PREVENTION OF INDWELLING CENTRAL VENOUS CATHETER SEPSIS

In an attempt to decrease the incidence of central venous catheter sep sis in children with cancer, we conducted a study to evaluate the bene fit of adding broad-spectrum antibiotics to the catheter ''flush solut ion.'' In a prospective, placebo-controlled, double-blinded, randomize d trial, 69 children with different types of malignancies were studied . The central venous catheters in these children were flushed with eit her the standard solution (normal saline + 100 U/ml of heparin) or the study solution (25 mu g/ml of both amikacin and vancomycin added to t he standard solution). At the conclusion of the study, 64 children wit h a total of 67 indwelling central venous lines were assessable. The t otal catheter days on study were 20,700 days, with a median of 323 cat heter days per patient. We documented 10 events of catheter-related in fections (0.49 events/1,000 catheter days at risk). Five of these even ts were catheter-related sepsis (0.24 sepses/1,000 catheter days): two were fungal and three were bacterial. Due to the low incidence of cat heter-related sepsis in this study, no statement regarding the prophyl actic use of antibiotics could be made. The extremely low rate of cath eter-related sepsis reported herein may be retrospectively attributed to continuous staff education regarding aseptic techniques in handling these catheters. Staff education is essential, and probably the most effective factor in preventing catheter-related sepsis. (C) 1996 Wiley -Liss, Inc.