Central Lines: All you ever wanted to know Allison Ballantine, MD Assistant Professor of Pediatrics...
-
Upload
maud-henry -
Category
Documents
-
view
214 -
download
0
Transcript of Central Lines: All you ever wanted to know Allison Ballantine, MD Assistant Professor of Pediatrics...
Central Lines:All you ever wanted to
knowAllison Ballantine, MD
Assistant Professor of PediatricsMedical Director, Integrated Care Service
Director of EducationDivision of General Pediatrics
The Children’s Hospital of Philadelphia
pH and osmolarity• What can you give peripherally?
– pH between 5 and 9 (What works? 9 to 5) – Osmolarity < 600 mOsm/L– Samples of agents that are not in these ranges:
• Acyclovir: pH = 10 – 11– Acyclovir = ammonia
• Vancomycin pH = 2.5 - 4.5– Vanco = vinegar
• Phenytoin: pH = 12– Dilantin = Draino
Part II: Catheter-Related
Complications
• Catheter Insertion-
pneumothorax
- vascular injury
- air embolism
- arrhythmias
• Catheter Removal- bleeding- air
embolism
• Catheter Use- fibrin and
thrombosis formation
- dysfunction
- infection
Occulsion
Cause Treatment
Thrombus Urokinase
Lipid Ethanol
CaPhos Precipitate
HCl
Basic Drug Sodium Bicarbonate
Acidic Drug HCl
Pinch-Off Syndrome
- compression of the catheter between the clavicle and the 1st rib
claviclecompression of
the subclavian vein
Non Functioning Device
• History• Examine (site, variablity with
positioning?) • Diagnostics (X-ray, veinogram)• Pharamco-theraputics• Replacement
Points of Entry
•Insertion site
•Catheter hubs
•Hematogenous
•Contaminated infusate
Skin
Vein
Filter
Catheter hub
Common Pathogens
Staph Staph AureusAureus
Enterobacter Enterobacter sppspp
EnterococcEnterococcusus
Coag Coag Negative Negative StaphStaph
3838%%
6%6%
1111%%
99%%
Common Pathogens (con’t)
PseudomonPseudomonas as AeruginosaAeruginosa
E. coliE. coli
Klebsiella Klebsiella pneumoniapneumoniaee
Candida Candida AlbicansAlbicans
5%5%
3%3%
4%4%
55%%
Diagnosis• Line cultures• Peripheral cultures• Routine diagnostics• Differential time to positivity• Tip culture
Treatment• Empiric Antibiosis:
– CoNS and Staph Aureus coverage (Vanc)– Gram negative (Gent)– Resistent pseudomonas or E. coli
(Ceftazidime)
• Line Salvage• Duration
– 10-14 days without removal– Less (t/c PO) if removed
“Bundle”• Minimize line entrances• Modified barrier for line entrances• Hub scrub• Optimize environment/care team
Infection Rate per 1000 Line Days
CLA
BS
I per
100
0 lin
e da
ys
Month
0
20
40
60
80
100
120
140
4/1/
2005
5/1/
2005
6/1/
2005
7/1/
2005
8/1/
2005
9/1/
2005
10/1
/200
5
11/1
/200
5
12/1
/200
5
1/1/
2006
2/1/
2006
3/1/
2006
4/1/
2006
5/1/
2006
6/1/
2006
7/1/
2006
8/1/
2006
9/1/
2006
10/1
/200
6
11/1
/200
6
12/1
/200
6
1/1/
2007
2/1/
2007
3/1/
2007
4/1/
2007
5/1/
2007
ICS CLABSI Rate
Annual Median