Letters

Central venous catheters and infection

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7159.683 (Published 05 September 1998) Cite this as: BMJ 1998;317:683

Surveillance is effective in reducing catheter related sepsis

  1. E T Curran, Senior nurse infection control.,
  2. M Booth, Consultant anaesthetist.,
  3. J Hood, Consultant microbiologist.
  1. Royal Infirmary, Glasgow G4 0SF
  2. Departments of Medical Microbiology and Intensive Care, District General Hospital, Eastbourne, East Sussex BN21 2UD
  3. Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DY mcnabernau@enterprise.net
  4. Wycombe General Hospital, Buckinghamshire HP11 2TT
  5. University Hospital Birmingham NHS Trust, Birmingham B15 2TH

    EDITOR—We would like to comment on Cyna et al's survey of various intensive care units with regard to their policy on the routine replacement of central venous catheters.1 We agree with the Hospital Infection Control Practices Advisory Committee, which recommends that central venous catheters should not be routinely replaced.2 Cyna et al recommend that surveillance of catheter related infection be undertaken and the results expressed as catheter related infections in the bloodstream per 1000 catheter days. We recently showed that this surveillance is effective in reducing episodes of catheter related sepsis and can take as little as two hours a month.3

    If other intensive care units used similar surveillance programmes then not only could catheter related sepsis be reduced but the efficacy of other traditional practices could be assessed. Furthermore, the necessity and efficacy of new equipment for central lines could be monitored.

    References

    Routine replacement of central venous catheters should be retained

    1. R P D Cooke,
    2. N A Watson,
    3. K Myerson,
    4. R S Umasankar,
    5. J Cook
    1. Royal Infirmary, Glasgow G4 0SF
    2. Departments of Medical Microbiology and Intensive Care, District General Hospital, Eastbourne, East Sussex BN21 2UD
    3. Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DY mcnabernau@enterprise.net
    4. Wycombe General Hospital, Buckinghamshire HP11 2TT
    5. University Hospital Birmingham NHS Trust, Birmingham B15 2TH

      EDITOR—The audit of routine replacement of central venous catheters in British intensive care units by Cyna et al1 and the accompanying editorial by O'Leary and Bihari assume that the evidence for recommending a no-change policy is soundly based. It is not.

      The American Hospital Infection Control Practice Advisory Committee recommends that non-tunnelled central venous catheters should not be routinely replaced as a method of preventing catheter related sepsis and cites three articles supporting this.2 Two compared a change of catheter when indicated with routine guidewire exchange at day 3 and described similar rates of sepsis. Since the incidence of sepsis increases with duration of catheterisation,3 it is not surprising that a three day policy is practised by a only minority of British intensive …

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