Effectiveness Not Established

Antimicrobial Coated CVC Catheters in Pediatric Patients

for Prevention of Infection: General

IV catheters that are coated or impregnated with agents such as chlorhexidine, rifampin, silver sulfadiazine, or other antimicrobial agents have been examined for effectiveness in preventing central line-associated infections. This approach has been used with nontunneled, short-term catheters in adults and children, and in the general and HCT patient populations. Findings differ between use in adults and children.

Systematic Review/Meta-Analysis

Secola, R., Lewis, M. A., Pike, N., Needleman, J., & Doering, L. (2012). "Targeting to zero" in pediatric oncology: a review of central venous catheter-related bloodstream infections. Journal of Pediatric Oncology Nursing, 29, 14–27.

Purpose

To summarize existing adult and pediatric data on central venous catheter (CVC)-related bloodstream infections (BSIs) and identify models of care that can improve pediatric oncology outcomes.

Search Strategy

Databases searched were PubMed, CINAHL, and Google Scholar (1998–2010).

Keywords searched were CVC, BSI, and pediatric oncology.

Patients were included if they

  • Had a central venous access device.
  • Had the device in place 48 hours prior to development of symptoms and/or culture.
  • Had a confirmed culture unrelated to another site.
  • Reported a fever of higher than 100.4ºF.

No exclusion criteria were specified.

Sample Characteristics

  • The total number of studies included was 24. 
  • The studies provided 8,682 total cases; the sample range was not relevant.
  • Patients were either adult or pediatric in terrtiarty hospitals or intensive care units. 
  • Diagnoses involved were not described, although pediatric oncology was included.
     

Phase of Care and Clinical Applications

  • Patients were undergoing the active antitumor treatment phase of care. 
  • The study has clinical applicability for pediatrics.

Results

Strategies to reduce CVC-related BSIs reported were summarized.  In regard to insertion site selection and catheter type, some data supported the use of an externalized catheter versus a port in children.  Use of impregnated catheters in children is controversial. Evidence-based guidelines (CVC “bundles”) have been shown to be effective to reduce BSI rates.

Bundles include

  • Hand hygiene
  • Full barriers at insertion
  • Chlorhexidine skin cleansing
  • Avoiding the femoral site
  • Removal of all unnecessary catheters.

For CVC education, studies showed that annual education enhanced adherence to policy.

Conclusions

Findings suggested that the implementation of CVC care bundles was effective in reducing CVC-related BSI rates.
 

Limitations

Most studies involved critical care patients and not necessarily those with cancer who would be more immunocompromised.  There was limited research information on pediatric oncology cases.

Nursing Implications

This review supported the use of CVC care bundles to reduce rates of CVC-related BSIs.  Findings suggested that regular and repeated education on CVC care can improve adherence to care protocols.

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