NO DIFFERENCE IN CATHETER SEPSIS BETWEEN STANDARD AND ANTISEPTIC CENTRAL VENOUS CATHETERS

Objective: To determine the efficacy of antiseptic compared with stand ard triple lumen central venous catheters (CVCs) in reducing the incid ence of catheter sepsis and catheter site infection in patients with C VCs for total parenteral nutrition. Design: A prospective, randomized, controlled trial. Setting: Truman Medical Center, the public teaching hospital for University of Missouri, Kansas City, School of Medicine. Patients: Seventy-two inpatients on the Metabolic Support Service rec eived a CVC for the infusion of total parenteral nutrition. Diagnoses included pancreatic disease, cancer, bowel obstruction, and intestinal surgery, among others. Patients who had a higher risk for contaminati on during insertion, such as those with a catheter placed through an i ntroducer, inserted in the emergency department, or changed over a gui dewire were excluded from the study. Intervention: The control group r eceived a standard CVC without antiseptics. The treatment group receiv ed a CVC with a coating of silver sulfadiazine and chlorhexidine gluco nate. Each CVC was inspected for infection or malfunction by the Metab olic Support Service 5 times per week. A transparent occlusive dressin g was changed every 7 days or more often if there were signs of infect ion or nonocclusion. When the CVC was removed, the catheter tip, the b lood, and the insertion site were cultured. Main Outcome Measures: Alt hough 88 catheters were inserted, only 72 catheters were evaluable. Th ere were 40 patients in the standard group and 32 in the antiseptic gr oup. There were no statistically significant differences between the 2 groups for diagnosis, sex, age, length of stay, days with a CVC, or c atheter location. The catheter sepsis rate in the standard group was 8 % and in the antiseptic group it was 6%. There were no statistically s ignificant differences between the 2 groups in frequency of site infec tions or catheter sepsis. Conclusions: In this study, there were no st atistically significant differences in the incidence of catheter-relat ed sepsis or catheter site infections between the standard and antisep tic groups. Future prospective, randomized controlled trials with a la rger number of antiseptic catheters are encouraged to confirm or refut e these results.