Access technique and its problems in parenteral nutrition – Guidelines on Parenteral Nutrition, Chapter 9

000078 10.3205/000078 urn:nbn:de:0183-0000787 Review Article Access technique and its problems in parenteral nutrition – Guidelines on Parenteral Nutrition, Chapter 9 Technik und Probleme der Zugänge in der parenteralen Ernährung – Leitlinie Parenterale Ernährung, Kapitel 9 Jauch Jauch K. W. KW

Dept. Surgery Grosshadern, University Hospital, Munich, Germany

author Schregel Schregel W. W

Dept. of Anaesthetics, St. Joseph's Hospital Krefeld-Uerdingen, Germany

author Stanga Stanga Z. Z

Polyclinic for Endocrinology, Diabetology and Clinical Nutrition, Clinic for General Internal Medicine, University of Berne, Switzerland

author Bischoff Bischoff S. C. SC

Polyclinic for Endocrinology, Diabetology and Clinical Nutrition, Clinic for General Internal Medicine, University of Berne, Switzerland

author Braß Braß P. P

Dept. of Anaesthesiology and Operative Intensive Medicine, University of Cologne, Germany

author Hartl Hartl W. W

Dept. Surgery Grosshadern, University Hospital, Munich, Germany

author Muehlebach Muehlebach S. S

CSO Vifor Pharma Ag, Villars-sur-Glâne, Switzerland

author Pscheidl Pscheidl E. E

Dept. of Anaesthesiology, Intensive Medicine and Special Pain Therapy, Landshut, Germany

author Thul Thul P. P

Dept. of General, Visceral, Vascular and Thorax Surgery, Humboldt University of Berlin, Germany

author Volk Volk O. O

Dept. of Internal Medicine I/Cardiology, Krefeld, Germany

author Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine author German Medical Science GMS Publishing House

