Each year, more than 5 million central venous catheters are inserted in patients in the United States. Types of catheters are listed in Table 71–1. A substantial proportion of these are used in children for delivery of intravenous fluids, total parenteral nutrition, antibiotics, and chemotherapy. Infectious complications occur in 5–26% of all patients with central venous catheters. According to data reported to the National Nosocomial Infection Surveillance System (NNIS) between 1992 and 2003, the pooled mean catheter-associated bloodstream infection (CA-BSI) rate in pediatric intensive care unit patients was 7.3/1000 catheter days.1 Rates in neonatal intensive care units (NICUs) ranged from 3.7/1000 catheter days in infants with birth weights >2500 g to 10.6/1000 catheter days in infants with birth weights <1000 g. In addition to patient factors such as immunosuppression and prematurity, longer duration of catheter use,2 use of multiple central lines,3 dialysis,2 extracorporeal membrane oxygenation therapy,2 total parenteral nutrition,4 mechanical ventilation,5 and receipt of packed red blood cell transfusion6 are all associated with increased risk of infection. In premature infants, duration of intravenous lipid use has been associated with coagulase-negative staphylococci (CoNS) bacteremia and fungemia.7
Table 71–1. Types of Central Catheters |Favorite Table|Download (.pdf)
Table 71–1. Types of Central Catheters
Subclavian, jugular, femoral veins
For short-term intravenous therapy, typically less than 21 d
Subclavian, jugular, and femoral veins
Broviac, Hickman, Groshong; can remain in place for months to years
Subclavian or internal jugular
“Infusaport” or “port”; can remain in place for months to years
Percutaneously inserted central catheter (PICC)
Peripheral vein in the arm, leg or scalp; terminates in central vein
Commonly used for outpatient therapy; can remain in place for weeks to months
Umbilical artery or vein
Used in neonates
Umbilical artery catheters should not be used >5 d
Umbilical venous catheters can be used up to 14 d
Types of catheter-associated infection are listed in Table 71–2. Various definitions have been proposed for central venous catheter-associated bloodstream infection (CVC-BSI), including catheter-related BSI (CR-BSI) and catheter-associated BSI. CR-BSI—a BSI attributable to the catheter—is often difficult to diagnose in children because obtaining a peripheral culture is not always feasible and catheters are often not removed for diagnostic purposes because of the difficulty of inserting another catheter. Therefore, CA-BSI—a BSI in the context of a catheter—is a practical definition used in many children's hospitals. This definition is also used for nosocomial infection surveillance.
Table 71–2. Types of Central Catheter-Related Infection |Favorite Table|Download (.pdf)
Table 71–2. Types of Central Catheter-Related Infection
Local infection (in the absence of concomitant bloodstream infection)
Exit site infection
Erythema or induration within 2 cm of the the catheter exit site
Tenderness, erythema, or induration within 2 cm of the subcutaneous tract of a tunneled catheter
Purulent fluid in the subcutaneous pocket of a totaled implanted vascular catheter with or ...
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