Subclavian catheter changes every third day in high risk patients

The subclavian catheter is commonly used in burn and trauma patients but remains a significant source of bacterial invasion in this group of seriously compromised individuals. The authors arbitrarily decided to change the catheter routinely every 3 days in consecutive patients to evaluate whether early detection of colonization and lowering of the infection rate was possible with this technique. At the time of change, catheter tips and central venous blood samples were sent for culture. Twenty-four venous blood samples were sent for culture. Twenty-four patients were studied in whom a total of 143 catheter changes over a wire introducer were performed. There were 20 men and four women with an average age of 34.5 years. Twenty patients with burns (average 48% body surface area involved), two patients with abdominal gunshot wounds, and two patients with complicated blunt trauma were studied. Five patients (three burns, two trauma) died, four because of sepsis, one of respiratory failure. Forty of the 143 catheter tips yielded positive cultures; however, 26 of these were not associated with overt sepsis. This 28 per cent incidence of positive catheter cultures was significantly less than the 47 per cent incidence reported previously in an identical patient population in whom the catheter was changed and cultured on clinical suspicion of sepsis (P value less than 0.001). There were 38 clinical episodes of sepsis, but the catheter could be implicated as the source in only five of these. Pseudomonas was the most common organism isolated from all sources. The authors conclude from this study that the incidence of positive catheters is significant in this high-risk group, but is decreased when the routine change protocol is implemented.(ABSTRACT TRUNCATED AT 250 WORDS)