Düsseldorf

610 intravenous access central venous catheter handling of central catheter catheter-related infections in-line filter intravenöse Zugänge zentralvenöse Katheter Handhabung zentraler Katheter katheterassoziierte Infekte In-line-Filter Special Issue 20090114 20091118 engl 1612-3174 7 GMS German Medical Science GMS Ger Med Sci 19 Abhängig von der voraussichtlichen Dauer der PE sollte der Kathetertyp, die Zugangstechnik und die Katheterposition mit dem geringsten Komplikationsrisiko (infektiös und nicht-infektiös) gewählt werden. Eine langfristige (>7–10 Tage), bedarfsadaptierte parenterale Ernährung (PE) ist auf einen suffizienten zentralvenösen Zugangsweg angewiesen, wobei für eine PE <3 Wochen perkutan eingelegte Katheter und für eine PE >3 Wochen subkutan tunnelierte Katheter oder implantierte Portsysteme zur Anwendung kommen. Der zentralvenöse Katheter (ZVK) sollte vor und nach der PE-Applikation und bei ZVK-Okklusion mit physiologischer NaCl-Lösung gespült werden. Die Indikationsstellung zur Anlage eines venösen Zugangs muss streng erfolgen und der Katheter sollte schnellst möglich wieder entfernt werden, wenn er nicht mehr benötigt wird. Zur Reduktion des Infektionsrisikos sollten Blutentnahmen aus dem ZVK vermieden werden. Bei Verdacht auf Katheterinfektion sollten gleichzeitig Blutkulturen peripher und aus jedem Katheterlumen entnommen werden. Bei ausgeprägten lokalen Infektzeichen der Insertionsstelle und klinischem Verdacht auf Katheter-induzierte Blutstrom-Infektion ist die ZVK-Neuanlage vorzunehmen. Im Falle einer kurzzeitig indizierten PE (max. 7–10 Tage) kann eine periphervenöse Zufuhr durchgeführt werden, wenn keine hyperosmolaren Lösungen (>800 mosm/l) und keine Lösungen mit einer hohen Titrationsazidität bzw. -alkalität</PlainText></TextGroup> (Bikarbonat, Trispuffer) appliziert werden. Die periphere Kanüle (PVK) kann so lange liegen bleiben, wie sie benötigt wird, wenn an der Einstichstelle keine Entzündungszeichen auftreten.</Pgraph> </Abstract> <Abstract language="en" linked="yes"> <Pgraph>Catheter type, access technique, and the catheter position should be selected considering to the anticipated duration of PN aiming at the lowest complication risks (infectious and non-infectious). Long-term (>7–10 days) parenteral nutrition (PN) requires central venous access whereas for PN <3 weeks percutaneously inserted catheters and for PN >3 weeks subcutaneous tunnelled catheters or port systems are appropriate. CVC (central venous catheter) should be flushed with isotonic NaCl solution before and after PN application and during CVC occlusions. Strict indications are required for central venous access placement and the catheter should be removed as soon as possible if not required any more. Blood samples should not to be taken from the CVC. If catheter infection is suspected, peripheral blood-culture samples and culture samples from each catheter lumen should be taken simultaneously. Removal of the CVC should be carried out immediately if there are pronounced signs of local infection at the insertion site and/or clinical suspicion of catheter-induced sepsis. In case PN is indicated for a short period (max. 7–10 days), a peripheral venous access can be used if no hyperosmolar solutions (>800 mosm/L) or solutions with a high titration acidity or alkalinity are used. A peripheral venous catheter (PVC) can remain in situ for as long as it is clinically required unless there are signs of inflammation at the insertion site. </Pgraph> </Abstract> <TextBlock linked="yes" name="Central venous access"> <MainHeadline>Central venous access</MainHeadline> <Pgraph> <UnorderedList> <ListItem level="1">Long-term (>7–10 days) parenteral nutrition (PN) requires central venous access (A).</ListItem> <ListItem level="1">Strict indications are required for central venous access placement, and the catheter should be removed as soon as possible (A).</ListItem> <ListItem level="1">Catheter type, access technique, and the catheter position should be selected considering to the anticip<TextGroup><PlainText>ate</PlainText></TextGroup>d duration of PN aiming at the lowest complication risks (infectious and non-infectious) (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary </SubHeadline> <Pgraph>PN solutions are administered either via a central venous catheter or over short term via peripheral venous cannulae, depending on the condition of the patient (type of illness, current state of health etc.), composition of the infused solution, amount of energy to be administered, and duration of PN. Accessibility of the venous system needs to be evaluated considering vascular status, a<TextGroup><PlainText>na</PlainText></TextGroup>tomy, and coagulation status. PN associated complications such as infections and mechanical problems result in significantly increased morbidity and mortality <TextLink reference="1"></TextLink>, <TextLink reference="2"></TextLink>. Regular monitoring of metabolic response to PN is also required <TextLink reference="3"></TextLink>. Any venous access that is no longer required should be immediately removed <TextLink reference="4"></TextLink>, <TextLink reference="5"></TextLink>.</Pgraph> <Pgraph>PN is usually administered via a central venous catheter because of the high osmolarity of nutrient admixtures. The objective of a central venous catheter (CVC) is to get access to the vena (V) cava. The tip of the CVCs is often placed in the superior vena cava. Peripheral and central venous access sites are available for this placement.</Pgraph> <Pgraph>When using central venous access sites, the CVC is ins<TextGroup><PlainText>erte</PlainText></TextGroup>d directly into a large vein close to the heart. The location of the catheter tip should generally be radiologically documented; ECG-controlled position monitoring is possible.</Pgraph> <Pgraph>An alternative to central venous cannulation is a peripherally inserted central catheter (PICC) using an ultrasound-guided cannulation of a peripheral vein in the upper arm <TextLink reference="6"></TextLink>. A technically simpler method is the placement of a PICC-line in an elbow vein without ultrasound control, and advancement of this peripheral catheter to the superior vena cava. The advantages of these peripheral access sites are lower rates of acute complications such as pneumothorax, life-threatening bleedings, etc. The disadvantage is that local complications (phlebitis etc.) <TextLink reference="7"></TextLink>, and late complications, especially thromboses and infections, occur more frequently <TextLink reference="8"></TextLink> (see also section on peripheral venous access (below) under peripheral venous PN).</Pgraph> <SubHeadline>Selection of catheters for central venous access</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">Central venous catheters inserted by percutaneous cannulation are favoured for short-term administration of PN (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>The estimated duration of PN is extremely important when selecting the type of catheter. If less than three weeks of PN are anticipated, then percutaneously inserted cathe<TextGroup><PlainText>ter</PlainText></TextGroup>s (e.g. by means of Seldinger technique) are appropriate <TextLink reference="9"></TextLink>. The Seldinger method is favoured as it offers signific<TextGroup><PlainText>an</PlainText></TextGroup>t advantages when compared to other techniques: lower risk of injury with cannulation, lower risk of air embolism <TextLink reference="10"></TextLink>, <TextLink reference="11"></TextLink> and higher success rate <TextLink reference="12"></TextLink>.</Pgraph> <SubHeadline>Infusion pumps </SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">High-caloric PN should preferably be administered with infusion pumps (C).</ListItem> <ListItem level="1">PN should always be administered by an infusion pump in neonatal and paediatric patients (C).