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A semiquantitati ve culture method for identifying intravenous-ca theter-related infection: N Engl J Med, Vol. 296, No. 23. (9 June 1977), pp. 1305-1309.We evaluated a semiquantitati ve culture technic for identifying infection due to intravenous catheters: rolling the catheter segment across blood agar. This method was compared to broth culture. Of 250 catheters studied, 225 (90%) had low-density colonization on semiquantitati ve culture (less than 15 colonies on the plate) although 49 (19.6%) of these grew some organisms in broth or on the plate. None of these catheters led to septicemia. Twenty-five catheters (10%) grew greater than or equal to 15 colonies by the semiquantitati ve technic; most gave confluent growth. Septicemia originated from four of these catheters (P = 0.008). Of 37 catheters exposed to bacteremias from distant foci of infection, four yielded matching growth in broth, whereas none were concordant with the blood isolate on semiquantitati ve culture. Local inflammation was associated with high-density colonization semiquantitati ve culture (P less than 0.001). The semiquantitati ve technic distinguishes infection (greater than or equal to 15 colonies) from contamination and is more specific in diagnosis of catheter-relat ed septicemia than culture of the catheter in broth.DG Maki, CE Weise, HW Sarafin

Source: N Engl J Med, Vol. 296, No. 23. (9 June 1977), pp. 1305-1309.
368: Central Line Emergency Access Registry: A Multi-Center Study to Determine Resident Competency With Central Venous Catheter Insertion: Annals of Emergency Medicine, Vol. 50, No. 3, Supplement 1. (September 2007), S115.A Balls, F Lovecchio, S Stapczynski

Source: Annals of Emergency Medicine, Vol. 50, No. 3, Supplement 1. (September 2007), S115.
Clear Central Line Emergency Access Registry: A Multi-Center Study to Determine Resident Competency in Placement of Central Venous Catheters: Journal of Emergency Medicine, Vol. 33, No. 3. (October 2007), pp. 325-326.AG Balls, F Lovecchio, S Stapczynski, M Mulrow, D Hatch

Source: Journal of Emergency Medicine, Vol. 33, No. 3. (October 2007), pp. 325-326.
Effect of a second-generat ion venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-relat ed infections: a randomized, controlled trial.: Annals of internal medicine, Vol. 143, No. 8. (18 October 2005), pp. 570-580.BACKGR OUND: Central venous catheter-relat ed infections are a significant medical problem. Improved preventive measures are needed. OBJECTIVE: To ascertain 1) effectiveness of a second-generat ion antiseptic-coa ted catheter in the prevention of microbial colonization and infection; 2) safety and tolerability of this device; 3) microbiology of infected catheters; and 4) propensity for the development of antiseptic resistance. DESIGN: Multicenter, randomized, double-blind, controlled trial. SETTING: 9 university-aff iliated medical centers. PATIENTS: 780 patients in intensive care units who required central venous catheterizatio n. INTERVENTION: Patients received either a standard catheter or a catheter coated with chlorhexidine and silver sulfadiazine. MEASUREMENTS: The authors assessed catheter colonization and catheter-relat ed infection, characterized microbes by molecular typing, and determined their susceptibility to antiseptics. Patient tolerance of the catheter was monitored. RESULTS: Patients with the 2 types of catheters had similar demographic features, clinical interventions, laboratory values, and risk factors for infection. Antiseptic catheters were less likely to be colonized at the time of removal compared with control catheters (13.3 vs. 24.1 colonized catheters per 1000 catheter-days; P < 0.01). The center-stratif ied Cox regression hazard ratio for colonization controlling for sampling design and potentially confounding variables was 0.45 (95% CI, 0.25 to 0.78). The rate of definitive catheter-relat ed bloodstream infection was 1.24 per 1000 catheter-days (CI, 0.26 to 3.62 per 1000 catheter-days) for the control group versus 0.42 per 1000 catheter-days (CI, 0.01 to 2.34 per 1000 catheter-days) for the antiseptic catheter group (P = 0.6). Coagulase-nega tive staphylococci and other gram-positive organisms were the most frequent microbes to colonize catheters. Noninfectious adverse events were similar in both groups. Antiseptic susceptibility was similar for microbes recovered from either group. LIMITATIONS: The antiseptic catheter was not compared with an antibiotic-coa ted catheter, and no conclusion can be made regarding its effect on bloodstream infection. CONCLUSIONS: The second-generat ion chlorhexidine- silver sulfadiazine catheter is well tolerated. Antiseptic coating appears to reduce microbial colonization of the catheter compared with an uncoated catheter.ME Rupp, SJ Lisco, PA Lipsett, TM Perl, K Keating, JM Civetta, LA Mermel, D Lee, EP Dellinger, M Donahoe, D Giles, MA Pfaller, DG Maki, R Sherertz

