Intravascular catheter

Diagnostic studies should be performed to identify the source of infection, causative pathogen, and any complications (e.g., abscess, empyema, infected intravascular catheter, etc). 

Persistence of fever beyond 1 week may indicate ineffective antimicrobial therapy, emboli, infections of intravascular catheters, or drug reactions. In some patients, low-grade fever may persist even with appropriate antimicrobial therapy. 

Vancomycin and teicoplanin display excellent activity against staphylococci and streptococci, but because of the wide availability of equally effective and less toxic drugs, they are second-line drugs in the treatment of most infections. As antistaphylococcal agents they are less effective than 3-lactam cephalosporin antibiotics, such as nafciUin and cefazoUn. They have attained much wider use in recent years as a consequence of the emergence of methicUlin-resistant S. aureus (MRSA) infections, in particular the growing importance of Staphylococcus epidermidis infections associated with the use of intravascular catheters and in patients with peritonitis who are on continuous ambulatory peritoneal dialysis. 

Fig. 2.10. Head of the self-guided intravascular catheter (modified from [30]...

RF catheter ablation is complicated by thromboembolism in about 0.6% of patients (23). The risk of stroke from RF ablation may be higher in paroxysmal AF patients with prior TIA (24). As reflected by elevated plasma D-dimer levels, RF ablation has a thrombogenic effect that persists through the first 48 hours after the procedure (25). Activation of the coagulation cascade in RF ablation procedures is not related to the delivery of RF energy, but is related to the placement of intravascular catheters and to the duration of the ablation procedure (26,27). Furthermore, RF lesions themselves have been shown to be thrombogenic (28). The risk of a thromboembolic complication is higher for left-sided ablations... 

Topical antibiotics are typically available as ointments and are excellent for use on open wounds. Coupled with the antibacterial action of the antibiotic ingredient, topical antibiotic ointments provide a safe and effective option in wound healing. In addition, topical antibiotics are effective for the localized treatment of primary and secondary pyodermas with minimal systemic side effects.14 Prophylactic uses include application for traumatic and surgical wounds, burns, intravascular catheters, and eradication of S. aureus nasal carriage.16 42 The advantage of antibiotic therapy in the treatment of eczematous skin will be discussed in the following article considering AD as an example. 

The intravascular catheter, used on a routine basis to image arterial tissue, is an essential medical tool enabling the surgeon to identify disease type and to take appropriate steps to combat it, and the demand is for very large numbers (currently approximately 175000 p.a.). 

Fig. 6.36 The intravascular catheter (a) the phased array principle (b) a schematic of the catheter head (the guide-wire tube is 1.47mmo.d.). The catheter as a whole is passed through the artery along a pre-inserted guide-wire ((b) reproduced with permission of Jomed Inc.).

Lubricity. Outer-wall lubricity is particularly important for intravascular catheters, otherwise the endothelial layer of blood vessels is easily damaged by interventional insertion. Lubricity is usually acquired by coating with hydrogels or biopolymers. 

Inderbitzen B., Yon S., Lasheras J., Dobak J., Perl J., and Steinberg G. K. (2002) Safety and performance of a novel intravascular catheter for induction and reversal of hypothermia in a porcine model. Neurosurgery 50, 364—370. 

Benzyl alcohol is commonly used as a preservative in multidose injectable pharmaceutical formulations. For this purpose, concentrations in the range of 0.5-2.0% are used and the whole amount of benzyl alcohol injected is generally very well tolerated. Concentrations of 0.9% are used in Bacteriostatic Sodium Chlorine (USP), which is often used in the management of critically ill patients to flush intravascular catheters after the addition of medications or the withdrawal of blood, and in Sterile... 

Raad I, Hanna H. Intravascular catheters impregnated with antimicrobial agents a milestone in the prevention of bloodstream infections. Support Care Cancer 1999 7(6) 386-90. 

O Grady N P, Alexander M, Dellinger E P et al 2002 Guidelines for the prevention of intravascular catheter-related infections. Pediatrics 110 e51... 

Devices that contact circulating blood (intravascular catheters, temporary pacemaker electrodes, oxygenators, dialyzers,... 

Benzyl alcohol is a preservative that may be present in multidose vials of bacteriostatic sodium chloride and bacteriostatic water for injection and pharmaceuticals available in multidose vials for parenteral use. An association between the presence of benzyl alcohol in solutions used for flushing intravascular catheters and to reconstitute medications and a gasping syndrome and deaths in neonates was first reported in the early 1980s.The neonates also displayed clinical findings such as an elevated anion gap, metabolic acidosis, CNS depression, seizures, respiratory failure, renal and hepatic failures, cardiovascular collapse, and death. Those at highest risk were premature infants who weighted less... 

Many clinicians advocate early institution of empirical TV amphotericin B in patients with neutropenia and persistent (>5-7 days) fever. However, the potential toxicities (particularly nephrotoxicity) of this agent preclude its routine use in all patients. Suggested criteria for the empirical use of amphotericin B include (1) fever of 5 to 7 days duration that is umesponsive to antibacterial agents, (2) neutropenia of more than 7 days duration, (3) no other obvious cause for fever, (4) progressive debilitation, (5) chronic adrenal corticosteroid therapy, and (6) indwelling intravascular catheters. In patients who fail therapy with amphotericin B, hpid formulations of amphotericin B may be used (3-5 mg/kg per day). 

Physical assessment should include examination of all common sites of infection, including mouth/pharynx, nose and sinuses, respiratory tract, gastrointestinal tract, urinary tract, skin, soft tissues, perineum, and intravascular catheter insertion sites. 

Mermel LA, Farr BM, Sherertz RJ, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001 32 1249-1272. 

Cancer chemotherapy Dialysis (renal) Hyperalimentation Illicit drug use Intravascular catheters Organ transplantation Prosthetic heart valves Steroid therapy (high dose) Urinary catheters... 

Another inventionl l has described a method of producing a laminated composite for use as intravascular catheters such as angioplasty catheters (Fig. 6.60). In the first step, a parison was formed in a coextmsion of a multilayer sheet through a die. The parison was heated in a mold and drawn to several times its original length. Next, the parison was expanded radially to the desired dimension and strength. The exterior of the expander was coated... 

DA Redelmeier, NJ Livesley. Adhesive tape and intravascular-catheter-associated infections. J Gen Intern Med 14(6) 373-375, 1999. 

Raad, LI. and Hanna, H.A. 2002. Intravascular catheter-related infections. New horizons and recent advances. Arch Intern Med. 162 871-878. 

Raad, I., Hanna, H., and Maki, D. 2007. Intravascular catheter-related infections Advances in diagnosis, prevention, and management. Lancet Infect Dis. 1 645-657. 

The design of intravascular catheters requires special considerations related to the sterility and bio-compatibihty of the sensor. For example, intravascular fiberoptic sensors must be sterilizable and their material nonthrombogenic and resistant to platelet and protein deposition. Therefore, these catheters are typically made of materials covalently bound with heparin or antiplatelet agents. The catheter is normally introduced into a peripheral artery or vein via a cut-down and a slow heparin flush is maintained until the device is removed from the blood. 

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