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>The supply rate of infusion solutions can be set, with a high degree of accuracy by using infusion pumps, or by employing the effects of gravity and setting the infusion speed via a drop counter. All-in-one solutions should preferably be administered via an infusion pump. The advantage of such devices is a precise control of the flow rate, which may enhance PN tolerance. </Pgraph> <Pgraph>The drop speed, when using gravity infusions, cannot be regulated as precisely as with the use of infusion pumps, resulting in potentially excessive infusion rates. The use of infusion pumps is generally recommended for infants and children, to secure a controlled flow rate.</Pgraph> <SubHeadline>Infectious CVC complications</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">CVC cannulation predisposes patients to infectious complications (A).</ListItem> <ListItem level="1">Blood samples should not to be taken from the CVC to reduce the risk of infection (B).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>There is close correlation between length of hospital stay (LOS) and risk of infection <TextLink reference="13"></TextLink>, <TextLink reference="14"></TextLink>, <TextLink reference="15"></TextLink>. Thrombotic complications also depend on LOS <TextLink reference="15"></TextLink>, <TextLink reference="16"></TextLink>.</Pgraph> <Pgraph>Difficult cannulations, severe infectious underlying illnesses, immune deficiency or cannulations carried out under emergency conditions or by inexperienced doctors, predispose patients to infectious CVC complications in PE <TextLink reference="17"></TextLink>, <TextLink reference="18"></TextLink>, <TextLink reference="19"></TextLink>.</Pgraph> <Pgraph>Blood sampling from a CVC increase the risk of catheter-associated infections <TextLink reference="20"></TextLink>, <TextLink reference="21"></TextLink>, <TextLink reference="22"></TextLink>, <TextLink reference="23"></TextLink>, <TextLink reference="24"></TextLink>.</Pgraph> <Pgraph>Patients with structural heart disease and associated risk factors should receive endocarditis prophylaxis prior to cannulation. </Pgraph> <SubHeadline>Used catheter/flush system</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">Subcutaneous tunnelled catheters or port systems should be implanted and used for long-term PN, especially for home PN (A).</ListItem> <ListItem level="1">Port needles should be replaced every three to seven days (B).</ListItem> <ListItem level="1">Routine flushing of non-utilised CVCs or port systems with heparin is not recommended (A).</ListItem> <ListItem level="1">CVC should be flushed with isotonic NaCl solution before and after PN application (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Tunnelled or implanted permanent devices (Broviac<Superscript>®</Superscript> or Hickman<Superscript>®</Superscript>/Groshong<Superscript>®</Superscript> catheters, port systems) are suitable for long-term PN (>3 weeks) <TextLink reference="1"></TextLink>. Broviac<Superscript>®</Superscript> and <TextGroup><PlainText>Hickman</PlainText></TextGroup><Superscript>®</Superscript>/Groshong<Superscript>®</Superscript> catheters are implantable, percutaneously inserted venous silicone catheters. The majority of tunnelled devices have a short polyester cuff attached to the catheter that encourages fibrosis, and therefore anchorage within the subcutaneous tissues, and thus can prevent bacteria from penetrating <TextLink reference="25"></TextLink>.</Pgraph> <Pgraph>If the CVC is temporarily not in use, it should be flushed daily with isotonic NaCl solution <TextLink reference="26"></TextLink>. A heparin flush solution is not recommended as no benefits are known <TextLink reference="26"></TextLink>, but there is a risk of heparin-induced thrombocytop<TextGroup><PlainText>eni</PlainText></TextGroup>a (HIT) and incompatibilities.</Pgraph> <Pgraph>In 1993, Raad et al. <TextLink reference="27"></TextLink> described the non-tunnelled silastic catheter as a safe and economical alternative to the surgically implanted systems (tunnelled and port catheters). Port systems are totally implantable venous silicone or polyurethane catheters with subcutaneous reservoir chambers made of titanium or ceramic. The port membrane is made of silicone, and is only punctured with special port cannulae (non-coring port needles). It is recomm<TextGroup><PlainText>ende</PlainText></TextGroup>d that the port needle be replaced every third to seventh day in patients receiving home PN with cyclical nutritional application. The transparent dressing should be replaced at similar intervals <TextLink reference="28"></TextLink>, <TextLink reference="29"></TextLink>, <TextLink reference="30"></TextLink>, <TextLink reference="31"></TextLink>, <TextLink reference="32"></TextLink>. If no nutrient solution and only drugs (cytostatic) are administered via the port, the port needle can be left in situ for 2 weeks <TextLink reference="33"></TextLink>, <TextLink reference="34"></TextLink>, <TextLink reference="35"></TextLink>. Extremely good long-term usability and high patient acceptance have been observed with correct handling <TextLink reference="36"></TextLink>. Numerous prospective, non-randomised studies show a drop in the infection rate when using subcutaneous port systems <TextLink reference="37"></TextLink>, <TextLink reference="38"></TextLink>. The tunnelled CVC (Broviac/Hickman) should be preferred over the port system for long-term PN administration in children and teenagers because relatively large flush volumes are required to flush the infusion chamber.</Pgraph> <Pgraph>In a prospective cohort study, the instillation of minocycline ethylene diamine tetraacetate (M-EDTA) (port lock) significantly reduced rate of infections and thrombosis in children <TextLink reference="39"></TextLink>.</Pgraph> <SubHeadline>Access sites/catheter position</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">In adults, the subclavian vein is preferred over the internal jugular vein or any other access site with respect to infection risk (A).</ListItem> <ListItem level="1">In paediatric patients, access through the groin results in comparable infection rates that other access sites (B).</ListItem> <ListItem level="1">PN solutions should be administered through a CVC with its tip positioned in the superior vena cava (C).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Clinical research data are still limited with regard to the insertion site <TextLink reference="40"></TextLink>, <TextLink reference="41"></TextLink>. Percutaneously inserted catheters should usually be placed in the superior vena cava. In adults, femoral catheters correlate with an increased risk of thrombosis and catheter-related sepsis and are, therefore, inappropriate for the administration of PN solutions <TextLink reference="42"></TextLink>, <TextLink reference="43"></TextLink>, <TextLink reference="44"></TextLink>, <TextLink reference="45"></TextLink>, <TextLink reference="46"></TextLink>, <TextLink reference="47"></TextLink>, <TextLink reference="48"></TextLink>, <TextLink reference="49"></TextLink>, <TextLink reference="50"></TextLink>, <TextLink reference="51"></TextLink>, <TextLink reference="52"></TextLink>. Access to the superior vena cava can be achieved through the internal jugular vein, subclavian vein or a peripheral vein in the arm. Catheters placed through the jugular vein are associated with an increased rate of local haematomas, arterial damage and catheter-associated infections as compared to subclavian and femoral catheters <TextLink reference="53"></TextLink>, <TextLink reference="54"></TextLink>, <TextLink reference="55"></TextLink>, <TextLink reference="56"></TextLink>, <TextLink reference="57"></TextLink>, <TextLink reference="58"></TextLink>. On the other hand, subclavian catheters are associated with an increased risk of pneumothorax as compared to jugular catheters <TextLink reference="13"></TextLink>, <TextLink reference="14"></TextLink>, <TextLink reference="54"></TextLink>, <TextLink reference="59"></TextLink>, <TextLink reference="60"></TextLink>, <TextLink reference="61"></TextLink>. </Pgraph> <Pgraph>It has not been conclusively determined whether the tip of the catheter is better positioned in the superior vena cava or in the right atrium <TextLink reference="62"></TextLink>, <TextLink reference="63"></TextLink>, <TextLink reference="64"></TextLink>, <TextLink reference="65"></TextLink>. However, pericardial tamponades, cardiac arrhythmia, heart lesions and thromboses have been described when the catheter tip has been positioned in the atrium, rendering this an obsolete position.