Nuove indicazioni cliniche e
possibili ambiti di utilizzo dei
cateteri venosi centrali medicati
Giancarlo Scoppettuolo!
For HAIs, it is widely demonstrated
that all are preventable, but some are
partly preventable and some others
(CLABSI), on the contrary, are
Central Line Bundle
Hand Hygiene
Maximal Barrier Precautions Upon Insertion Chlorhexidine Skin Antisepsis
Optimal Catheter Site Selection, with Subclavian Vein as the Preferred Site for Non-Tunneled Catheters
‘Bundle’ GAVeCeLT per la prevenzione delle
infezioni associate a cateteri venosi centrali non tunnellizzati a breve e medio termine
Igiene delle mani e Massime precauzioni di barriera durante l’impianto del catetere venoso
Scelta appropriata del sito di inserzione (in ordine di preferenza: metà braccio, zona sottoclaveare, zona sopraclaveare, collo, inguine)
Impianto ecoguidato, ovunque possibile, sia per i cateteri a inserzione centrale che per i cateteri a inserzione periferica
Utilizzo di clorexidina al 2% per la disinfezione cutanea prima dell’inserzione nonché per la disinfezione continua o discontinua dell’exit site
Impiego di “sutureless devices” per il fissaggio del catetere, ovunque possibile Impiego di medicazioni semipermeabili trasparenti, ovunque possibile
Targeting zero CLABSI in patients with
PICC lines: a case-control study
G. Scoppettuolo§, L. Dolcetti§, C. Taraschi§, C. Chiarini§, C. Donato§, S. Lardo§, A. La Greca*, M. Pittiruti*
§ Clinic of Infectious Diseases, * Dpt. of Surgey, Catholic University, Rome
98 23 126 96 112 187 480 722 46 123 0 200 400 600 800 Sepsi da Candida Sepsi KPC
Inf ferita chirurgica
Colite da Clostridium diff
Bone and joint inf
IAI
UTI
Polmoniti
Endocardite
Sepsi CVC-relate
2004-2005: in UK impiantati 238.500 CVC Di questi, 10.777 (4.2%) erano medicati (34% impregnati con argento e 66%
• POLICLINICO UNIVERSITARIO
• 10 DIPARTIMENTI
• 1200 POSTI LETTO
• CINQUE POLI ASSISTENZIALI
(CARDIOVASCOLARE, DONNA, EMERGENZE, NEUROSCIENZE, ONCOLOGICO)
Utilizzo cateteri trattati Policlinico Gemelli
• Cateteri trattati con clorexidina-sulfadiazina di II generazione • Agenti battericidi!
• Attività comprovata sui funghi!
• Tassi di resistenza in vivo e in vitro molto bassi!
• Minore possibilità di resistenza indotta rispetto ad antibiotici!
• Comprovata costo-efficacia!
• Indicazioni “allargate” SHEA-IDSA 2014
Efficacy of chlorhexidine and silver
sulfadiazine coating in preventing
colonization of central venous
catheters inserted in bacteremic
patients.
Giancarlo Scoppettuolo, Antonio La Greca, Mauro Pittiruti
Patients with positive blood cultures (either
patients with Central Line Associated Bloodstream Infections or patients with bacteremia from other
sources) often require
placement of a central line for hemodymanic
Background
The presence of
microrganisms in the blood may cause
extraluminal
colonization of venous catheters, through
Background
The secondary colonization of the
venous catheter inserted in a
bacteremic patient may be
associated with a slower resolution
of the symptoms and signs of
Background
• In such cases, antimicrobial catheters may be an interesting option.
• Catheters coated with chlorhexidine and
Goal of the study
• To prove the efficacy of the antimicrobial C-SS coating in preventing the secondary
Methods
• Pilot Study. Observational, perspective.
• Setting: A. Gemelli Hospital, a 1.200 beds University Hospital in Rome.
• Patients included:
– Patients with positive blood cultures requiring a central venous access
Methods
• At the time of diagnosis, placement of an antimicrobial catheter, via ultrasound
cannulation of the axillary vein.
– All catheters were inserted with maximal barrier precautions
– Exit site was in the infra-clavicular area
Methods
• Two weeks after resolution of symptoms and signs of bacteremia, each catheter was
removed (or exchanged over guidewire,
Results
•
15 bacteremic patients
Results
• Resolution of symptoms and signs of
bacteremia was obtained in few days
in all patients (average: 4 days).
• Tip culture NEGATIVE in 14 patients
• Tip culture POSITIVE only in 1 case
Conclusions
• In this pilot study, antimicrobial coating with chlorhexidine and silver sulfadiazine
successfully prevented the hematogenous colonization of central venous catheters in patients with positive blood cultures.
