|
|
 |
Author |
Post |
|
|
|
| |
User Comment
|
Eliminating Central Line-Related Bloodstream Infections with Bundle Compliance
12/22/2005 3:54:02 PM
User Comments on Eliminating Central Line-Related Bloodstream Infections with Bundle Compliance
|
|
|
|
|
|
| |
Total Posts: 7
|
Re: Eliminating Central Line-Related Bloodstream Infections with Bundle Compliance
1/27/2007 4:41:09 AM
I am a firm believer in the use of the bundle concept for achieving improved outcome with respect to central line related BSI. I am concerned that with time interest in the bundle within any given institution will diminish unless some steps are taken to provide some science to back up the initiative. There is very little science related to the prevention of central line infections. In most institutions anesthesiologists would be the most likely individuals to insert central lines, and yet the anesthesia literature is almost devoid of literature on the subject.
I am approaching retirement age and am not in a position to pursue investigations along these lines. I do have some ideas that I would like to put on the table for anyone interested in pursuing related research.
I think it would be very worthwhile to look at the segment of a central line from the skin insertion site to the interface with the blood stream. Scanning electron microscopy might provide some useful information about the quality and character of the film that forms around the device. An investigational study to look at the adherent film on catheters where no localized infection or inflammation is present and on catheters where obvious tract infection has occurred might provide some interesting data. Correlating the data with observations on technique of fixation of the device, prep solution used, and dressing used with frequency of change of dressing might provide further illumination on the subject.
Many jurisdictions are mandating ultra sound guided insertion of these devices. I have yet to see any attempt made to use ultra sound during the withdrawal of the device particularly in the setting of BSI. I have no idea if the technology is up to the task of defining the presence of adherent clot on the intravascular segment. If this can be done it would be very interesting to look at a series of patients with and without infection to see if this was a contributing factor. A nidus of infection in the form of an infected clot which is stripped off the device at the time of withdrawal and subsequently contributes to a BSI recognized only after the device is withdrawn may open our eyes to a whole process of pathogenesis not yet recognized.
Just a couple of ideas that might stimulate some research if they were widely disseminated and your forum and institution seems like a reasonable place to start.
Sincerely:
R. N. Lyall MD
Division of CVT Anesthesia
King Faisal Specialist Hospital
Riyadh, Saudi Arabia
roblyall@hotmail.com
Edit by: Robert Lyall on 1/28/2007 7:33:41 AM
|
|
|
|
|
