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Paper summary: How frequently are intravenous catheters removed as a result of complications due to bacterial contamination?

Incidence of and associated factors for bacterial colonization of intravenous catheters removed from dogs in response to clinical complications 

Guzmán Ramos et al. 2018. Journal of Veterinary Internal Medicine. 32(3): 1084-1091.

What did the research find?

In the study population, 23.2% of intravenous (IV) catheters removed in response to a list of defined clinical complications had a positive bacterial culture, this equated to 39.6% of dogs enrolled. Factors associated with the colonisation of IV catheters, as well as the colonising bacterial species, were also identified.

How was it conducted?

Information relating to the nosocomial bacterial colonisation of IV catheters is limited in the veterinary literature. The primary aim of this study was to determine the incidence of such IV catheter colonisation in dogs where catheters were removed as a result of either clinical signs of phlebitis, extravasation or catheter obstruction. The authors also sought to identify causal factors as well as the genus and species of the most commonly identified microorganisms.

This prospective longitudinal cohort study used privately owned dogs and was performed at the Veterinary Teaching Hospital of Alfonso X el Sabio University of Madrid between January 2015 and July 2015. Only dogs that had been hospitalised for at least 48 hours and had developed complications of IV catheterisation, as outlined above, were included in the study. During the study period 182 cases met the inclusion criteria, patients hospitalised for less than 48 hours and aggressive patients were excluded. 

Multiple patient variables were recorded for later statistical analysis, these included sex, weight, age, corticosteroid and/or antibiotic administration either prior to or during hospitalisation, catheter type (central or peripheral), aseptic technique, use of gloves, experience of staff placing the catheter (i.e. senior veterinary surgeons, junior veterinary surgeons or veterinary students) and the grade of phlebitis if this was the cause of catheter removal.

All catheters were placed using a non-touch aseptic technique and secured in place using adhesive tape and a soft cohesive bandage. Placement was performed by veterinary staff after washing and disinfecting their hands regardless of whether gloves were subsequently worn. Prior to placement, catheterisation site was aseptically prepared using two different protocols to help identify if disinfection technique could contribute to development of catheter colonisation. 

If clinical signs of phlebitis, extravasation or catheter obstruction occurred the catheter was removed using aseptic technique. A sample taken from the catheter tip was then plated and cultured on blood agar. Samples were considered negative when no growth was observed following 72 hours for aerobic or 7 days for anaerobic cultures.

Results

The incidence of bacterial colonisation of IV catheter placement in individual patients was 39.6%. However, as some patients had more than one colonised catheter, the overall incidence of IV catheter colonisation was 23.2%. The proportion of catheters that remained in place at 24, 48 and 72 hours was 89.5%, 78.0% and 59.4% respectively. The cumulative proportion of IV catheters that developed bacterial colonisation were 10.5% at 24 hours, 22.0% at 48 hours and 40.6% at 72 hours. The most frequently isolated microorganisms were those belonging to the genus Acinetobacter (21.7%) and Klebsiella (18.0%).

Statistical analysis identified that the rate of catheter colonisation was 84% higher when veterinarians with less than 1-year experience (i.e. junior veterinary surgeons) inserted the catheter when compared to senior staff. The colonisation rate was two times higher when students performed catheterisation when compared to senior veterinary surgeons. The rate of catheter colonisation was also increased in patients that had received corticosteroid therapy during hospitalisation (increase of 57%) when compared to non-treated patients. The grade of phlebitis was also positively associated with the bacterial colonisation of IV catheters.

Why is it important?

Intravenous catheter-related bacteraemia is a well-recognised cause of nosocomial infections in human medicine (Crnich and Maki, 2005; Maki et al. 2006; Gahlot et al. 2014). Bacteraemia associated with IV catheterisation may occur secondary to contamination from the skin at the site of IV catheter insertion and/or the external and internal surfaces of the catheter. This catheter-related bacteraemia leads to an increase in patient morbidity and mortality, longer durations of patient hospitalisation and further diagnostic investigation and therapy, all of which also increase the economic costs associated with patient care (O’Grady et al. 2002; Shah et al. 2013). 

For the same reasons as above, infections associated with IV catheter placement are emerging as an important issue in small animal veterinary medicine. As such, the identification of potential causal factors may provide useful information for the surveillance and prevention of these infections. This study identifies that, in the population studied, corticosteroid administration during period of catheterisation, staff experience and skill performing catheterisation, and the phlebitis grade at the time of catheter removal are all factors associated with the bacterial colonisation of IV catheters.

Article by
Dr. Dan Cripwell
BSc (Hons) BVSc CertAVP (EM) PgCert (VPS) MRCVS

Veterinary Technical Advisor UK
RCVS Recognised Advanced Veterinary Practitioner

Originally published: Thursday, 2nd May 2019

References

Crnich, C.J., Maki, D.G. 2005. Infections caused by intravascular devices: epidemiology, pathogenesis, diagnosis, prevention, and treatment. APIC text of infection control and epidemiology. 1: 24-21.

Gahlot, R., Nigam, C., Kumar, V., Yadav, G., Anupurba, S. 2014. Catheter-related bloodstream infections. International journal of critical illness and injury science. 4(2): 161-167.

Maki, D.G., Kluger, D.M. and Crnich, C.J.. 2006, September. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clinic Proceedings. 81(9): 1159-1171.

O'Grady, N.P., Alexander, M., Burns, L.A., Dellinger, E.P., Garland, J., Heard, S.O., Lipsett, P.A., Masur, H., Mermel, L.A., Pearson, M.L., Raad, I.I. 2011. Guidelines for the prevention of intravascular catheter-related infections. Clinical infectious diseases. 52(9): 162-193.

Shah, H., Bosch, W., Thompson, K.M., Hellinger, W.C. 2013. Intravascular catheter-related bloodstream infection. The Neurohospitalist. 3(3): 144-151.

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