Source: Annals of internal medicine, Vol. 143, No. 8. (18 October 2005), pp. 570-580.
Searching for evidence to support pulmonary artery catheter use in critically ill patients.: JAMA, Vol. 294, No. 13. (5 October 2005), pp. 1693-1694.JB Hall

Source: JAMA, Vol. 294, No. 13. (5 October 2005), pp. 1693-1694.
Exit of catheter lock solutions from double lumen acute haemodialysis catheters--an in vitro study.: Nephrology, dialysis, transplantatio n : official publication of the European Dialysis and Transplant Association - European Renal Association, Vol. 22, No. 12. (December 2007), pp. 3533-3537.BACK GROUND: Double lumen dialysis catheters are routinely heparin or citrate 'locked' to maintain patency. Heparin lock-related bleeding episodes and antibiotic lock-related toxicity have been reported. The aim of this study is to quantify the amount of leak during 'lock' procedures and to compare leakage for different double lumen dialysis catheters. METHODS: In an experimental, in vitro study at a University research laboratory, five different double lumen dialysis catheters were tested using three different lock volumes. RESULTS: Using the catheter flush volume, leak ratios for Flexxicon II 15 cm and 20 cm catheters were greater than that seen in the Arrow 16 cm catheter (P < 0.05). Using 20% less than the catheter flush volume, the Flexxicon II 20 cm catheter had greater leak than the Duo-flow 15 and 20 cm catheters and Arrow 16 cm catheter (P < 0.05). The Flexxicon II 15 cm catheter had greater leak than the Duo-flow 15 cm and Duo-flow 20 cm catheters with 20% less locking volume (P < 0.05). Using 20% greater than the catheter flush volume, the Duo-flow 20 cm catheter had significantly less leak ratio than the Flexxicon II 20 cm catheter (P < 0.05). There were no other significant differences in leak ratios between the catheters. CONCLUSION: All double lumen dialysis catheters we tested have a substantial amount of leak even when the catheter 'lock' volumes were used, and leak ratio increases significantly with 20% overfill. There is a leak even when using 20% less 'lock' volume. The amount of leak can be clinically important and may explain the reports of bleeding episodes after heparin lock and antibiotic toxicity after antibiotic and anticoagulant combination lock. Some devices have lower leak ratios than others, likely related to catheter design.M Sungur, E Eryuksel, S Yavas, A Bihorac, AJ Layon, L Caruso

Source: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Vol. 22, No. 12. (December 2007), pp. 3533-3537.
One year follow-up after cryoballoon isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation.: Europace : European pacing, arrhythmias, and cardiac electrophysiol ogy : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiol ogy of the European Society of Cardiology, Vol. 10, No. 11. (November 2008), pp. 1271-1276.AIMS : Pulmonary vein isolation (PVI) with cryoenergy delivered through a balloon is a new approach in the treatment of atrial fibrillation (AF), but long-term follow-up is lacking. The aim of this study was to provide insight in the success rate and the incidence of recurrences. METHODS AND RESULTS: Patients with symptomatic AF despite anti-arrhythmi c drugs (AADs) were treated with cryoballoon PVI. Daily transtelephoni c ECG monitoring, 24 h Holter-ECG, and an arrhythmia-foc used questionnaire were used to document AF. One hundred and forty-one patients completed a follow-up of 457 +/- 252 days. Before ablation, Holter-ECG showed AF in 45%, including 16% continuous AF throughout the recording. Event recording revealed a median AF burden of 26%. The questionnaire showed a median of weekly AF complaints lasting for hours. All but one patient had successful PVI with a single procedure. After ablation, AF (defined as lasting for more than 30 s) was seen in 11% of Holter-ECGs, with 1% continuous AF. The event recording showed an AF burden of 9%. The median patient reported no more AF-related symptoms. Recurrence during the first 3 months was predictive for later recurrence. A second procedure was performed in 24 patients. The freedom of AF was 59% without AADs after 1,2 procedures. Four right phrenic nerve paralyses occurred, all resolving within 6 months. No PV stenoses were observed. CONCLUSION: Pulmonary vein isolation with a cryothermal balloon is an effective treatment for paroxysmal AF, resulting in a clinical success rate comparable to studies involving radiofrequency ablation. Temporary right phrenic nerve paralysis is the most important complication.Y Van Belle, P Janse, D Theuns, T Szili-Torok, L Jordaens