</Pgraph> <Pgraph>The prospective randomised study by Cowl et al. <TextLink reference="65"></TextLink> compared 102 patients receiving PN through a subclavian catheter compared to peripherally inserted CVCs. The study concluded that peripherally inserted CVCs are associated with a significantly higher rate of thrombophlebitis and placement problems. No differences have been recorded regarding rate of infection, catheter dislocation and occlusions. These results are in line with those of other authors <TextLink reference="66"></TextLink>, <TextLink reference="67"></TextLink>, <TextLink reference="68"></TextLink>.</Pgraph> <Pgraph>Studies in paediatric patients have shown a lower incid<TextGroup><PlainText>enc</PlainText></TextGroup>e of mechanical complications with access through the groin, and the rate of infection is similar to that of non-femoral access <TextLink reference="69"></TextLink>, <TextLink reference="70"></TextLink>, <TextLink reference="71"></TextLink>.</Pgraph> <SubHeadline>Control of catheter position</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">An x-ray examination should be carried out after every CVC placement, if the subclavian venous access route is used, or if there were any complications with regard to implantation, or if no alternative procedure can be used to verify the catheter position (B).</ListItem> <ListItem level="1">Ultrasound-controlled catheter positioning significantly reduces the rate of complications associated with cannulation (A).</ListItem> <ListItem level="1">ECG-controlled CVC placement represents a safe method (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Fluoroscopic control permits immediate correction of the catheter position in the superior vena cava <TextLink reference="72"></TextLink>, but is no longer recommended due to the relatively high radiation exposure. A radiological confirmation to ensure correct position of a CVC is recommended, by some <TextGroup><PlainText>authors</PlainText></TextGroup>, before commencing PN <TextLink reference="73"></TextLink>, <TextLink reference="74"></TextLink>, <TextLink reference="75"></TextLink>.</Pgraph> <Pgraph>Various meta analyses have shown that ultrasound-guided CVC insertion via venous cannulation is clearly superior to conventional standard catheter placement, which uses fixed anatomical reference points, with regard to the rate of success and complications <TextLink reference="76"></TextLink>, <TextLink reference="77"></TextLink>, <TextLink reference="78"></TextLink>, <TextLink reference="79"></TextLink>, <TextLink reference="80"></TextLink>, <TextLink reference="81"></TextLink>. Another method for confirming the position of the catheter tip in the superior vena cava or the right atrium is to use electrocardiographically guided placement <TextLink reference="82"></TextLink>, <TextLink reference="83"></TextLink>, in which a fluid-filled catheter or the retracted guide wire <TextLink reference="83"></TextLink>, <TextLink reference="84"></TextLink> are used as an electrode for intravascular ECG-guidance <TextLink reference="85"></TextLink>, <TextLink reference="86"></TextLink>, <TextLink reference="87"></TextLink>. Prerequisites are a sinus rhythm and an ECG device authorised for intracardial ECG-guidance. The procedure is not recommended limited for use in left-sided internal jugular vein cannulation because of limited accuracy <TextLink reference="88"></TextLink>.</Pgraph> <Pgraph>Watters et al. <TextLink reference="89"></TextLink> compared 1236 ECG-controlled placements with 586 fluoroscopically-controlled CVC placements. Radiological thorax monitoring resulted in an optimum catheter position in both groups <TextLink reference="89"></TextLink>. Other studies (partly randomised, prospective) show that ECG-guided CVC placement is a safe method <TextLink reference="90"></TextLink>, <TextLink reference="91"></TextLink>, <TextLink reference="92"></TextLink>, <TextLink reference="93"></TextLink>.</Pgraph> <SubHeadline>Material-related issues</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">Catheter material, catheter design, mechanical properties and anti-infectious potential correlate with the rate of complications (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>There are strict requirements regarding the materials used for venous catheters. Catheters must be manufactured from tissue-friendly material, must have a length classification and be X-ray opaque. Generally, every CVC represents a foreign body that can result in inflammation, formation of thromboses, and infections.</Pgraph> <Pgraph>The catheter material may increase thrombogenicity which can result in catheter colonisation and catheter-associated infections <TextLink reference="94"></TextLink>, <TextLink reference="95"></TextLink>. Special attention should be paid to potential reactions of incompatibility to the material or coatings. The associated thrombogenicity and contamination rate, due to physicochemical reactions, is high in catheters made of PVC, polypropylene or polyethylene but low in coated polyurethane catheters <TextLink reference="62"></TextLink>, <TextLink reference="96"></TextLink>, <TextLink reference="97"></TextLink>, <TextLink reference="98"></TextLink>, <TextLink reference="99"></TextLink>. Catheters with a rough surface make it easier for microorganisms to attach themselves (especially coagulase-negative staphylococci, Pseudomonas aeruginosa and Acinetobacter calcoaceticus) <TextLink reference="62"></TextLink>, <TextLink reference="94"></TextLink>, <TextLink reference="100"></TextLink>, <TextLink reference="101"></TextLink>. Some candida species can produce mucous in the presence of glucose-based solutions which enables fungal pathogens to attach themselves easily, and explains the high rate of infection <TextLink reference="102"></TextLink>. More recent data on heparin-coated CVCs show positive results regarding the reduction of CVC colonisation by microorganisms <TextLink reference="102"></TextLink>, <TextLink reference="103"></TextLink>, <TextLink reference="104"></TextLink>, <TextLink reference="105"></TextLink>. A few isolated cases of heparin-induced thrombocytopenia (HIT) using heparin-coated pulmonary catheters and CVCs have been described in literature <TextLink reference="106"></TextLink>, <TextLink reference="107"></TextLink>.</Pgraph> <Pgraph>The catheter used for central venous access should be as thin as possible and the lumen of the analogous vein should be as large as possible. The rate of infection with CVC was reported increases with the number of CVC lumina <TextLink reference="108"></TextLink>, <TextLink reference="109"></TextLink>, <TextLink reference="110"></TextLink>, <TextLink reference="111"></TextLink>, <TextLink reference="112"></TextLink>, but there are also studies showing no increased infection risks with multi-lumen catheters, especially if PN is administered through a separate lumen and no blood samples are taken via the CVC <TextLink reference="52"></TextLink>, <TextLink reference="113"></TextLink>, <TextLink reference="114"></TextLink>, <TextLink reference="115"></TextLink>. As short intravascular length of the CVC catheter and limited venous wall contact appear preferable.