Mechanisms and risk factors for infection of pulmonary artery catheters and introducer sheaths in cancer patients admitted to an intensive care unit

Pulmonary artery catheters (PACs) are typically inserted for short periods, and the extra-luminal route is assumed to be the overriding source of cont amination and/or infection. Our aim was to assess the incidence of PAC and introducer colonization in cancer patients, and to study the mechanisms and risk factors for infection. Patients xith a Swan-Ganz catheter admitted to an intensive care unit,were prospectively analyzed over 14 months. As soon they were no longer necessar y, PACs and introducer sheaths were removed and cultured. We recorded the m ean duration of placement, the number of times PACs were handled and the si te of insertion. Seventy-nine catheters were inserted in 68 patients. The median (range) dur ation was three days (0-10) for PACs, and 3.6 days (0-18) for introducers. PAC and/or percutaneous introducer sheath colonization was diagnosed in sev en patients (8.9%), but in only one case were both colonized. Colonization rates were 15.5 per 1000 days for PACs and 14.1 per 1000 days for introduce rs. Introducers were mainly colonized before the 5th day, while PACs were m ainly colonized after the 5th day. No PAC or introducer-related local infec tion or bacteraemia was diagnosed. Colonization was more frequent on cathet ers inserted into the internal jugular vein. The colonization rate was 5% for PACs and introducers. Our findings suggest that contamination of introducers and PACs may, be dissociated and could r esult from either extraluminal or endoluminal colonization. As three of fou r PAC colonizations occurred after 5 days, the duration of catheter placeme nt should be considered important. There vas little clinical impact of micr obial colonization. (C) 2001 The Hospital Infection Society.