Prevention and Treatment of Central Venous Catheter Sepsis by Exchange via a Guidewire

Abstract

A new approach for preventing and treating sepsis due to central venous catheter (CVC) was devised at the Istituto Nazionale Tumori of Milan [Italy]. A prospective protocol was developed that includes the weekly exchange of the CVC via a guidewire as well as its exchange when a CVC-related sepsis is suspected. Growth of microorganisms on the tip of the CVC is defined as contamination if peripheral blood culture is negative and as sepsis if it is positive for the same microorganism. Colonization simply means growth of microorganism independently of the results of peripheral blood culture. CVC (207) (64 polyvinyl chloride and 143 rubber silicone) were evaluated in 62 patients, for a total of 170 exchanges. The incidence of colonization and sepsis was 33.8 and 4.8%, respectively, a rate which is not significantly differnt from the values found in 81 historical controls (30.8 and 11.1%). The sepsis rate was reduced strongly during the 1st mo. of observation (0 vs. 11.9%; P = 0.01); in the 2nd mo., it was similar in both groups (15 vs. 7.1%). Of the colonized CVC, 3/4 became negative after the 1st exchange and virtually all were negative at the 4th exchange. All of the episodes of sepsis resolved spontaneously with the CVC exchange. Apparently, this procedure is without risk for CVC cross contamination, is effective in the treatment of contaminated CVC and of septic patients without any interruption of total parenteral nutrition and can reduce the incidence of CVC sepsis during the 1st mo. of total parenteral nutrition. Caution must be used concerning the possible onset of pulmonary embolism in patients with subclavian venous thrombosis, since a transient pulmonary embolism occurred in one of the patients. With the use of silastic CVC, which are less thrombogenic than polyvinyl ones, the rate of pulmonary embolism due to blind exchange (without previous venography) is estimated to be 0.1%-0.2%.