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Intensive care

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K Schumacher, J Brierley. Great Ormond Street Hospital, London, UK

Introduction: Central venous lines (CVL) are necessary to provide care for critically ill children. However, CVL infection is a major complication of the intensive care unit and preventing CVL infections is one of the US “5 million lives” campaign aims. A previous study (2000) in a mixed tertiary paediatric and neonatal surgical intensive care unit (ICU) showed a reduction in CVL-related infections using heparin-bonded lines (46.96 to 5.17/1000 line days). The current infection rates were studied to see whether the effect had been maintained.

Methods: All neonatal/paediatric ICU admissions from December 2006 to May 2007 were studied.

Inclusion Criteria: CVL inserted on this unit, or by the ICU retrieval service—ensuring all CVL studied were heparin bonded.

Exclusion Criteria: No CVL, line inserted by local team, other central venous catheters. Duration of CVL, site of insertion and cultures (tip plus blood) were measured. CVL infection was defined as per consensus criteria as systemic inflammatory response syndrome (international paediatric sepsis definitions) and confirmed/suspected CVL infection: positive blood culture from any site (bloodstream infection; BSI), positive CVL tip and blood culture (catheter-related (CR)-BSI) or clinical CVL sepsis suspected, but culture negative (?CR-BSI)

Results: 333 children were admitted during the period, with 210 needing CVL. Heparin-bonded CVL, 134; Hickman/peripherally inserted central catheter, 39; silastic, 12; umbilical venous catheter, 5; continuous venovenous haemofiltration, 20. 186 heparin-bonded catheters were used (multiple catheters during stay). Total CVL days 572. 10 clinical episodes …

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