Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients

An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates

Bruce C. Friedman, Mohammad Mian, Robert F. Mullins, Zaheed Hassan, Joseph R. Shaver, Krystal K. Johnston

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P =.01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

Original languageEnglish (US)
Pages (from-to)493-499
Number of pages7
JournalJournal of Burn Care and Research
Volume36
Issue number4
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Catheter-Related Infections
Central Venous Catheters
Thigh
Anti-Bacterial Agents
Equipment and Supplies
Catheters
Subclavian Vein
Acinetobacter baumannii
Skin
Minocycline
Femoral Vein
Jugular Veins
Rifampin
Centers for Disease Control and Prevention (U.S.)
Burns
Venous Thrombosis
Stem Cells
Safety

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Rehabilitation

Cite this

Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients : An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates. / Friedman, Bruce C.; Mian, Mohammad; Mullins, Robert F.; Hassan, Zaheed; Shaver, Joseph R.; Johnston, Krystal K.

In: Journal of Burn Care and Research, Vol. 36, No. 4, 01.01.2015, p. 493-499.

Research output: Contribution to journalArticle

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abstract = "The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5{\%}) with a mean TBSA of 50{\%}. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2{\%}), subclavian vein (5.3{\%}), and internal jugular vein (3.3{\%}). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60{\%} experienced significantly higher rates of CRBSI than patients with a TBSA ≤60{\%} (16.2 vs 7.3, P =.01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7{\%}). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.",
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