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Incidence of luminal occlusion in multi-lumen central venous catheters Implication for the diagnosis of catheter related blood-stream infection

Incidence of luminal occlusion in multi-lumen central venous catheters Implication for the diagnosis of catheter related blood-stream infection

Abstracts of the General Meeting of the American Society for Microbiology 102: 100

Background: Recently described in situ techniques for the diagnosis of CRBSI, including differential time to positivity (DTP) of central and peripheral paired blood cultures (>2hours), Gram staining and Acridine-Orange Leukocyte Cytospin (G/AOLC)(>1 cfu) tests rely on aspirated blood from the CVC lumen. Endoluminal brushing allows assessment of catheter lumens without blood aspiration. We compared catheter blood aspiration with the results of endoluminal brushing to evaluate the success rate of techniques that require luminal blood for diagnosing CRBSI. Methods: Assessment of multi-lumen CVCs used in intensive care and high dependency unit patients was carried out on suspicion of CRBSI (temperature >37degreeC, white cell count>11X109/ml). Aspiration of blood from each lumen was attempted (1ml for gram stain and AOLC and 10ml for DTP), followed by individual brushing of each lumen. Positive endoluminal brush result criteria was >100cfu/ml. Simultaneous peripheral blood was taken and cultured by an automated qualitative method (Vital). Results: The study identified 74 CVCs with suspected CRBSI (56 triple and 18 quadruple lumen CVCs, median 8.5 days dwell time (range 2-43)). Blood was successfully aspirated from 136 of the 240 lumens investigated. A total of 43 lumens were positive on endoluminal brushing, 32.5% of which could not be aspirated. Of the 19 cases of CRBSI identified all were detected by endoluminal brushing, 12 by DTP and 10 by G/AOLC. Conclusion: Techniques that rely on luminal aspiration to diagnose CRBSI may fail to sample nearly half of the lumens in multi-lumen CVCs. We recommend that endoluminal brushing is the most appropriate in situ sampling technique for assessing multi-lumen CVCs for CRBSI when blood aspiration cannot be achieved.

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Accession: 035114396

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