Source: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 10, No. 11. (November 2008), pp. 1271-1276.
Types of urethral catheters for management of short-term voiding problems in hospitalised adults.: Cochrane Database Syst Rev, No. 1. (2004)BACKGROU ND: Urinary tract infection is the most common hospital acquired infection. The major associated cause is indwelling urinary catheters. Currently there are many types of catheters available. A variety of specialised urethral catheters have been designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Other issues that should be considered when choosing a catheter are ease of use, comfort and the cost. OBJECTIVES: The primary objective of this review was to determine the effect of type of indwelling urethral catheter on the risk of urinary tract infection in adults who undergo short-term urinary catheterisatio n. SEARCH STRATEGY: We searched the specialised trials registers of the Cochrane Incontinence Group (November 2003) and the Cochrane Renal Group (February 2003). We also examined the bibliographies of relevant articles and contacted catheter manufacturer representative s for trials. SELECTION CRITERIA: All randomised and quasi randomised trials comparing types of indwelling urinary catheters for short-term catheterisatio n in hospitalised adults. Short-term catheterisatio n was defined as up to and including fourteen days, or other temporary short-term use as defined by the trialists. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and independently verified by a second reviewer. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Where data in trials were not fully reported, clarification was sought directly from the trialists (secondary sources were used to confirm results of one trial). MAIN RESULTS: Eighteen trials met the inclusion criteria involving 4237 hospitalised adults in 17 parallel group trials and 27,878 adults in one large cluster-random ised cross-over trial. Only three of the possible six comparisons were addressed in these trials: antiseptic impregnated catheters versus standard catheters (n=11 trials), antibiotic impregnated catheters versus standard catheters (n=1 trial) and comparison of different standard catheters (n=6 trials).The results of the antiseptic versus standard catheter trials differed according to the antiseptic used to impregnate the catheter. The antiseptic catheters were either impregnated with silver oxide or silver alloy. Silver oxide catheters were not associated with a statistically significant reduction in bacteriuria in short-term catheterised hospitalised adults but the confidence intervals were wide (RR 0.89, 95% CI 0.68 to 1.15). Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.36, 95% CI 0.24 to 0.52) in hospitalised adults catheterised for less than one week. At greater than one week catheterisatio n the risk of asymptomatic bacteriuria was still reduced with the use of silver alloy catheters (RR 0.67, 95% CI 0.50 to 0.90). The risk of symptomatic urinary tract infection was also found to be reduced with the use of silver alloy catheters (RR 0.60, 95% CI 0.50 to 0.73). The randomised cross-over trial of silver alloy catheters versus standard catheters was excluded from the pooled results because data were not available prior to crossover. The results of this trial indicated benefit from the silver alloy catheters and included an economic analysis that indicated cost savings of between 3.3 per cent and 35.5 per cent.One small trial investigated men post radical prostatectomy catheterised with antibiotic impregnated catheter versus standard catheters and found a lower rate of asymptomatic bacteriuria in the antibiotic group at less than one week of catheterisatio n (RR 0.36, 95% CI 0.18 to 0.73). The trial at less than one week found that the risk of bacteriuria was also less in the antibiotic impregnated catheter group (RR 0.36, 95% CI 0.18 to 0.73); however, at greater than one week the result was not significant (RR 0.94, 95% CI 0.86 to 1.03). One of 56 men in the antibiotic impregnated group had a symptomatic UTI compared with 6 of 68 who had standard catheters (RR 0.20, 9h 6 of 68 who had standard catheters (RR 0.20, 95% CI 0.03 to 1.63).Three trials compared two different types of standard catheters (defined as catheters that are not impregnated with antiseptics or antibiotics) to investigate infection but the results were not pooled because of the clinical and statistical heterogeneity between trials. Individual findings of the trials did not show whether or not one type of standard catheter reduced the risk of catheter related urinary tract infection compared to another type of standard catheter. Another three trials compared different types of standard catheters to investigate for adverse urethral effects in catheterised men. Once again the trials were not pooled due to significant heterogeneity; however, the results of the individual trials indicate a trend toward silicone catheters being less likely to result in adverse urethral effects in men. REVIEWER'S CONCLUSIONS: The results suggest that the use of silver alloy indwelling catheters for catheterising hospitalised adults short-term reduces the risk of catheter acquired urinary tract infection. Further economic evaluation is required to confirm that the reduction of infection compensates for the increased cost of silver alloy catheters.Cath eters coated with a combination of minocycline and rifampin may also be beneficial in reducing bacteriuria in hospitalised men catheterised less than one week but this requires further testing. There was not enough evidence to suggest whether or not any standard catheter was better than another in terms of reducing the risk of urinary tract infection in hospitalised adults catheterised short-term. Siliconised catheters may be less likely to cause urethral side effects in men: however, this result should be interpreted with some caution as the trials were small and the outcome definitions and specific catheters compared varied.J Brosnahan, A Jull, C Tracy