</Pgraph> <SubHeadline>Hygiene measures</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">Rigorous asepis must be applied during CVC insertion (use of mask, cap, sterile gown, sterile gloves).</ListItem> <ListItem level="1">Prior to the CVC insertion, the insertion site should be disinfected, preferably with chlorhexidine (B). </ListItem> <ListItem level="1">Antibiotic prophylaxis and the use of antibiotic-cont<TextGroup><PlainText>ainin</PlainText></TextGroup>g creams are not recommended for CVC insertion (B). </ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Evidence-based measures for the prevention of catheter-related infections in PN have been reviewed by Attar et al. <TextLink reference="116"></TextLink> and O’Grady et al. <TextLink reference="13"></TextLink>. Their recommendations are to wear a sterile cap, mask, gown and gloves after hand disinfection, to sufficiently disinfect the skin at the insertion site (at least for 30 seconds with 2% chlorhexidine) as well as to use a sufficiently large, sterile drape for the cannulation site <TextLink reference="117"></TextLink>, <TextLink reference="118"></TextLink>. The importance of team training in CVC handling is emphasised <TextLink reference="13"></TextLink>, <TextLink reference="119"></TextLink>, <TextLink reference="120"></TextLink>.</Pgraph> <Pgraph>Skin disinfection with a 2% chlorhexidine gluconate aqueous solution reduced the colonisation rate by micro-organisms compared to 10% polyvidon-iodine solution or 70% alcohol (residual effect of chlorhexidine) <TextLink reference="118"></TextLink>. A randomised, prospective study showed that other chlorhexidine preparations (e.g. 0.5% tincture) are not more effective than the 10% polyvidon-iodine solution with regards to catheter colonisation <TextLink reference="121"></TextLink>. In a study on newborns, a 0.5% chlorhexidine reduced the catheter colonisation rate more effectively than polyvidon-iodine solutions <TextLink reference="122"></TextLink>. A multicentric study confirmed that a chlorhexidine-impregnated polyurethane foam over the catheter exit site reduces the risk of CVC colonisation and infection <TextLink reference="123"></TextLink>.</Pgraph> <Pgraph>Antibiotic prophylaxis during catheter insertion, for prevention of line-induced infections, is not useful <TextLink reference="61"></TextLink>, <TextLink reference="124"></TextLink>, <TextLink reference="125"></TextLink>, <TextLink reference="126"></TextLink>. The prophylactic use of antibiotic-containing creams promote resistant flora and fauna, and should, therefore, not be used <TextLink reference="20"></TextLink>, <TextLink reference="127"></TextLink>. No difference has been observed in catheter-associated infections when it was covered with gauze or transparent film <TextLink reference="20"></TextLink>.</Pgraph> <SubHeadline>Covering the catheter insertion site</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">Sterile gauzes or sterile, transparent, semi-permeable films should be used to cover the catheter insertion site (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>A large-scale study has compared gauze dressings and transparent film dressings in peripheral venous access. The results showed a comparable incidence of phlebitis and catheter colonisation <TextLink reference="98"></TextLink>. This data indicates that transparent film dressings can remain on the insertion site throughout the duration of the intravenous therapy, without the risk of increasing thrombophlebitis <TextLink reference="98"></TextLink>. A meta-analysis confirmed similar results for gauze and film dressing with regards to catheter-associated risk of infection in CVC. Film dressings could, however, result in damp patches and theoretically promote infections <TextLink reference="128"></TextLink>.</Pgraph> <Pgraph>Well-healed insertion sites from tunnelled catheters require no dressing. A gauze dressing should, preferably, be used if the catheter insertion site is bleeding or oozing <TextLink reference="20"></TextLink>, <TextLink reference="129"></TextLink>, <TextLink reference="130"></TextLink>, <TextLink reference="131"></TextLink>, <TextLink reference="132"></TextLink>. Dressings that have become wet/damp or loosened should be immediately replaced <TextLink reference="61"></TextLink>, <TextLink reference="129"></TextLink>, <TextLink reference="130"></TextLink>.</Pgraph> <Pgraph>The recommendation for preferentially using alcohol-based skin disinfectants (fast-acting, positive effect) when changing the dressing has to be evaluated against the warnings of numerous catheter manufacturers regarding potential damage to catheter materials and induction of breaks by such disinfectants.</Pgraph> <SubHeadline>Catheter care</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">Catheter care in patients with PN should be carried out by specially trained staff, according to define standards of care (B).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>A reduction in catheter-associated infections can be achieved by specifically trained personnel (training on indications, insertion and care), and by minimising manipulation of the catheter <TextLink reference="61"></TextLink>, <TextLink reference="119"></TextLink>, <TextLink reference="133"></TextLink>, <TextLink reference="134"></TextLink>, <TextLink reference="135"></TextLink>, <TextLink reference="136"></TextLink>. Disinfection must be carried out in accordance with standards of hygiene prior to any manipulation of the catheter cuff or catheter <TextLink reference="20"></TextLink>, <TextLink reference="21"></TextLink>, <TextLink reference="137"></TextLink>, <TextLink reference="138"></TextLink>, <TextLink reference="139"></TextLink>, <TextLink reference="140"></TextLink>, <TextLink reference="141"></TextLink>, <TextLink reference="142"></TextLink>.</Pgraph> <SubHeadline>CVC changes</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">CVC changes should not be performed routinely, and if an infection is suspected, no guide wire should be used for changing a CVC (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Prophylactic catheter changes over the guide wire do not result in a drop in the risk of catheter-associated infections <TextLink reference="143"></TextLink>, but in an increase <TextLink reference="110"></TextLink>. A CVC should not be routinely changed <TextLink reference="13"></TextLink>, <TextLink reference="114"></TextLink>, except for a CVC ins<TextGroup><PlainText>erte</PlainText></TextGroup>d under emergency conditions which should be reinserted after the patient’s condition has been stabilised. A CVC should be replaced when a local infection occurs at the insertion site, or if a catheter-associated bloodstream infection is suspected, but under such conditions a guide wire technique should not be used <TextLink reference="13"></TextLink>.</Pgraph> <SubHeadline>Special catheters</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">Antibiotic or silver-coated catheters should only be used in at-risk patients and high-risk care situations (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>The rate of catheter-associated infections is reduced when using CVCs impregnated with chlorhexidine and silver sulfadiazine or with minocycline and rifampicin as compared to untreated catheters <TextLink reference="20"></TextLink>, <TextLink reference="118"></TextLink>, <TextLink reference="144"></TextLink>, <TextLink reference="145"></TextLink>. A meta analysis outlines the infection-related b<TextGroup><PlainText>en</PlainText></TextGroup>efits of a CVC impregnated with chlorhexidine-silver sulfadiazine on the exterior <TextLink reference="103"></TextLink>, <TextLink reference="146"></TextLink>, <TextLink reference="147"></TextLink>, <TextLink reference="148"></TextLink>. Catheters coated with minocycline/rifampicin on the inside and outside performed even better in a randomised study <TextLink reference="146"></TextLink>, <TextLink reference="149"></TextLink>, <TextLink reference="150"></TextLink>, <TextLink reference="151"></TextLink>, <TextLink reference="152"></TextLink>, <TextLink reference="153"></TextLink>. There are also positive results with silver-impregnated catheter systems <TextLink reference="154"></TextLink>, <TextLink reference="155"></TextLink>, <TextLink reference="156"></TextLink>.