Systematic review of emergency department central venous and arterial catheter infectionReport as inadecuate

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International Journal of Emergency Medicine

, Volume 3, Issue 4, pp 409–423

First Online: 05 November 2010Received: 02 April 2010Accepted: 27 July 2010


BackgroundThere is an extensive critical care literature for central venous catheter and arterial line infection, duration of catheterization, and compliance with infection control procedures. The emergency medicine literature, however, contains very little data on central venous catheters and arterial lines. As emergency medicine practice continues to incorporate greater numbers of critical care procedures such as central venous catheter placement, infection control is becoming a greater issue.

AimsWe performed a systematic review of studies reporting baseline data of ED-placed central venous catheters and arterial lines using multiple search methods.

MethodsTwo reviewers independently assessed included studies using explicit criteria, including the use of ED-placed invasive lines, the presence of central line-associated bloodstream infection, and excluded case reports and review articles. Finding significant heterogeneity among studies, we performed a qualitative assessment.

ResultsOur search produced 504 abstracts, of which 15 studies were evaluated, and 4 studies were excluded because of quality issues leaving 11 cohort studies. Four studies calculated infection rates, ranging 0–24.1-1,000 catheter-days for central line-associated and 0–32.8-1,000 catheter-days for central line-related bloodstream infection. Average duration of catheterization was 4.9 days range 1.6–14.1 days, and compliance with infection control procedures was 33–96.5%. The data were too poor to compare emergency department to in-hospital catheter infection rates.

ConclusionsThe existing data for emergency department-placed invasive lines are poor, but suggest they are a source of infection, remain in place for a significant period of time, and that adherence to maximum barrier precautions is poor. Obtaining accurate rates of infection and comparison between emergency department and inpatient lines requires prospective study.

KeywordsCentral venous catheter Central line Systematic review Infectious disease Central line-associated bloodstream infection Central line-related bloodstream infection Catheter-associated bloodstream infection Catheter-related bloodstream infection The views expressed in this paper are those of the authors and not those of the editors, editorial board or publisher.

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Author: Christopher H. LeMaster - Ashish T. Agrawal - Peter Hou - Jeremiah D. Schuur


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