CRBSI comparison by VAD type

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Intravenous literature: Trerotola, S.O., Patel, A.A., Shlansky-Goldberg, R.D., Solomon, J.A., Mondschein, J.I., Stavropoulos, S.W., Soulen, M.C., Itkin, M. and Chittams, J. (2010) Short-term infection in cuffed versus noncuffed small bore central catheters: a randomized trial. Journal of Vascular & Interventional Radiology. 21(2), p.203-11.

Abstract:

PURPOSE: To determine if a polyester cuff offered benefit in jugular small-bore central catheters (SBCCs).

MATERIALS AND METHODS: Eighty-four patients were randomly assigned to receive a 5-F single- or 6-F dual-lumen SBCC with (n = 42) or without (n = 42) a polyester cuff. Follow-up was performed at 2 weeks, 1 month, and 3 months or at catheter removal, whichever came first. At scheduled follow-up, catheter function, patient satisfaction, and infection were determined. At catheter removal, tip culture was performed to determine colonization and jugular vein patency was determined with ultrasonography (US).

RESULTS: The overall infection rate was 0.4 per 1,000 catheter days. There was one clinical infection (noncuffed catheter). Colonization occurred in two noncuffed catheters and one cuffed catheter. There was one catheter dislodgment in the noncuffed group and none in the cuffed group. Cuffed catheters were no more difficult to insert but took slightly longer to remove (6 minutes +/- 4.7 vs 5 minutes +/- 3, P = .39) and often required local anesthesia for removal, whereas noncuffed catheters did not (41% vs 0%, P = .001). Partial (two cuffed, 0 noncuffed) or complete (two cuffed, one noncuffed) jugular thrombosis was seen on five of 58 completion US studies (8.6%).

CONCLUSIONS: A polyester cuff on a SBCC confers no significant benefit in short-term colonization rates. Infection in SBCCs is uncommon. Despite their small diameters, SBCCs can result in jugular thrombosis, an important consideration in any patient requiring long-term venous access.


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