Central venous catheters and infection
Authors: E T Curran, M Booth, J Hood, R P D Cooke, N A Watson, K Myerson, R S Umasankar, J Cook, F. Bernau, T J Dexter, T. Elliott, M. Faroqui
Journal: BMJ (1998)

# Surveillance is effective in reducing catheter related sepsis {#article-title-2} EDITOR—We would like to comment on Cyna et al's survey of various intensive care units with regard to their policy on the routine replacement of central venous catheters.1 We agree with the Hospital Infection Control Practices Advisory Committee, which recommends that central venous catheters should not be routinely replaced.2 Cyna et al recommend that surveillance of catheter related infection be undertaken and the results expressed as catheter related infections in the bloodstream per 1000 catheter days. We recently showed that this surveillance is effective in reducing episodes of catheter related sepsis and can take as little as two hours a month.3 If other intensive care units used similar surveillance programmes then not only could catheter related sepsis be reduced but the efficacy of other traditional practices could be assessed. Furthermore, the necessity and efficacy of new equipment for central lines could be monitored. 1. ↵1. Cyna AM, 2. Hovenden JL, 3. Lehmann A, 4. Rajaseker K, 5. Kalia P . Routine replacement of central venous catheters: telephone survey of intensive care units in mainland Britain. BMJ 1998; 316: 1944–1945. (27 June.) [OpenUrl][1][FREE Full Text][2] 2. ↵1. Hospital Infection Control Practices Advisory Committee . Part II: Recommendations for the prevention of nosocomial intravascular device-related infections. Am J Infect Control 1996; 24: 277–293. [OpenUrl][3][PubMed][4] 3. ↵1. Curran ET, 2. Booth MG, 3. Dickson L, 4. Lockhart M, 5. Hood J . Catheter related sepsis in an ICU. Eighth annual meeting of the Society of Healthcare Epidemiology of America (SHEA). Orlando: SHEA, 1998 [Abstract S7.] # Routine replacement of central venous catheters should be retained {#article-title-5} EDITOR—The audit of routine replacement of central venous catheters in British intensive care units by Cyna et al1 and the accompanying editorial by O'Leary and Bihari assume that the evidence for recommending a no-change policy is soundly based. It is not. The American Hospital Infection Control Practice Advisory Committee recommends that non-tunnelled central venous catheters should not be routinely replaced as a method of preventing catheter related sepsis and cites three articles supporting this.2 Two compared a change of catheter when indicated with routine guidewire exchange at day 3 and described similar rates of sepsis. Since the incidence of sepsis increases with duration of catheterisation,3 it is not surprising that a three day policy is practised by a only minority of British intensive … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DCyna%26rft.auinit1%253DA%2BM%26rft.volume%253D316%26rft.issue%253D7149%26rft.spage%253D1944%26rft.epage%253D1945%26rft.atitle%253DRoutine%2Breplacement%2Bof%2Bcentral%2Bvenous%2Bcatheters%253A%2Btelephone%2Bsurvey%2Bof%2Bintensive%2Bcare%2Bunits%2Bin%2Bmainland%2BBritain%26rft_id%253Dinfo%253Apmid%252F9641930%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=316/7149/1944&atom=%2Fbmj%2F317%2F7159%2F683.atom [3]: {openurl}?query=rft.jtitle%253DAmerican%2Bjournal%2Bof%2Binfection%2Bcontrol%26rft.stitle%253DAm%2BJ%2BInfect%2BControl%26rft.volume%253D24%26rft.issue%253D4%26rft.spage%253D277%26rft.epage%253D293%26rft.atitle%253DGuideline%2Bfor%2Bprevention%2Bof%2Bintravascular%2Bdevice-related%2Binfections.%2BPart%2BII.%2BRecommendations%2Bfor%2Bthe%2Bprevention%2Bof%2Bnosocomial%2Bintravascular%2Bdevice-related%2Binfections.%2BHospital%2BInfection%2BControl%2BPractices%2BAdvisory%2BCommittee.%26rft_id%253Dinfo%253Apmid%252F8870911%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=8870911&link_type=MED&atom=%2Fbmj%2F317%2F7159%2F683.atom