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A randomized trial on the effect of tubing changes on hub contamination and catheter sepsis during parenteral
Abstract:
In previous studies the contamination of the catheter hub was found to be a common portal of entry for bacteria causing catheter-related sepsis. Since hub manipulations during tubing changes may increase the risk of contamination, a prospective trial was conducted to find out the effects of the frequency of tubing replacements on hub colonization and catheter sepsis rates. The results were compared with those obtained during an outbreak of coagulase negative staphylococci septicemia. Fifty-two patients were randomly allocated into two groups. Group A (n = 20) had the line changes every 2 days while group B (n = 32) had it replaced every 4 days. When the catheter was removed, the catheter tip and the hub were cultured by a quantitative method. Sterile, colonized, or infected hubs were equally distributed in both groups (A: 80, 15, and 5% vs B: 84, 6, and 10%). There were three episodes of catheter sepsis, one in group A and one in group B due to hub infection, and one in group B due to hematogenous seeding of the catheter tip. There were significant (p less than 0.001) differences between the trial and the historic series in respect to rates of hub colonization infection (19 vs 50%) and catheter sepsis (5.7 vs 40%). Delaying tubing changes does not increase catheter sepsis or hub contamination rates and, together with adequate hub protection, has proved to be a valuable factor in controlling an outbreak of catheter sepsis due to the coagulase negative staphylococci.
Insights
Changing central venous catheter tubing less frequently (every 4 days) does not increase catheter-related sepsis or hub contamination. This finding, combined with proper hub protection, helps control sepsis outbreaks.
Area of Science:
- Infectious Diseases
- Medical Devices
- Clinical Trials
Background:
- Catheter hub contamination is a primary cause of catheter-related sepsis.
- Frequent manipulation during tubing changes may elevate contamination risks.
Purpose of the Study:
- To evaluate the impact of tubing replacement frequency on hub colonization and catheter sepsis.
- To compare findings with historical data from a coagulase-negative staphylococci outbreak.
Main Methods:
- A prospective trial randomized 52 patients into two groups: 2-day (Group A) and 4-day (Group B) tubing replacements.
- Quantitative cultures of catheter tips and hubs were performed post-removal.
- Results were compared to historical data from a sepsis outbreak.
Main Results:
- Hub colonization and infection rates were similar between the 2-day and 4-day replacement groups.
- Catheter sepsis rates were significantly lower in the trial groups (5.7%) compared to historical data (40%).
- Hub colonization infection rates were also significantly lower in the trial (19%) versus historical (50%) data.
Conclusions:
- Less frequent tubing changes (every 4 days) do not increase catheter sepsis or hub contamination.
- Adequate hub protection and less frequent tubing changes are effective in controlling catheter-related sepsis outbreaks.