Simultaneous placement of long-term central venous catheters and surgical debridement for treatment of osteomyelitis

Nonhealing wounds with underlying osteomyelitis require surgical debridement and a course of intravenous antibiotics usually via long-term venous catheter. Fear of catheter infection resulting from bacteremia or direct cross-contamination has traditionally led to staged procedures. A protocol for simultaneous placement of a long-term central venous catheter (Hickman) for antibiotic therapy and surgical debridement of chronic wounds with osteomyelitis does not result in elevated catheter-related infections. We conducted a prospective consecutive trial at a community-based tertiary-care training hospital. From October 1995 through June 1997 100 consecutive patients received 105 central venous catheters and surgical debridement for treatment of chronic wounds with underlying osteomyelitis at the same operative setting. Four catheters required removal because of infectious complications. There was no correlation between the bacteria cultured from the central venous line or blood cultures and the wound cultures. Combining placement of long-term central venous catheters and surgical debridement of chronic wounds with osteomyelitis at one operative setting results in an acceptably low catheter infection rate.