Intravascular catheters are used
for a wide range of adjunctive therapies in pediatric patients,
such as administering total parenteral nutrition and chemotherapy
and facilitating blood drawing. For the purposes of discussing complication risks
and preventive strategies, these catheters can be subdivided into
short-term, intermediate-term, and long-term devices. Approaches
to catheter device placement and care that prevent infection are
discussed in Chapters 34 and 107.
The pathogenesis of bloodstream infections for both short-, intermediate-,
and long-term devices includes migration of potential pathogens from
the skin at the exit site along the external surface of the catheter
to the catheter tip, intraluminal migration of organisms from the
catheter hub, contaminated infusates, and rarely, seeding of the
catheter hematogenously from a distant focus.1 The
true incidence of bowel translocation of microorganisms with subsequent
seeding of the catheter is unknown, but this is proposed as a potential
mechanism of catheter-related bloodstream infections (CR-BSI) in
patients with dysfunctional bowel. Short-term and intermediate-term,
noncuffed, nontunneled catheters are more prone to migration of
organisms along the external surface of the catheter, and as a result they
are infected by a greater proportion of skin flora including coagulase
negative staphylococci and Staphylococcus aureus.2-5 Long-term, cuffed,
tunneled catheters are less likely to be infected by organisms along
the external catheter surface because the cuff acts as a fibrotic
dam to migration. The definitions of different types of catheter-related
infections are presented in Table 239-1.
Table 239-1. Definitions of Catheter-Related
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Table 239-1. Definitions of Catheter-Related
|Catheter-related bloodstream infection (CR-BSI)||Patient has a recognized pathogen cultured from one or more
blood cultures and organism cultured from blood is not related to
an infection at another site or patient has at least one of the
following signs or symptoms: fever (> 38°C), chills, or hypotension
and signs and symptoms and positive laboratory results are not related
to an infection at another site.a|
|Colonized catheter||Growth of ⩾ 15 colony-forming units (semiquantitative) or
> 103 (quantitative) from a proximal or distal
catheter segment without accompanying signs or symptoms of infection|
|Exit site infection||Erythema, tenderness, induration, or purulence within 2 cm
of the exit site of the catheter|
|Tunnel infection||Erythema, tenderness, induration in the tissues overlying
the catheter and > 2 cm from the exit site|
|Pocket infection||Erythema and necrosis of the skin over the reservoir of a
totally implantable device or purulent exudate in the pocket containing
the device reservoir|
|Infusate-related bloodstream infection||Isolation of the same organism from the infusate and from
a peripheral blood culture with no other identifiable source of
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