</Pgraph> <Pgraph>Coated catheters should be used if the CVC is required for more than 5 days, and there is also a high risk of infection <TextLink reference="13"></TextLink>. The slightly higher costs no longer presents a plausible argument against general use in at-risk patients <TextLink reference="150"></TextLink>, <TextLink reference="157"></TextLink>. There is an indication for coated catheters in these <Mark2>at-risk patient groups</Mark2>: critically-ill patients, patients with compromised immune systems, newborns, infants and children <TextLink reference="154"></TextLink>.</Pgraph> <SubHeadline>Anticoagulation</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">A low-dosed oral prophylactic anticoagulant should be administered to patients with home PN (B).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Clinically relevant catheter-associated thromboses are late complications of long-term PN <TextLink reference="63"></TextLink>, <TextLink reference="64"></TextLink>, <TextLink reference="65"></TextLink>. Catheter occlusions can occur because of the generation of fibrin or thrombin build-up or partial or total parietal thrombosis <TextLink reference="158"></TextLink>. Two studies indicated that heparin-coated CVCs showed disadvantages regarding the potential for developing thrombosis <TextLink reference="159"></TextLink>, <TextLink reference="160"></TextLink>. Prophylaxis with low-dosage warfarin showed a drop in the risk of thrombosis <TextLink reference="161"></TextLink>, <TextLink reference="162"></TextLink>, but not in oncology patients <TextLink reference="163"></TextLink>. The favourable effect of warfarin (dose: 1 mg/day) is confirmed in the systematic review by Klerk et al. <TextLink reference="164"></TextLink>, but it is not confirmed for heparin <TextLink reference="165"></TextLink>.</Pgraph> <SubHeadline>Filters</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">The use of in-line filters for removing particles is recommended for at-risk groups (children, immune-suppressed patients) but controversial in patients who are not at increased risk (B).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Infusion solutions can be contaminated with particles through the manufacturing process, from the container, or during the transportation or storage process. Mixing macronutrients with electrolytes, trace elements and v<TextGroup><PlainText>it</PlainText></TextGroup>amins can result in further particle contamination (incompatibility problems). Patients receiving PN are exposed to potential contamination through container materials and administration equipment (e.g. plastic particles) as well as the unintentional introduction of bacteria and precipitates. The use of filters during PN administration is effective for the mechanical removal of larger particles, precipitates, bacteria, fungi, larger lipid particles and air <TextLink reference="166"></TextLink>. However, there has not been an adequate study to date which confirms that the use of in-line filters sign<TextGroup><PlainText>if</PlainText></TextGroup>icantly reduces the rates of catheter-associated infection <TextLink reference="20"></TextLink>.</Pgraph> <Pgraph>The greatest concern regarding particles introduction relates to AIO admixtures containing calcium phosphate precipitates, which can cause diffuse microvascular lung embolisms <TextLink reference="167"></TextLink>. Precipitates are usually not visible due to the lipid content. Calcium hydrogen phosphate is often highly-concentrated, having better solubility at 2–8°C than at 37°C, which questions the reliability of filtration. Ball et al. analysed particle contamination in “ready to use” application systems. Two admixture samples were taken from the infusion set immediately before being administered to the patient and one sample was then filtered. Both samples were evaluated microscopically. The results showed that the unfiltered sample contained significantly more particles <TextLink reference="168"></TextLink>.</Pgraph> <Pgraph>Bethune et al. <TextLink reference="166"></TextLink> recommend the use of filters in the administration of PN to the following <Mark2>at-risk patient groups</Mark2>: patients with total and/or prolonged PN, patients with weak immune systems, newborns and children. In the paper of Ball et al. <TextLink reference="168"></TextLink> in-line filters are recomm<TextGroup><PlainText>ende</PlainText></TextGroup>d for all patients receiving PN. The in-line filter should be placed as close to the patient as is practical. A 1.2 μm filter is used for lipid-containing AIO admixtures and should be changed every 24 hours. A 0.2 μm filter can only be used for non-lipid-containing infusion solutions and should only be replaced after 96 hours <TextLink reference="169"></TextLink>. Filters themselves can, however, also cause problems (e.g. occlusions, adsorption of PN components like micro e<TextGroup><PlainText>le</PlainText></TextGroup>ments and drugs, cost of filters).</Pgraph> <Pgraph>Currently, there is no proof that in-line filters have any significant influence on the rate of catheter-associated septicaemia <TextLink reference="170"></TextLink>. Therefore, no recommendation can be made on their routine use for infection prevention.</Pgraph> <Pgraph>There are no legally binding rules for using in-line filters in PN. Guidance by the Robert Koch Institute <TextLink reference="61"></TextLink> on using in-line filters argues against the routine use of such filters for infection prevention purposes, but it does not refer in any detail to particle infiltration.</Pgraph> <SubHeadline>Occlusions of the CVC or port system: measures</SubHeadline> <Pgraph> <UnorderedList> <ListItem level="1">CVC occlusions can be caused by blood clots, precipitations and/or residues of PN solution components, or drugs administered (A).</ListItem> <ListItem level="1">Isotonic NaCl solution should be instilled as an initial measure (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Catheter occlusion is the most frequent non-infectious complication. Understanding and correctly identifying the potential aetiologies leading to occlusion is extremely important for the treatment strategy <TextLink reference="171"></TextLink>.</Pgraph> <Pgraph>Occlusions can occur in the form of blood clots or due to fibrin residues, especially after blood samples have been taken via the catheter or port systems. As an initial measure in CVC occlusions, NaCl (0.9%) should be inj<TextGroup><PlainText>ecte</PlainText></TextGroup>d after first aspirating the contents of CVC applying slight pressure. This procedure should be repeated if not initially successful. If the catheter remains blocked, it should be flushed with urokinase or RTPase (5000 IE/mL) (and left to work for 30–60 minutes), especially if there is a suspicion of a blood clot <TextLink reference="172"></TextLink>, <TextLink reference="173"></TextLink>, <TextLink reference="174"></TextLink>. The catheter should be replaced if none of these measures are successful.</Pgraph> <Pgraph>In individual cases, it is possible that tiny amounts of blood stick to the catheter wall and cannot be removed even through intensive flushing. This is an ideal breeding ground for bacteria and can result in the colonisation of the catheter system <TextLink reference="175"></TextLink>, <TextLink reference="176"></TextLink>.