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Jasmin Wagner Gernot Schilcher Ines Zollner‐Schwetz Martin Hoenigl Thomas Valentin Werner Ribitsch Joerg Horina Alexander R. Rosenkranz Andrea Grisold Matthias Unteregger Katharina Troppan Angelika Valentin Peter Neumeister Robert Krause 《European journal of clinical investigation》2013,43(9):964-969
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Dania Comparcini RN MSN Sonia Labeau MNSc PhD RN Stijn Blot MNSc PhD RN Gilda Pelusi RN MSN Pamela Di Giovanni MD 《Journal of clinical nursing》2014,23(17-18):2578-2588
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目的:了解中心静脉导管相关血行感染的相关因素和病原菌分布特点。方法:回顾性分析2012-01-2013-06收治ICU内行中心静脉置管患者的临床资料,对不同留置部位、留置时间的中心静脉导管感染率及病原菌分布进行分析。结果:不同留置部位、留置时间是CRBSI的独立危险因素,CRBSI与留置时间呈正相关(r=0.225,P〈0.01)。CRBSI的病原菌中革兰阳性菌(G+菌)、革兰阴性菌(G-菌)、真菌各占67.16%、26.87%、5.97%,以耐药菌为主。结论:规范CVC无菌操作,加强导管护理,缩短导管留置时间,加强病原学监测,是控制CRBSI发生的关键。 相似文献
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目的 探讨ICU患者发生导管相关性血流感染(catheter related bloodstream infection,CRBSI)的原因,并制订相应的对策.方法 回顾性分析2010年5月~2011年5月本院实施中心静脉置管治疗的患者751例,其中发生CRBSI 21例,分析发生的原因并制订相应的对策.结果 21例患者发生CRBSI的原因与操作流程不当、患者个体因素、导管的类型和材料、置管部位和时间等有关;其中2例患者进行了导管更换,4例拔除了导管,其余15例感染得到控制,病情稳定转出ICU,1例患者死亡.结论 ICU应制订完善的预防机制,对医护人员进行正规的置管培训,同时加强无菌观念,落实血管内导管的管理与监测,以保证患者的置管安全,预防CRBSI的发生. 相似文献
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Summary. Central venous catheters are extensively used in patients with cancer to secure delivery of chemotherapy and facilitate phlebotomy. Unfortunately, considerable morbidity can result from early complications or late sequelae, ranging from arterial puncture, pneumothorax and bloodstream infections to catheter‐related thrombosis (CRT). Contemporary studies have shown that the incidence of symptomatic CRT is ~ 5%, whereas the incidence of asymptomatic CRT is higher, at 14–18%. The significance and mechanisms of catheter design, material, insertion location and technique, position of the catheter tip and other risk factors in contributing to the development of CRT are not well understood. Efforts to reduce thrombotic complications, involving flushing the catheter with heparinized solutions, the use of heparin‐bonded catheters, and systemic anticoagulant prophylaxis, have been largely ineffective. More studies are needed to understand the pathophysiology of thrombotic complications, to help identify effective interventions to reduce this adverse outcome. 相似文献
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BackgroundIn adult Intensive Care Units, the complexity of patient treatment requirements make the use of central venous lines essential. Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters.AimIdentify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters.MethodsA systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion.ResultsNineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the ‘On the CUSP: Stop Blood Stream Infections' national programme.ConclusionsCentral venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection. 相似文献
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BACKGROUND:
Catheter-related infection (CRI) of the central vein is a common cause of nosocomial infection. This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit (EICU) in order to provide the beneficial reference.METHODS:
From January 2008 to December 2010, a total of 1 363 patients were subjected to catheterization. In these patients, the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:
CRI happened in 147 of the 1 363 patients using the central venous catheter. The peak rate of CRI was 10.79%, with an incidence of 3.05 episodes per 1 000 catheter days. Of the 147 patients, 46.94% had gram-negative bacilli, 40.14% had gram-positive cocci, and 12.92% had fungi. Unconditional logistic regression analysis suggests that multiple catheterization, femoral vein catheterization, the application of multicavity catheter, and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:
The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.KEY WORDS: Central venous, Cather related infection, Femoral vein catheter, Multiple lumen catheter, Long-term indwelling catheter, Long-term use of antibiotics, Emergency intensive care unit, Nosocomial infection 相似文献10.