Source: Cochrane Database Syst Rev, No. 1. (2004)
Long-term bladder management by intermittent catheterisatio n in adults and children.: Cochrane database of systematic reviews (Online), No. 4. (2007)BACKGROU ND: Intermittent catheterisatio n (IC) is a commonly recommended procedure for people with incomplete bladder emptying not satisfactorily managed by other methods. The most frequent complication of IC is urinary tract infection (UTI). It is unclear which catheter types, techniques or strategies, affect the incidence of UTI. There is wide variation in practice and important cost implications for using different catheters, techniques or strategies. OBJECTIVES: To compare sterile versus clean catheterisatio n technique, coated (pre-lubricate d) versus uncoated (separate lubricant) catheters, single (sterile) or multiple use (clean) catheters, self-catheteri sation versus catheterisatio n by others, and any other strategies designed to reduce UTIs in respect of incidence of symptomatic UTI, haematuria, other infections and user preference, in adults and children using intermittent catheterisatio n for incomplete bladder emptying. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 19 June 2006), MEDLINE (January 1966 to June 2007), EMBASE (January 1988 to June 2007), CINAHL (January 1982 to June 2007), ERIC (January 1984 to June 2007), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification. SELECTION CRITERIA: Randomised controlled trials comparing at least two different catheterisatio n techniques, strategies or catheter types. DATA COLLECTION AND ANALYSIS: Three reviewers assessed the methodological quality of trials and abstracted data. For dichotomous variables, relative risks and 95% confidence intervals (CI) were derived for each outcome where possible. For continuous variables, mean differences and 95% CI were calculated for each outcome. Because of trial heterogeneity, data were not combined to give an overall estimate of treatment effect. MAIN RESULTS: Fourteen studies met the inclusion criteria; all were small (less than 60 participants). There was considerable variation in length of follow-up and definitions of UTI. Participant drop-out was a problem for several studies. Several studies were more than ten years old and outcome measures varied between studies. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor ruled out reliably. AUTHORS' CONCLUSIONS: Intermittent catheterisatio n is a critical aspect of healthcare for individuals with incomplete emptying who are otherwise unable to void adequately to protect bladder and renal health. There is a lack of evidence to state that incidence of UTI is affected by use of sterile or clean technique, coated or uncoated catheters, single (sterile) or multiple use (clean) catheters, self-catheteri sation or catheterisatio n by others, or by any other strategy. The current research evidence is weak and design issues are significant. In light of the current climate of infection control and antibiotic resistance, further, well-designed studies are strongly recommended. Based on the current data, it is not possible to state that one catheter type, technique or strategy is better than another.KN Moore, M Fader, K Getliffe