</Pgraph> <Pgraph>If no blood sample had been taken from the occluded system, then it must be assumed that an occlusion has probably occurred due to residue from the nutrient solution components. Lipid residues can result in CVC occlusions. These usually take a few days to form <TextLink reference="177"></TextLink>. In these cases, it may be effective to instil sodium hydroxide (NaOH: 0.1 mmol/ml, 0.1 M, pH 13) <TextLink reference="178"></TextLink>. Flushing with alcohol (ethanol 96%) should not be carried out, as according to silicone catheter manufacturers, alcohol immediately changes the surface of such catheters.</Pgraph> <Pgraph>Insoluble precipitates develop with the administration of drugs and electrolytes like calcium or phosphates. Precipitates can be caused by incompatibilities between these components e.g. by the formation of insoluble crystals <TextLink reference="179"></TextLink>. Calcium phosphate precipitates are of special significance, and are influenced by various factors in the admixture like amino acid composition, relative calcium and phosphate content, pH etc. <TextLink reference="180"></TextLink>, <TextLink reference="181"></TextLink>. A subcutaneously implanted permanent catheter, which is occluded due to insoluble precipitates, can be potentially re-utilised by pH changes in the PN solution <TextLink reference="182"></TextLink>, <TextLink reference="183"></TextLink>, <TextLink reference="184"></TextLink>, <TextLink reference="185"></TextLink>. Bicarbonate is very incompatible, and should not be added.</Pgraph> <SubHeadline>Infection of the CVC or port system</SubHeadline> <Pgraph>Flow diagram on suspicion of catheter-induced bloodstream infection (see Figure 1 <ImgLink imgNo="1" imgType="figure"/>) <TextLink reference="186"></TextLink>, <TextLink reference="187"></TextLink>, <TextLink reference="188"></TextLink>, <TextLink reference="189"></TextLink>.</Pgraph> <Pgraph> <UnorderedList> <ListItem level="1">If catheter infection is suspected peripheral blood-culture samples, and culture samples from each catheter lumen should be taken simultaneously (A).</ListItem> <ListItem level="1">Removal of the CVC should be carried out immediately when there are pronounced signs of local infection at the insertion site and/or clinical suspicion of catheter-induced sepsis (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Bacterial or fungal colonisation of a CVC is a potentially life threatening complication of PN as an infection of the vascular bed with the risk of complications such as septic thrombosis, infectious colonisation of other organs and endocarditis <TextLink reference="190"></TextLink>. Catheter-related sepsis occurs in 5–8 of 1000 patient days and is associated with increased morbidity, mortality and medical costs <TextLink reference="20"></TextLink>, <TextLink reference="127"></TextLink>, <TextLink reference="191"></TextLink>, <TextLink reference="192"></TextLink>.</Pgraph> <Pgraph>If catheter infection is suspected and any resulting complications, the guidelines for antimicrobial therapy for catheter infections, which have been drawn up by the Paul Ehrlich society, should be observed.</Pgraph> <Pgraph>It is not always easy to diagnose a catheter-associated infection by using only clinical parameters. In order to substantiate the suspected diagnosis, CVC blood cultures (in multi-lumen catheters, two blood-culture samples drawn from each catheter lumen) <TextLink reference="193"></TextLink> and peripherally drawn blood cultures (collected from two separate venous cannulation sites) must be obtained (Figure 1 <ImgLink imgNo="1" imgType="figure"/>); they should be taken at a maximum of 2 hours apart <TextLink reference="187"></TextLink>, <TextLink reference="188"></TextLink>, <TextLink reference="189"></TextLink>, <TextLink reference="194"></TextLink>. However, the decision to remove the catheter (with the exception of subcutaneously implanted permanent catheters <TextLink reference="195"></TextLink>) should be taken according to clinical criteria, and does not depend exclusively on the results of the microbiol<TextGroup><PlainText>ogi</PlainText></TextGroup>cal tests.</Pgraph> <Pgraph>The catheter must be removed if there are clear and definitive signs of local infection (e.g. purulent secretion at the exit site). Although, the removed catheter tip can become contaminated by this procedure, a routine microbiological test should still be carried out. Systemic antibiotic treatment (AB) should be started and adapted, if necessary, after receiving the culture and antibiotic sensitivity results. In exceptional cases, and in the absence of an immediate threat (subclinical infection), treatment with systemic antibiotics can be attempted without removing the catheter, especially if the removal of the catheter (special subcutaneously implanted permanent catheter) or the resulting consequences are likely to be problematic <TextLink reference="20"></TextLink>. Potential advantages or disadvant<TextGroup><PlainText>age</PlainText></TextGroup>s of catheter removal should be considered in <TextGroup><PlainText>decision-making</PlainText></TextGroup> in individual patients, e.g. those on long-term home PN <TextLink reference="196"></TextLink>, <TextLink reference="197"></TextLink>.</Pgraph> <Pgraph>In the absence of local signs of infection and in clinically stable patients (subclinical infection), the catheter is left in situ temporarily. Systemic antibiotic therapy should be provided and PN continued. In patients with signs of acute sepsis (acute rise in temperature with new clinical symptoms), organ dysfunction and/or haemodynamic instability (e.g. systolic blood pressure <90 mmHg or drop in systolic blood pressure of ≥40 mmHg relative to initial value, or a mean arterial pressure <60 mmHg, or the need for blood pressure lowering drugs), the catheter must be removed. The tip should be sent for microbiol<TextGroup><PlainText>ogi</PlainText></TextGroup>cal tests and a new catheter inserted at another appropriate site <TextLink reference="198"></TextLink>. In these cases, a systemic antibiotic therapy must be commenced. Guidelines are available regarding further adjuvant therapy for sepsis (diagnostic and therapy of sepsis – no. 079/001 – <Hyperlink href="http://www.awmf-leitlinien.de/">http://www.awmf-leitlinien.de/</Hyperlink>)</Pgraph> <SubHeadline>Evaluation of blood culture results</SubHeadline> <Pgraph>If peripheral blood cultures are negative with subclinical signs of infection, but blood cultures from the CVC are positive, and if other sources of inflammation can be excluded or are unlikely from a clinical point of view, the CVC should be removed and the patient treated with antibiotics. If blood cultures drawn from both the peripheral veins and CVC are positive, or there are subclinical signs of infection, a temporary (non-tunnelled) CVC should always be removed. This particularly applies to patients with artificial heart valves <TextLink reference="199"></TextLink>, <TextLink reference="200"></TextLink>, <TextLink reference="201"></TextLink> and to infections with Staphylococcus aureus or candida species. Systemic antibiotic therapy should also be commenced <TextLink reference="202"></TextLink>, <TextLink reference="203"></TextLink>, <TextLink reference="204"></TextLink>. If there are only subclinical signs of infection in patients with tunnelled CVCs, as in port systems, the situation should be monitored. However, a supplementary antibiotic lock treatment and systemic antibiotic therapy should be started <TextLink reference="205"></TextLink>, <TextLink reference="206"></TextLink>. Surgical removal of the port system must be considered if these measures have no effect. Complicated infections with acute symptoms present high-risk situations regardless of blood culture results <TextLink reference="207"></TextLink>, <TextLink reference="208"></TextLink>, <TextLink reference="209"></TextLink>, <TextLink reference="210"></TextLink>. In such cases the catheter must be removed as quickly as possible and systemic antibiotic therapy started, even before the blood culture results are received <TextLink reference="202"></TextLink>, <TextLink reference="208"></TextLink>, <TextLink reference="209"></TextLink>, <TextLink reference="210"></TextLink>, <TextLink reference="211"></TextLink>. This particularly applies to secondary complications (septic thrombosis, septic embolisms or endocarditis), and also inpatients with tunnel or port system infections or with artificial heart valves <TextLink reference="202"></TextLink>, <TextLink reference="207"></TextLink>.