Introduction Parenteral nutrition (PN) via a central venous catheter (CVC) is associated with risk of thrombosis and catheter-related bloodstream infection (CRBSI). Factors believed to reduce the risk of infection include using a tunnelled CVC or peripherally inserted central catheter (PICC), and using a single lumen CVC where possible. A CVC tip above the mid-section of the superior vena cava increases thrombosis risk.1 Strict aseptic technique is required to prevent CRBSI.
Methods Between 1st January and 31st December 2011 patients transferred to the St Mark's Intestinal Failure Unit with a CVC in situ for PN were assessed. We recorded CVC type, number of lumens, and CVC tip position (see Abstract OC-035 figure 1: dashed lines (mid & proximal superior vena cava (SVC), brachiocephalic, subclavian & internal jugular veins) & solid lines (distal third SCV, proximal & distal right atrium). CVC tip position in the dashed region is associated with a higher thrombosis risk (Cadman et al).1 Blood cultures were taken from all lumens of the CVC. CVCs with bacteraemia were treated with antibiotics. If a CVC was felt to be unusable it was removed. Reasons included tip position, multiple lumens, unsuitable for long-term use (not PICC or tunnelled), or for use by patient (PICC), CVC-related sepsis, CRBSI at risk of seeding (S aureus or fungus), and >1 CVC in situ.
Results 60 patients with 65s CVC from other centres were transferred. Some patients were admitted more than once. 24 were female and 36 were male, from 41 English Hospitals & two from Kuwait. 21 CVCs were tunnelled, 22 untunnelled, 21 were PICCs and one was a midline. Results are summarised in Abstract OC-035 table 1. 32(48%) CVCs had a tip that was too high, increasing thrombosis risk. 32% (21/65) of blood cultures were positive. 12 (18%) CVCs were retained and used. 13 (20%) were removed because of discontinuation of PN. 38 (58%) of CVCs were replaced.
Conclusion This data demonstrates that on transfer patients CVCs are often infected, have a tip that is too high and multi-lumen CVCs are placed inappropriately. Reasons may include lack of attention to aseptic technique, lack of awareness of the thrombosis risk from a high CVC tip, and lack of availability of single lumen tunnelled CVCs as stock.
Competing interests None declared.
Reference 1. Cadman A, Lawrance JAL, Fitzsimmons L, et al. To clot or not to clot? That is the question in central venous catheters. Clin Radiol 2004;59:349–55.