Bacuzzi Alessandro, Cecchin Andrea, Del Bosco Andrea, Cantone Giovanni, Cuffari Salvatore
Anaesthesia and Palliative Care, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Surg Infect (Larchmt). 2006;7 Suppl 2:S65-7. doi: 10.1089/sur.2006.7.s2-65.
Central venous catheters (CVCs) are used to deliver a variety of therapies, as well as for measurement of hemodynamic parameters. The major associated complication is catheter-related blood stream infection (CRBSI).
Review of the pertinent English-language literature.
The incidence of CRBSI depends on how such infections are defined. Generally, the term includes all BSIs in patients with CVCs when other sources can be excluded, and if a culture of the catheter tip demonstrates a substantial number of colonies of the organism found in the blood stream. Important pathogenic determinants of catheter-related infection are the material of which the device is made and the intrinsic virulence of the organism. The site at which a catheter is placed influences the risk of infection. The types of organisms that most commonly cause hospital-acquired BSIs have changed over time. Migration of skin organisms at the insertion site into the cutaneous catheter tract with colonization of the catheter tip is the most common route of infection. Good hand hygiene before catheter insertion, combined with proper aseptic technique during its manipulation, provides protection against infection; maximal sterile barrier precautions during insertion reduce the incidence of CRBSI. Catheters that are coated or impregnated with antimicrobial or antiseptic agents can decrease the risk and the associated hospital costs. No studies have demonstrated that oral or parenteral antibacterial or antifungal drugs reduce the incidence of CRBSI in adults. Use of anticoagulants might have a role in the prevention of CRBSI. Catheter replacement at scheduled intervals has not lowered rates of local or systemic complications.
Central venous catheters are used commonly to deliver a variety of therapies, such as large amounts of fluid or blood products during surgery or in intensive care units, chemotherapy, and parenteral nutrition, as well as for measurement of hemodynamic variables. The major complication associated with CVCs is CRBSI.
中心静脉导管（CVC）用于多种治疗，以及血流动力学参数的测量。主要相关并发症是导管相关血流感染（CRBSI）。
回顾相关英文文献。
CRBSI的发生率取决于感染的定义方式。一般来说，该术语包括在排除其他感染源后，中心静脉导管患者发生的所有血流感染，且导管尖端培养物显示出在血流中发现的大量微生物菌落。导管相关感染的重要致病决定因素是导管的制作材料和微生物的内在毒力。导管置入部位会影响感染风险。随着时间推移，最常导致医院获得性血流感染的微生物类型发生了变化。皮肤微生物在插入部位迁移至皮下导管通道并在导管尖端定植是最常见的感染途径。导管插入前良好的手部卫生，以及操作过程中适当的无菌技术可预防感染；插入过程中采取最大无菌屏障预防措施可降低CRBSI的发生率。涂有或浸渍抗菌或防腐剂的导管可降低风险及相关医院费用。尚无研究表明口服或胃肠外使用抗菌或抗真菌药物可降低成人CRBSI的发生率。使用抗凝剂可能在预防CRBSI中起作用。定期更换导管并未降低局部或全身并发症的发生率。
中心静脉导管常用于多种治疗，如手术期间或重症监护病房大量输注液体或血液制品、化疗及胃肠外营养，以及血流动力学变量的测量。与中心静脉导管相关的主要并发症是CRBSI。
