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Implanted Devices Vulnerable to Infection
Indwelling Intravenous catheters
Prosthetic cardiac valves foreign body infections, device infections
Prosthetic orthopedic devices (joint replacements) Cerebrospinal fluid shunts/Ventriculostomy drains Peritoneal dialysis catheters
Arterious-venous anastomoses (dialysis) Vascular grafts
Mesh soft tissue support
Silicon Implants (plastic surgery)
Cardiac pacemakers
Intravascular Device Infections Types (Examples)
Peripheral Short Lines (Angiocath)
Peripheral Long Lines (Landmark)
Percutaneous CVP (Cooke triple lumen)
Pulmonary artery catheter (Swann-Ganz)
Tunnel/Cuff (Broviac)
Implanted Port (Port-a-Cath)
Intravascular Device Infections
Risk factors
Cutdowns > Percutaneous Insertion Central lines > peripheral Femoral > Jugular · Subclavian
Long duration · short duration (< 72 hours) Polyvinyl chloride · Teflon or silastic Direct insertion · tunneled Frequent access > Infrequent access Parenteral nutrition · noninitiative fluids ·
antibiotics
Tegaderm · open air dressings
Intravascular Device Infections
Pathogenesis
Contamination of Intradermal Insertion
wound (+ bleeding)
Formation of intravascular "fibrin
sheath"
Colonization of catheter, formation of
"bifilms" and "macrocolonies" Infection of "fibrin sheath" Release of "planktonic" organisms Local or generalized intravascular
infection
Intravascular Device Infections
Common organisms Coagulase-negative staphylococci Staph. aureus (including MRSA) Candida albicans Klebsiella - Enterobacter Enterococci (now including VRE) Pseudomonas aeruginosa
Intravascular Device Infections
Unusual organisms Corynebacterium jeikeium Pseudomonas cepacia Serratia marcescens Acinetobacter calcoaceticus Torulopsis