Sepsis intravenous catheter

Side effects, such as headache and jaw pain, are observed, but the major drawbacks with epoprostenol therapy relate to its delivery. Epoprostenol has an extremely short half-life in the blood (2-3 min) and therefore must be administered by continuous intravenous infusion via a surgically implanted central vein catheter. This can lead to complications such as local infections, sepsis, or catheter-associated thrombosis. In addition, interruption of therapy due, for example, to pump failure can lead to a life-threatening rebound of symptoms. The compound itself is unstable at room temperature and must be stored in the refrigerator. Despite these severe drawbacks, i.v. epoprosenol remains a useful treatment for patients presenting with WHO class IV PAH. The problems with epoprostenol have led to the development of alternative agents. 

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. 

Vancomycin is the drug of choice against serious infections caused by methicihin-resistant strains of Staphylococcus aureus and coagulase-negative staphylococci [172]. It may also be used for treatment of infections by gram-positive organisms in penicillin-intolerant patients. Vancomycin has been extensively used to treat endocarditis caused by streptococci, enterococci and staphylococci. The empiric treatment of intravenous catheter sepsis and hemodialysis vascular access infection by vancomycin has led to a linear increase in its use in the last decade [173]. Oral vancomycin is efficacious in the treatment of Corynebacterium difficile-mediated diarrhea. Of major concern is the recent emergence of vancomycin-resistant enterococcus strains [174,175]. 

The infected patient, whether locally infected at the site of introduction of the intravenous catheter, as in a burn, or with disseminated sepsis, as in diverticulitis, is, in theory, at added risk from septicemia. In these patients there is a marked increase in the possible sources of line contamination. This particular aspect has not markedly increased our own incidence of line-related... 

A wide variety of infectious complications may develop after transplantation (Fig. 6.1.4). During the neutropenic period, fever appears in practically all patients. The causative pathogens are usually Gram positive cocci entering the body through the intravenous catheter or as a consequence of severe oral mucositis. Gram-negative sepsis may also oc-... 

Intravenous epoprostenol increases exercise tolerance, improves pulmonary hemodynamics, and improves survival in patients with primary pulmonary hypertension. However, there are limitations to intravenous administration, and a significant proportion of patients develop catheter-related problems, such as thrombosis, pump failure, and catheter-related sepsis. In an attempt to improve delivery, several trials of aerosolized prostacyclin have been undertaken, primarily in patients with primary pulmonary hypertension. 

Initial studies of continuous intravenous prostacyclin infusion in patients with primary pulmonary hypertension have shown sustained improvement in pulmonary artery pressure, exercise capacity, and survival compared with historical controls (31,32). Minor complications (diarrhea, jaw pain, flushing, photosensitivity, and headache) were dose-related. Serious complications were related to problems with the drug delivery system, including catheter thrombosis, sepsis, and temporary interruption of the infusion, resulting in abrupt deterioration (31). 

One infant died of Candida Sepsis on the 5th day of infusion no other catheter complications were encountered. Three other infants died from causes unrelated to the intravenous alimentation. 

Cultures of blood, burn wound, and urine were routinely taken every three days. When signs of sepsis existed, standard cultures were taken, nutritional fluid was cultured, and the entire intravenous administration apparatus was replaced down to the catheter. 

A two year old girl with 90% third degree burns survived. She had received central hyperalimentation for a period of two months. When catheter sepsis continued to be a major problem, she was treated by peripheral alimentation using 10% Intralipid, Aminofusin 600 and the hypertonic carbohydrate solution for a period of four weeks. This allowed intravenous provision of calories to 2,500 calories per square meter body surface per day. Her infection was controlled with the change from central to peripheral venous alimentation. Three other patients who were treated only with peripheral alimentation showed no evidence of infection that could be related to the intravenous therapy. 

The association of duration of catheterization, with the incidence of catheter positive sepsis has been widely debated. Some believe duration to be a factor (14,18,22,31), and others do not (10,44). The latter group believe that the catheter is contaminated at the time of introduction. In our experience (Table 4) duration does appear to be a factor. The ability of the nutritive solutions to support bacterial and fungal growth is now well established (12, 14,43). Candida albicans will grow particularly well in casein hydrolysates with dextrose, and in intravenous soy bean fat emulsions. 

A 41-year-old Caucasian man presenting sudden unconsciousness, tachyarrhythmia and fever of 40 °C was referred to the ICU. Sepsis was suspected and intravenous antibiotics were initiated. Liver failure was diagnosed but patient started to recover slowly. On day 23, a culture of a central venous catheter tip was positive with Candida glabrata. Anidulafundin was started with... 

Powell DA, Aungst J, Snedden S, Hansen N, Brady M. Broviac catheter-related Malassezia furfur sepsis in five infants receiving intravenous fat emulsions. J Pediatr 1984 105 987-990. 

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