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目的探讨肿瘤患者外周中心静脉置管(PICC)导管相关性感染的危险因素。方法 348例行PICC的肿瘤患者根据是否发生导管相关性感染分为感染组61例和对照组287例,回顾性分析2组患者临床资料,筛选导管相关性感染的危险因素。结果单因素分析表明,年龄、文化程度、病程、是否应用高营养化疗药物、是否应用激素、白细胞计数(WBC)、是否掌握PICC自我护理知识、置管部位、导管类型、留置时间及操作者的经验等因素均与导管相关性感染相关(P0.01),Logistic回归分析显示,静脉高营养、应用激素、PICC自我护理知识掌握不良、导管留置时间长、留置部位为股静脉、操作者经验少、WBC降低为PICC导管相关性感染的危险因素(P0.05或P0.01)。结论 PICC导管相关性感染受多重因素影响,临床应针对上述因素进行干预,预防导管相关性感染的发生。 相似文献
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血液透析患者导管感染原因分析与对策 总被引:1,自引:0,他引:1
目的分析血液透析患者留置导管感染的相关因素、常见致病菌,并探讨预防措施。方法对238例血液透析患者进行回顾性分析,观察置管方式、常见致病菌与导管相关性感染的关系。结果长期留置导管患者的感染率3.35例次/1 000导管日,明显低于临时留置导管患者的感染率9.22例次/1 000导管日,差异具有统计学意义(P0.05)。常见致病菌为金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌。结论血液透析护士严格无菌操作,并加强透析室环境及物品清洁消毒,可以减少导管相关性感染的发生。 相似文献
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W. SABER T. MOUA E. C. WILLIAMS M. VERSO G. AGNELLI S. COUBAN A. YOUNG M. DE CICCO R. BIFFI C. J. van ROODEN M. V. HUISMAN D. FAGNANI C. CIMMINIELLO M. MOIA M. MAGAGNOLI S. P. POVOSKI S. F. MALAK A. Y. LEE 《Journal of thrombosis and haemostasis》2011,9(2):312-319
Background: Knowledge of independent, baseline risk factors for catheter‐related thrombosis (CRT) may help select adult cancer patients who are at high risk to receive thromboprophylaxis. Objectives: We conducted a meta‐analysis of individual patient‐level data to identify these baseline risk factors. Patients/Methods: MEDLINE, EMBASE, CINAHL, CENTRAL, DARE and the Grey literature databases were searched in all languages from 1995 to 2008. Prospective studies and randomized controlled trials (RCTs) were eligible. Studies were included if original patient‐level data were provided by the investigators and if CRT was objectively confirmed with valid imaging. Multivariate logistic regression analysis of 17 prespecified baseline characteristics was conducted. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Results: A total sample of 5636 subjects from five RCTs and seven prospective studies was included in the analysis. Among these subjects, 425 CRT events were observed. In multivariate logistic regression, the use of implanted ports as compared with peripherally implanted central venous catheters (PICCs), decreased CRT risk (OR, 0.43; 95% CI, 0.23–0.80), whereas past history of deep vein thrombosis (DVT) (OR, 2.03; 95% CI, 1.05–3.92), subclavian venipuncture insertion technique (OR, 2.16; 95% CI, 1.07–4.34) and improper catheter tip location (OR, 1.92; 95% CI, 1.22–3.02), increased CRT risk. Conclusions: CRT risk is increased with use of PICCs, previous history of DVT, subclavian venipuncture insertion technique and improper positioning of the catheter tip. These factors may be useful for risk stratifying patients to select those for thromboprophylaxis. Prospective studies are needed to validate these findings. 相似文献
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危重症患者经皮穿刺中心静脉插管术后感染因素分析 总被引:4,自引:0,他引:4
目的:分析经皮穿刺中心静脉插管术后感染因素,探讨有效防治感染的对策。方法:将75例实施经皮穿刺中心静脉插管术的危重症患者根据导管留置时间分成3组:第1组(≤7天),第2组(8~14天),第3组(>14天)。根据导管类型分为单腔中心静脉导管组及多腔中心静脉导管组。分别观察其术后感染发生率。结果:第1组、第2组和第3组术后感染发生率分别为2.86%,17.20%和54.50%,均存在显著性差异(P均<0.05)。其中应用单腔、多腔中心静脉导管术后感染率分别12.1%及19.0%,无显著性差异(P>0.05)。结论:引起经皮穿刺中心静脉插管术后感染的因素,以寄生于穿刺伤口局部皮肤的微生物沿导管向体内迁移所致的术后感染最多见。随着导管留置时间的延长,其感染发生率相应增加;中心静脉导管留置时间以不超过7天为宜,需长期留置者,应及时更换导管。 相似文献
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Sevgen Tanır Basaranoglu Eda Karadag-Oncel Kubra Aykac Yasemin Ozsurekci Ahmet Emre Aycan Ali Bulent Cengiz Ates Kara Mehmet Ceyhan 《Journal of infection and chemotherapy》2018,24(1):25-30
Background
Catheter related blood stream infections (CRBSI) are mostly preventable hospital-acquired conditions. We aimed to investigate the value of presepsin in detection of CRBSI in hospitalized children.Methods
Hospitalized pediatric patients who had clinical suspicion of CRBSI were followed. Results of peripheral blood cultures and blood cultures from central venous catheters, procalcitonin (PCT), C-reactive protein (CRP), total white blood cell (WBC) counts were recorded. Serum samples for presepsin were studied at the same time with the samples of healthy controls. The patients with positive blood cultures were defined as proven CRBSI and with negative cultures as suspected CRBSI.Results
Fifty-eight patients and 80 healthy controls were included in the study. Proven CRBSI group consisted of 36 patients (62%) with positive blood cultures and compared with the suspected CRBSI group (n = 22, 36%) with negative culture results. There was no difference between proven and suspected CRBSI groups concerning WBC, PCT, CRP and presepsin. Presepsin was significantly higher in patient groups when compared with healthy controls. The receiver operating characteristic curve area under the curve was 0.98 (%95 CI: 0.97–1) and best cut-off value was 990 pg/ml.Conclusion
In hospitalized pediatric patients with CRBSI, presepsin may be a helpful rapid marker in early diagnosis. 相似文献17.
