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Incidence of infection related to arterial catheterization in children: a prospective study
F M Ducharme1, M Gauthier, J Lacroix
1Pediatric Intensive Care Unit, Hôpital Sainte-Justine, Montreal, Quebec, Canada.
Insights
In critically ill children, arterial catheterization rarely leads to infection. This study found no infections despite not changing catheter components, suggesting routine interventions may be unnecessary.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Vascular access device management
Background:
- Arterial catheterization is common in critically ill children.
- Infection risk associated with arterial catheters in this population is not well-established.
- Systematic catheter cultures are needed to accurately assess infection incidence.
Purpose of the Study:
- To determine the incidence of infection related to arterial catheterization in critically ill children.
- To evaluate the predictive value of local inflammation for catheter tip infection.
- To assess the necessity of routine interventions like catheter component changes.
Main Methods:
- Prospective study of 68 children with 70 arterial catheters.
- Aseptic insertion, no routine component changes.
- Daily inspection for local inflammation.
- Semiquantitative catheter tip cultures upon removal.
- Blood and fluid cultures if sepsis suspected.
Main Results:
- Mean catheterization duration was 59 +/- 6 hours.
- All catheter and infusion fluid cultures were negative.
- Local inflammation did not predict catheter tip infection (r = 0.2).
- No significant correlation between inflammation and catheter duration.
Conclusions:
- The incidence of arterial catheter-related infection in critically ill children appears low.
- Routine changes of infusion fluid, tubing, dressing, and insertion site are likely unwarranted.
- Systematic catheter cultures are not indicated in the absence of fever.
Abstract:
The incidence of infection related to arterial catheterization has not been studied in critically ill children, using systematic catheter cultures. We studied prospectively 68 children in whom 70 arterial catheters were inserted. After the aseptic catheterization procedure, no component of the system was changed. The insertion site was inspected daily for signs of inflammation. Upon removal, catheters were cultured using a semiquantitative method. Blood and infusion fluid specimens were also cultured if septicemia was clinically suspected. Mean duration of catheterization was 59 +/- 6 (SE) h. In our series, all catheter and infusion fluid cultures were negative. Local inflammation was not predictive of catheter tip infection and correlated poorly with duration of catheterization (r = 0.2). In our experience, the incidence of infection related to arterial catheterization is low. Routine change of infusion fluid, tubing, dressing and insertion site as well as systematic catheter culture in the absence of fever appears unwarranted.