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Principles of Critical Care, 3e
Part V. Infectious Disorders
Chapter 50. Infectious Complications of Intravascular Access Devices
J. M. Conly
device related infection; vascular access infection.
The use of intravascular access devices has become an integral part of modern patient care, and nowhere is this more evident than the ICU. Progress over the last two to three decades has provided an increasing array of devices other than the original peripheral and single-lumen central catheters. Included in the list of devices currently in use are multilumen central venous catheters (CVCs); tunneled CVCs such as the Hickman, Broviac, Cook, and Quinton catheters; flow-directed pulmonary artery catheters (PACs), peripherally inserted central and midline catheters, peripheral arterial catheters, and totally implantable devices. These indwelling intravascular devices provide a route for the administration for fluids, blood products, nutritional products, and medications; allow the monitoring of hemodynamic functions; and permit bloodletting and the maintenance of emergency access. However, vascular access devices may be associated with several complications, including local and bacteremic infections related to the device, thrombosis, thrombophlebitis, and septic thrombophlebitis. Infectious complications are the most frequent and among the most serious of these complications. The magnitude of CVC-related infectious complications can be appreciated when one realizes there are an estimated 15 million days of exposure to CVCs in patients in ICUs in the United States each year.
Bacteremias caused by intravascular devices are associated with increased morbidity, prolonging hospitalization a mean of 7 days, and have a reported attributable..."
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