Use of a chlorhexidine-impregnated patch does not decrease the incidence of bacterial colonization of femoral nerve catheters: a randomized trial
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- 作者：Kristopher M. Schroeder MD (1)
Robert A. Jacobs DO (1)
Christopher Guite MD (1)
Kyle Gassner MD (1)
Brooke Anderson MS ; RN (1)
Melanie J. Donnelly MD (1) - 刊名：Canadian Journal of Anesthesia/Journal canadien d'anesth篓娄sie
- 出版年：2012
- 出版时间：October 2012
- 年：2012
- 卷：59
- 期：10
- 页码：950-957
- 全文大小：386KB
- 参考文献：1. / Capdevila X, / Barthelet Y, / Biboulet P, / Ryckwaert Y, / Rubenovitch J, / d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 1999; 91: 8-15. CrossRef
2. / Liu SS, / Wu CL. The effect of analgesic technique on postoperative patient-reported outcomes including analgesia: a systemic review. Anesth Analg 2007; 105: 789-808. CrossRef
3. / Singelyn FJ, / Gouverneur JM. Extended “three-in-one-block after total knee arthroplasty: continuous versus patient-controlled techniques. Anesth Analg 2000; 91: 176-80.
4. / Heid F, / Muller N, / Piepho T, / et al. Postoperative analgesic efficacy of peripheral levobupivacaine and ropivacaine: a prospective, randomized double-blind trial in patients after total knee artroplasty. Anesth Analg 2008; 106: 1559-61. CrossRef
5. / Adam F, / Jaziri S, / Chauvin M. Psoas abscess complicating femoral nerve block catheter. Anesthesiology 2003; 99: 230-1. CrossRef
6. / Cuvillon P, / Ripart J, / Lalourcey L, / et al. The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 2001; 93: 1045-9. CrossRef
7. / Capdevila X, / Pirat P, / Bringuier S, / et al. Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1, 416 patients. Anesthesiology 2005; 103: 1035-45. CrossRef
8. / Aveline C, / Le Hetet H, / Le Roux A, / et al. Perineural ultrasound-guided catheter bacterial colonization: a prospective evaluation in 747 cases. Reg Anesth Pain Med 2011; 36: 579-84.
9. / Morin AM, / Kerwat KM, / Klotz M, / et al. Risk factors for bacterial catheter colonization in regional anaesthesia. BMC Anesthesiol 2005; 5: 1. CrossRef
10. / Compere V, / Legrand JF, / Guitard PG, / et al. Bacterial colonization after tunneling in 402 perineural catheters: a prospective study. Anesh Analg 2009; 108: 1326-30. CrossRef
11. / Rijinders BJ, / Van Wijingaerden E, / Peetermans WE. Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence? Clin Infect Dis 2002; 35: 1053-8. CrossRef
12. / Shapiro JM, / Bond EL, / Garman JK. Use of a chlorhexidine dressing to reduce microbial colonization of epidural catheters. Anesthesiolgy 1990; 73: 625-31. CrossRef
13. / Mann TM, / Orlikowski CE, / Gurrin LC, / Keil AD. The effect of the Biopatch, a chlorhexidine impregnated dressing, on bacterial colonization of epidural catheter exit sites. Anaesth Intensive Care 2001; 29: 600-3.
14. / Ho KM, / Litton E. Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. J Antimicrob Chemother 2006; 58: 281-7. CrossRef
15. / Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med 2006; 31: 311-23.
16. / Crawford AG, / Fuhr JP Jr, / Rao B. Cost-benefit analysis of chlorhexidine gluconate dressing in the prevention of catheter-related bloodstream infections. Infect Control Hosp Epidemiol 2004; 25: 668-74. CrossRef
17. / Ye X, / Rupnow M, / Bastide P, / Lafuma A, / Ovington L, / Jarvis WR. Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated injections in the United States. Am J Infect Control 2011; 39: 647-54. CrossRef
18. / Wiegel M, / Gottschaldt U, / Hennebach R, / Hirschberg T, / Reske A. Complications and adverse effects associated with continuous peripheral nerve blocks in orthopedic patients. Anesth Analg 2007; 104: 1578-82. CrossRef
19. / Neuburger M, / Buttner J, / Blumenthal S, / Breitbarth J, / Borgeat A. Inflammation and infection complications of 2285 perineural catheters: a prospective study. Acta Anaesthesiol Scand 2007; 51: 108-14. CrossRef
20. / Swenson JD, / Bay N, / Loose E, / et al. Outpatient management of continuous peripheral nerve catheters placed using ultrasound guidance: an experience in 620 patients. Anesth Analg 2006; 103: 1436-43. CrossRef
21. / Safdar N, / Maki D. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004; 30: 62-7. CrossRef
22. / Yuan HB, / Zuo Z, / Yu KW, / Lin WM, / Lee HC, / Chan KH. Bacterial colonization of epidural catheters used for short-term postoperative analgesia: microbiological examination and risk factor analysis. Anesthesiology 2008; 108: 130-7. CrossRef - 作者单位：Kristopher M. Schroeder MD (1)
Robert A. Jacobs DO (1)
Christopher Guite MD (1)
Kyle Gassner MD (1)
Brooke Anderson MS, RN (1)
Melanie J. Donnelly MD (1)
1. Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792, USA
文摘
Purpose Femoral nerve catheter (FNC) insertion is commonly performed for postoperative analgesia following total knee arthroplasty (TKA). A wide range of rates has been reported relating to the bacterial colonization of catheters complicating FNC insertion. The BIOPATCH? is a chlorhexidine (CHG) impregnated patch designed to inhibit bacterial growth for days. The BIOPATCH has proven to be effective at decreasing bacterial colonization in epidural and vascular catheters. We hypothesized that the BIOPATCH would be effective at decreasing the rates of FNC bacterial colonization. Methods Following Institutional Review Board approval and written informed consent, 100 patients scheduled for TKA were prospectively enrolled in the study. Patients at elevated risk for infection were excluded from analysis. Femoral nerve catheters were inserted and tunneled under sterile conditions using ultrasound guidance following CHG skin cleansing. Participants were then randomized either to have the BIOPATCH applied to the catheter exit site or not to have the patch applied. All patients received pre/postoperative antibiotic therapy. The FNC tip and catheter exit site were cultured for bacterial growth at the conclusion of therapy. Results No differences were observed between groups in regards to catheter exit site. Catheter colonization was observed in three of 48 (6.3%) BIOPATCH patients and two of 47 (4.3%) non-BIOPATCH patients?(risk ratio [RR]?=?1.5; 95% confidence interval [CI] 0.3 to 8.4; P?=?1.0). Colonization of the catheter exit site was observed in 12 BIOPATCH and 14 non-BIOPATCH patients (RR?=?0.8; 95% CI 0.4 to 1.6; P?=?0.65). Local skin inflammation (non-BIOPATCH 10.6% vs BIOPATCH 2.1%) and colonization of the FNC exit site by more than one type of bacteria trended towards increased values in the non-BIOPATCH group. Conclusions The baseline rate of bacterial colonization of FNCs is quite low in the setting of short-term use, CHG skin decontamination, ultrasound guidance, subcutaneous tunneling, and perioperative antibiotic therapy. No benefit was shown by using the BIOPATCH in this patient population. (ClinicalTrials.gov number: NCT01411891).