Central venous catheters chlorhexidine

Amikacin has been tested for compatibility with a chlorhexidine-bearing central venous catheter, the ARROWg+ard Blue Plus, and did not cause a substantial increase in chlorhexidine delivery (15). The amount of amikacin sulfate that was delivered was slightly less than the amount in the infusion solution (92%), but this was considered acceptable. 

Xu QA, Zhang Y, Trissel LA, Gilbert DL. Adequacy of a new chlorhexidine-bearing polyurethane central venous catheter for administration of 82 selected parenteral drugs. Ann Pharmacother 2000 34(10) 1109-16. 

Stephens R, Mythen M, Kahis P, Davies DW, Egner W, Rickards A. Two episodes of hfe-threatening anaphylaxis in the same patient to a chlorhexidine-sulphadiazine-coated central venous catheter. Br J Anaesth 2001 87(2) 306-8. 

Local hypersensitivity reactions to chlorhexidine-impregnated patches occur in neonates (49). In a randomized comparison of povidone-iodine and a chlorhexidine gluconate impregnated dressing for the prevention of central venous catheter infections in neonates, the risk of local contact dermatitis limited the use of the chlorhexidine dressing (50). 

However, although randomized studies have failed to show an association between hypersensitivity reactions and chlorhexidine-impregnated central venous catheters, there have been reports of anaphylaxis after insertion of these catheters (SEDA-22, 262) (56,57), and two life-threatening episodes of anaphylaxis in the same patient were attributed to a central venous catheter that had been impregnated with chlorhexidine and sulfadiazine (58). 

In a 51-year-old man, two episodes of pronounced, refractory cardiovascular collapse accompanied the insertion of a chlorhexidine-coated central venous catheter (59). Sensitivity to chlorhexidine was not at first suspected, but 5 months later, a skin prick test with chlorhexidine resulted in a characteristic sustained wheal and flare response, strongly suggesting IgE-mediated sensitivity. The patient subsequently underwent uneventful surgery following strict avoidance of chlorhexidine exposure. 

Terazawa E, Shimonaka H, Nagase K, Masue T, Dohi S. Severe anaphylactic reaction due to a chlorhexidine-impregnated central venous catheter. Anesthesiology 1998 89(5) 1296-8. 

Anaphylactic shock occurs rarely with sulfonamides (160,169,170,178,179). Anaphylaxis to a central venous catheter (ARROWg+ard Blue Catheter) coated with chlorhexidine and sulfadiazine has been reported in a... 

Infection risk Catheter-related bloodstream infections pose a significant problem for hospitalized patients. In a randomized comparison in 960 patients of 5-fiuoruracil or chlorhexidine-I-silver sulfadiazine as central venous catheter coatings, 5-fluorouracil was non-inferior to chlorhexidine-b silver sulfadiazine with respect to the incidence of catheter colonization (2.9% versus 5.3%) [ll ]. Local site infections occurred in 1.4% with 5-fluoruracil and 0.9% with chlorhexidine + silver sulfadiazine. There were no episodes of catheter-related bloodstream infections with 5-fluoruracil but two episodes with chlorhexidine + silver sulfadiazine. The incidence of adverse events was low and comparable in the two groups. 

Walz JM, Avelar RL, Longtine KJ, Carter KL, Mermel LA, Heard SO. Anti-infective external coating of central venous catheters a randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonization. Crit Care Med 2010 38(11) 2095-102. 

Bach A. Clinical studies on the use of antibiotic- and antiseptic-bonded catheters to prevent catheter-related infection. Zentralbl Bakteriol December 1995 283(2) 208-14. Greenfeld JI, Sampath L, Popilskis SJ, et al. Decreased bacterial adherence and biofilm formation on chlorhexidine and silver sulfadiazine-impregnated central venous catheters implanted in swine. Crit Care Med May 1995 23(5) 894-900. 

Ostendorf T, Meinhold A, Harter C, et al. Chlorhexidine and silver-sulfadiazine coated central venous catheters in haematological patients-a double-blind, randomised, prospective, controlled trial. Support Care Cancer December 2005 13(12) 993-1000. 

Observational studies The use of chlorhexidine in bathing patients has been studied in an evaluation of the effects on the rates of infections associated with central venous catheters in patients in coronary care units [11 ]. On one 70-bedded unit all consecutive patients admitted during 9 months received daily baths with 2% chlorhexidine. Infections in central venous catheters were compared with infections before and after... 

Immunologic Three cases of occupationally exposed workers with airway allergy to chlorhexidine were described [33 ]. A patient experienced anaphylaxis due to chlorhexidine delivered through multiple routes including a central venous catheter with chlorhexidine coating [34 ]. Three cases of anaphylaxis were caused by the insertion of central venous catheters impregnated with chlorhexidine [35 ]. Two further cases of anaphylaxis during urinary catheterisation with the aid of chlorhexidine gel lubrication were reported [36, 37 ]. 

Serious life-threatening anaphylaxis occurred in a patient receiving a central venous catheter impregnated with chlorhexidine... 

Guleri A, Kumar A, Morgan R]M, Hartley M, Roberts DH. Anaphylaxis to chlorhexidine-coated central venous catheters a case series and review of the literature. Surg Infect Larchmt 2012 13(3) 171. ... 

Faber M, Leysen J, Bridts C, Sabato V, E)e Clerck LS, Ebo DG. AUergy to chlorhexidine beware of the central venous catheter. Acta Anaesthe-siol Belg 2012 63(4) 191-4. 

Employ maximal sterile barrier precautions. Use aseptic techniques including the use of a cap, mask, sterile gown, sterile gloves, and a large sterile sheet for the insertion of all central venous catheters (CVCs). Use 2% chlorhexidine gluconate solution for skin sterilization at the CVC insertion site. Avoid the femoral site for nonemergency CVC insertion and ensure prompt removal of unnecessary catheters. 

Impregnated intravenous catheters Chlorhexidine-coated catheters have been developed in the hope of reducing the incidence of central venous line sepsis. Package inserts warn that these should not be used in individuals who are thought to be sensitive to chlorhexidine. 

It is possible that the potential benefit of reducing the incidence of central venous sepsis by using chlorhexidine-coated catheters is outweighed by the risk of sudden and profound anaphylaxis. Certainly a high degree of suspicion of chlorhexidine allergy shonld be exercised and skin tests performed. 

Rupp ME, Lisco SJ, Lipsett PA, et al. Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections a randomized, controlled trial. Ann Intern Med October 2005 143(8) 570-80. Darouiche RO, Raad II, Bodey GP, et al. Antibiotic susceptibility of staphylococcal isolates from patients with vascular catheter-related bacteremia potential role of the combination of minocycline and rifampin. Int J Antimicrob Agents September 1995 6(l) 31-6. 

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