric burn facility of whom 53, with an average burn size of 42 per cent TBSA, required 234 central venous catheters. A central venous catheter management protocol was followed which included catheter changes every 7 days. If insertion sites were clean and uninflamed, catheters were replaced by guidewire and the original catheter tip was semiquantitatively cultured. Catheters were replaced to a new site if insertion sites appeared inflamed or catheter tips grew 15 or more colony forming units. Overall, 3.2 per cent (10.9 per cent by Centers for Disease Control definition) of central venous catheters were associated with sepsis. When catheters were replaced by guidewire from one to three times, catheter sites were used for a mean of 15.6 days without an increased rate of line sepsis. There was no difference in sepsis rates between catheters placed at a new site or replaced by guidewire. There were no deaths attributed to catheter-related sepsis. We conclude that a protocol allowing for catheter change to a new site, or replacement by guidewire, every 7 days was associated with a low risk of catheter sepsis in paediatric burn patients.
Sheridan
R L
RL
Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston, USA.
Weber
J M
JM
Peterson
H F
HF
Tompkins
R G
RG
D000208:Acute Disease; D002056:Burns / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D004866:Equipment Contamination; D006801:Humans; D015993:Life Tables; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology*; D013234:Stem Cells; D013997:Time Factors; D014946:Wound Infection / Q000453:epidemiology / Q000382:microbiology*