Nisha Parbat Norelle Sherry Rinaldo Bellomo Antoine G Schneider Neil J Glassford Paul DR Johnson Michael Bailey 《Critical care (London, England)》2013,17(5):R184
Introduction
The management of suspected central venous catheter (CVC)-related sepsis by guide wire exchange (GWX) is not recommended. However, GWX for new antimicrobial surface treated (AST) triple lumen CVCs has never been studied. We aimed to compare the microbiological outcome of triple lumen AST CVCs inserted by GWX (GWX-CVCs) with newly inserted triple lumen AST CVCs (NI-CVCs).Methods
We studied a cohort of 145 consecutive patients with GWX-CVCs and contemporaneous site-matched control cohort of 163 patients with NI-CVCs in a tertiary intensive care unit (ICU).Results
GWX-CVC and NI-CVC patients were similar for mean age (58.7 vs. 62.2 years), gender (88 (60.7%) vs. 98 (60.5%) male) and illness severity on admission (mean Acute Physiology and Chronic Health Evaluation (APACHE) III: 71.3 vs. 72.2). However, GWX patients had longer median ICU lengths of stay (12.2 vs. 4.4 days; P < 0.001) and median hospital lengths of stay (30.7 vs. 18.0 days; P < 0.001). There was no significant difference with regard to the number of CVC tips with bacterial or fungal pathogen colonization among GWX-CVCs vs. NI-CVCs (5 (2.5%) vs. 6 (7.4%); P = 0.90). Catheter-associated blood stream infection (CA-BSI) occurred in 2 (1.4%) GWX patients compared with 3 (1.8%) NI-CVC patients (P = 0.75). There was no significant difference in hospital mortality (35 (24.1%) vs. 48 (29.4%); P = 0.29).Conclusions
GWX-CVCs and NI-CVCs had similar rates of tip colonization at removal, CA-BSI and mortality. If the CVC removed by GWX is colonized, a new CVC must then be inserted at another site. In selected ICU patients at higher central vein puncture risk receiving AST CVCs GWX may be an acceptable initial approach to line insertion. 相似文献18.
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A nurse–family partnership intervention to increase the self‐efficacy of family caregivers and reduce catheter‐associated urinary tract infection in catheterized patients
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Kwo‐Chen Lee RN PhD Yann‐Fen C Chao RN PhD Yueh‐Mien Wang RN Diploma Pi‐Chu Lin RN EdD 《International journal of nursing practice》2015,21(6):771-779
The purpose of this study was to evaluate the effects of a nurse–family partnership model on the self‐efficacy of family caregivers (FCs) and the incidence of catheter‐associated urinary tract infection (CAUTI) among patients. A randomized controlled study was conducted. We recruited 61 patients and their FCs, who were randomly divided into an experimental group (n = 30) and a control group (n = 31). In the experimental group, the main caregivers comprised a nurse–family partnership, whereas the control participants received routine care. The findings were as follows: (i) the incidence of CAUTI was lower in the experimental group than in the control group (20% vs. 38.8%), but the difference was not statistically significant; and (ii) no significant difference emerged for reported Caregiver Self‐Efficacy Score between the two groups. The nursing team and FCs must become partners in cooperative caregiving to enhance the quality of patient care. 相似文献