Source: Cochrane database of systematic reviews (Online), No. 4. (2007)
Types of urethral catheters for management of short-term voiding problems in hospitalised adults.: Cochrane database of systematic reviews (Online), No. 2. (2008)BACKGROU ND: Urinary tract infection (UTI) is the most common hospital acquired infection. The major associated cause is indwelling urinary catheters. Currently there are many types of catheters available. A variety of specialised urethral catheters have been designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Other issues that should be considered when choosing a catheter are ease of use, comfort and cost. OBJECTIVES: The primary objective of this review was to determine the effect of type of indwelling urethral catheter on the risk of urinary tract infection in adults who undergo short-term urinary catheterisatio n. SEARCH STRATEGY: We searched the Specialised Trials Register of the Cochrane Incontinence Group (searched 11 September 2007). We also examined the bibliographies of relevant articles and contacted catheter manufacturer representative s for trials. SELECTION CRITERIA: All randomised and quasi randomised trials comparing types of indwelling urinary catheters for short-term catheterisatio n in hospitalised adults. Short-term catheterisatio n was defined as up to and including fourteen days, or other temporary short-term use as defined by the trialists (for example less than 21 days with data time points at 7 day intervals). DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and independently verified by a second reviewer. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Where data in trials were not fully reported, clarification was sought directly from the trialists (secondary sources were used to confirm results of one trial). MAIN RESULTS: Twenty three trials met the inclusion criteria involving 5236 hospitalised adults in 22 parallel group trials and 27,878 adults in one large cluster-random ised cross-over trial.The antiseptic catheters were either impregnated with silver oxide or silver alloy. Silver oxide catheters were not associated with a statistically significant reduction in bacteriuria in short-term catheterised hospitalised adults but the confidence intervals were wide (RR 0.89, 95% CI 0.68 to 1.15) and these catheters are no longer available. Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.54, 95% CI 0.43 to 0.67) in hospitalised adults catheterised for less than one week. At greater than one week of catheterisatio n the risk of asymptomatic bacteriuria was still reduced with the use of silver alloy catheters (RR 0.64, 95% CI 0.51 to 0.80). The randomised cross-over trial of silver alloy catheters versus standard catheters was excluded from the pooled results because data were not available prior to crossover. The results of this trial indicated benefit from the silver alloy catheters and included an economic analysis that indicated cost savings of between 3.3 per cent and 35.5 per cent.Antibioti c impregnated catheters were compared to standard catheters and found to lower the rate of asymptomatic bacteriuria in the antibiotic group at less than one week of catheterisatio n for both minocycline and rifampicin (RR 0.36, 95% CI 0.18 to 0.73), and nitrofurazone (RR 0.52, 95% CI 0.34 to 0.78). However, at greater than one week the results were not statistically significant. One of 56 men in the antibiotic impregnated group had a symptomatic UTI compared with 6 of 68 who had standard catheters (RR 0.20, 95% CI 0.03 to 1.63).Three trials compared two different types of standard catheters (defined as catheters that are not impregnated with antiseptics or antibiotics) to investigate infection. Individual trials were too small to show whether or not one type of standard catheter reduced the risk of catheter related urinary tract infection compared to another type of standard catheter. AUTHORS' CONCLUSIONS: The results suggest that the use of silver alloy indwelling catheters for catheterising hospitalised adults short-term reduces the risk of catheter acquired urinary tract infection. Further economic evaluation is required to confirm that the reduction of infection compensates for the increased cost of silver alloy catheters.Cath eters impregnated with antibiotics are also beneficial in reducing bacteriuria in hospitalised adults catheterised for less than one week but the data were too few to draw conclusions about those catheterised for longer. There was not enough evidence to suggest whether or not any standard catheter was better than another in terms of reducing the risk of urinary tract infection in hospitalised adults catheterised short-term. Siliconised catheters may be less likely to cause urethral side effects in men; however, this result should be interpreted with some caution as the trials were small and the outcome definitions and specific catheters compared varied.K Schumm, TB Lam

Source: Cochrane database of systematic reviews (Online), No. 2. (2008)

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