Background Peripherally inserted central catheters (PICCs) are susceptible to Staphylococcus aureus (S.aureus) colonisation and subsequent dissemination into the bloodstream, leading to central line-associated bloodstream infections (CLABSI). Current detection for S.aureus PICC colonisation relies on the use of traditional culture-dependent methods, including the semi-quantitative roll-plate culture method. However, the minimum time to detection is between 24–48 hours. Furthermore, a definitive diagnosis may take up to 7 days and is therefore not useful in guiding appropriate and timely patient management. A quantitative real-time polymerase chain reaction (qPCR) assay has the potential to overcome these limitations.
Methods A qPCR assay, targeting the nuclease (nuc) gene, was developed to detect S.aureus PICC colonisation. The sensitivity threshold of the assay was determined using purified S.aureus genomic DNA (gDNA) and validated using 41 clinical PICC samples which were compared to results from the roll-plate culture method.
Results The sensitivity threshold of the qPCR assay was 102 CFU/mL-1. From a total of 41 clinical PICC samples, S.aureus colonisation was detected from one PICC by both qPCR (103 CFU/mL-1) and the roll-plate culture method (103 CFU/mL-1). The qPCR assay processing time was less than 2 hours after bacterial gDNA isolation compared with 24–48 hours for the roll-plate culture method.
Conclusion This developed qPCR assay is an accurate and rapid method to detect S.aureus PICC colonisation. With further research, this method has the potential to be used in a clinical setting.
Introduction Published guidelines recommend patients and carers are trained and meet competency in certain criteria of connecting and disconnecting procedures before discharge from hospital on home parenteral nutrition (HPN). Despite many HPN users requiring HPN indefinitely, Parenteral Nutrition Down Under Inc. (PNDU), the consumer support and advocacy organisation for HPN users and carers in Australia and New Zealand, was not aware of any retraining of HPN users unless the user had recurring central line-associated bloodstream infection (CLABSI).
Objectives To survey PNDU members on their experiences of formal retraining in HPN procedures, and to assess how members perform one aspect of these procedures – withdraw back (into syringe) – for comparison with the latest recommended protocols.
Methods An anonymous online questionnaire was circulated in November 2018 to all PNDU HPN users and carers in Australia and New Zealand, with an invitation to all active adult HPN users – or carers of active child/adult HPN users – to participate. Following screening and demographic questions, the survey had two parts. First, questions regarding the form of any initial training before hospital discharge, followed by questions regarding any experiences in formal retraining in HPN procedures, including extent, frequency and reason. Second, questions regarding one step of the connecting procedures – withdraw back (into syringe) – sought to identify responders’ specific protocols, and determine if this was taught during the initial HPN training.
Results There were 40 responders, representing 30 adult and 10 child HPN users. This represented 56.3% of active HPN users in PNDU, and 14.2% of the estimated 282 HPN users in Australia and New Zealand. A total of 32 (80.0%) responders had been on HPN for two or more years, receiving initial training before discharge. Just over half (57.9%) had received retraining, with most (81.0%) retraining prompted by a specific event, commonly related to a suspected or confirmed CLABSI, or change of medical equipment/item used to perform the procedure. Overall, 34 (85.0%) responders withdrew back into the syringe before connecting to parenteral nutrition (PN), 25 (73.5%) discarded the aspirate, and nine (26.5%) pushed the fluid back into the central line.
Conclusions Few HPN users receive regular retraining as part of HPN management. Beyond the written instructions given with initial HPN training, we recommend regular retraining and updating in protocols be included in HPN care to realise complication prevention benefits such as maintaining quality of life and reducing healthcare costs. Additionally, in view of technique variations, more research is needed to determine best practice for withdrawal of blood and, if required, how much drawback is sufficient and safe. These results should be included in HPN procedure guidelines.
Due to their unique developmental characteristics, preterm infants are more susceptible than most to iatrogenic harm arising from vascular cannulation and infusate infiltration or extravasation. It is therefore widely accepted that healthcare staff should take measures to prevent, detect, promptly treat, and mitigate these risks. Internationally, most neonatal units have implemented bundles of measures to reduce and manage risks associated with vascular access. One key element of these ‘care bundles’ is directed towards early detection of infiltration/extravasation events, often using a variety of visual assessment tools. The aim of this pilot product evaluation was to explore the feasibility of using a particular novel optical sensor-based infiltration detection technology (ivWatch®) in a neonatal unit.
The device was used on 15 preterm infants receiving short-term vesicant infusions while awaiting placement of central lines. Infiltration notifications were issued by the technology for 14 out of the 15 infiltrations confirmed by visual inspection. This corresponded to a sensitivity of 93.3% and, importantly, in all cases was detected earlier than was detected by staff using an hourly documented visual inspection tool. This pilot found that the technology was easy to use and apply, with only minor additions to existing intravenous (IV) access practice. Continuous IV site monitoring using optical sensor technology offers the potential to detect infiltration and extravasation events earlier than when using intermittent observational tools alone. Further study is required on larger neonatal study populations with a broader range of gestational ages, weights and IV site locations.
Background Whether to remove or retain vascular access devices (VADs) when they are suspected of infection is an important clinical question with no certain answer. This review aims to explore current literature related to removal versus retention of central venous catheters (CVCs) and intra-arterial lines (IALs) suspected of infection in the adult intensive care population.
Methods A narrative review of studies describing management of VADs suspected of infection in the intensive care unit (ICU) was undertaken. After a systematic search, two clinical studies were included in the review. The methodological rigour of these studies was assessed per the Mixed Methods Appraisal Tool (MMAT).
Results The two eligible studies consisted of one randomised control trial and one prospective observational study, including a total of 448 patients. Both studies scored highly on the MMAT, but only pertained to CVCs. No studies relating to other VAD types were identified. No significant differences in outcome were identified between patients whose VADs were removed or retained in the adult ICU cohort, apart from a reduction in number of CVC replacements in patients whose VAD was retained after infection was suspected.
Conclusions There is minimal evidence pertaining to removal versus retention of VADs suspected of infection in the adult ICU patient cohort, and there are limited recommendations specific to suspected infection guiding clinical practice. As a result, VADs may be unnecessarily removed. Further research assessing these important patient outcomes are urgently needed to inform clinical practice.