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Silicone elastomer catheter for chronic vascular access
M Haid1, S A Lipschultz, A Caughron
1Department of Medicine, Evanston Hospital, Northwestern University Medical School, Illinois.
Insights
Silicone elastomer central venous catheters offer safe and reliable venous access, with a low infection rate of 3.18%. These catheters are suitable for outpatient use, enhancing cost-effectiveness.
Area of Science:
- Medical Devices
- Infectious Diseases
- Vascular Access
Background:
- Central venous catheters (CVCs) are essential for long-term venous access.
- Silicone elastomer catheters are widely used due to their biocompatibility and flexibility.
- Assessing the safety and efficacy of CVCs is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the complication and infection rates of silicone elastomer central venous catheter insertions.
- To determine the most effective methods for diagnosing catheter-related infections.
- To assess the duration of service and cost-effectiveness of these catheters.
Main Methods:
- Retrospective review of 157 consecutive silicone elastomer CVC insertions.
- Analysis of complication rates, including insertion-related issues and catheter removal reasons.
- Evaluation of diagnostic methods for catheter-related bacterial infection, comparing peripheral blood cultures, catheter blood cultures, and insertion site cultures.
Main Results:
- A low insertion complication rate of 1.91% with no need for chest tube drainage.
- A bona fide infection rate of 3.18% (1 infection per 2,544 patient days).
- Catheter blood cultures and insertion site cultures were more predictive of contamination than peripheral blood cultures.
Conclusions:
- Silicone elastomer central venous catheters are safe and dependable for venous access.
- The infection rate is low, supporting their use in clinical practice.
- Outpatient insertion is feasible, offering a cost-effective alternative for patient care.
Abstract:
The Evanston and Glenbrook Hospitals' series of 157 consecutive silicone elastomer central venous catheter insertions is reviewed. The total experience was 12,721 patient days (34.85 patient years). The complication rate of insertion was 1.91%, but no patient required chest tube drainage. Seven catheters clotted and could not be salvaged. Seventeen catheters were removed for suspected bacterial infection. Peripheral blood culture was not predictive of catheter tip contamination, while culture of blood drawn through the catheter and insertion site cultures proved most useful. Five bona fide infections were documented for an infection rate of 3.18%. This corresponds to one infection per 2,544 patient days (6.97 patient years). The mean duration of service of the catheter was 81 days with a median of 36 days. The longest duration was 707 days. The silicone elastomer catheter provides safe, dependable venous access for most patients and may be inserted in an outpatient and therefore cost-effective setting.