</Pgraph> <Pgraph>In addition to the systemic antibiotics and within the framework of an anticipative strategy, a further antibiotic lock treatment can be applied to tunnelled CVCs or port systems and intraluminal catheter colonisation with s<TextGroup><PlainText>taphyl</PlainText></TextGroup>ococci, enterobacteriaceae, gram-negative bacteria or fungi in the absence of blood culture infection <TextLink reference="212"></TextLink>, <TextLink reference="213"></TextLink>, <TextLink reference="214"></TextLink>. A series of studies have shown that aminoglycosides or penicillin can have a favourable effect, similar to expensive third generation cephalosporins, leading to a drop in bacterial colonisation <TextLink reference="215"></TextLink>, <TextLink reference="216"></TextLink>, <TextLink reference="217"></TextLink>, <TextLink reference="218"></TextLink>. Positive clinical experiences have been observed with the administration of vancomycin (3 ml: <TextGroup><PlainText>2 mg/</PlainText></TextGroup>ml) or a mixture of garamycin (0.5 mg/ml) and vancomycin (1.0 mg/ml) <TextLink reference="219"></TextLink>, <TextLink reference="220"></TextLink>.</Pgraph> <Pgraph>Henrickson et al. randomised 126 paediatric oncological patients with tunnelled CVCs to a prophylactic lock treatment using three substances <TextLink reference="221"></TextLink>. The first patient group received heparin (10 U/ml), the second group received heparin and vancomycin (25 µg/ml), and the third group received heparin, vancomycin and ciprofloxacin (<TextGroup><PlainText>2 µg/</PlainText></TextGroup>ml). The use of vancomycin-ciprofloxacin significantly reduced catheter-associated infections relative to the group receiving only heparin (p=0.005). A similar beneficial effect was observed by using vancomycin lock treatment (p=0.004).</Pgraph> <Pgraph>An antibiotic lock solution does not represent a routine procedure, but makes sense in patients requiring long-term access, and if there are potential problems regarding CVC reinsertion <TextLink reference="212"></TextLink>, <TextLink reference="218"></TextLink>.</Pgraph> </TextBlock> <TextBlock linked="yes" name="Peripheral venous access"> <MainHeadline>Peripheral venous access</MainHeadline> <Pgraph> <UnorderedList> <ListItem level="1">In adult patients, PN through periperal venous access can be carried out if the PN is indicated for a short period (max. 7–10 days) of time and no hyperosmolar solutions (>800 mosm/L) or solutions with a high titration acidity or alkalinity (bicarbonate, TRIS-buffer) are used (B).</ListItem> <ListItem level="1">A peripheral venous catheter (PVC) in adults can remain in situ for as long as it is clinically required unless there are signs of inflammation at the insertion site (A).</ListItem> </UnorderedList> </Pgraph> <SubHeadline>Commentary</SubHeadline> <Pgraph>Peripheral venous access (PVC) is associated with less complications than central venous access <TextLink reference="222"></TextLink>, <TextLink reference="223"></TextLink>. PN administered via PVCs can only be used as additional nutritional support or as a temporary measure, as large volumes are required to deliver the required nutrients. Peripheral administration of PN should last for no more than 7(–10) days as the rate of complications increases after this time period <TextLink reference="224"></TextLink>, <TextLink reference="225"></TextLink>, <TextLink reference="226"></TextLink>, <TextLink reference="227"></TextLink>. There is no general consensus regarding the optimum PN-composition, infusion technique or pharmacological supplements, best suited to PVCs, in peripheral PN. In the absence of lipids, a limit of 800 mosm/L including potential electrolyte supplements should be adhered to. The vein quality of the patient also has to be taken into consideration.</Pgraph> <Pgraph>Thrombophlebitis is one of the most significant complications limiting peripheral PN. There are many factors involved in its pathogenesis. The incidence of thrombophlebitis depends on osmolarity, pH value and infusion speed of the PN solution <TextLink reference="228"></TextLink>, <TextLink reference="229"></TextLink>, <TextLink reference="230"></TextLink>. Problematic substrates are glucose, amino acids and electrolytes. Earlier studies have shown that infusion solutions containing glucose and crystalline amino acids rarely resulted in phlebitis despite an osmolarity of >600 mosmol/L <TextLink reference="231"></TextLink>, <TextLink reference="232"></TextLink>. The glucose concentration should not exceed 125 g/L <TextLink reference="233"></TextLink>. A maximum osmolarity of 800–1000 <TextGroup><PlainText>mosmol/L</PlainText></TextGroup> is recommended.</Pgraph> <Pgraph>No link between hyperosmolality and phlebitis has been observed in lipid-based mixtures. Kane et al. <TextLink reference="234"></TextLink> randomised 36 patients for the peripheral intake of nutrient solutions with an osmolarity of between 1200 and 1700 mosm/L. They found no difference in the incidence of phlebitis, although this either could be related to the catheter diameter and/or the flow rate. Williams et al. <TextLink reference="235"></TextLink> documented similar results for lipid-based solutions with 650 mosm/kg or 860 mosm/kg. A phlebitis rate of 7–26% was recorded by McMahon et al. <TextLink reference="225"></TextLink>, <TextLink reference="227"></TextLink>, <TextLink reference="236"></TextLink>, <TextLink reference="237"></TextLink> when lipid-based nutrient solutions with an osmolarity over 1100 mosm/L were administered.</Pgraph> <Pgraph>The pH value of commercial nutrient solutions is approximately 5 to 6. The acidity is caused by the amino acids and glucose degradation products which are produced during sterilisation <TextLink reference="238"></TextLink>. </Pgraph> <Pgraph>The frequently used PN bags made of ethylene-vinyl-acetate (EVA) are permeable to air; this allows for the oxidation of nutrients, for example, of glucose to gluconic acid <TextLink reference="239"></TextLink>. Experimental studies showed a significant correlation between increased acidity and an incidence of phlebitis in different infusion solutions <TextLink reference="229"></TextLink>, <TextLink reference="240"></TextLink>, <TextLink reference="241"></TextLink>. Adding a neutralising buffer to infusion solutions with crystalloids (normal pH 4.0–6.5) resulted in a reduction in the rate of phlebitis <TextLink reference="238"></TextLink>. There are, however, no significant clinical studies supporting the routine use of buffer supplements in peripheral PN. Furthermore, the effects of these supplements on the stability of PN would be difficult to assess. In addition, the amino acid mixtures themselves have a buffer effect (pK values).</Pgraph> <Pgraph>While an increased rate of phlebitis and infection at a LOS of over 3 days was postulated earlier <TextLink reference="99"></TextLink>, <TextLink reference="242"></TextLink>, more recent studies show that the time-specific risk of an obstruction, phlebitis and catheter colonisation remains the same even in longer LOS <TextLink reference="243"></TextLink>, <TextLink reference="244"></TextLink>, <TextLink reference="245"></TextLink>. Peripheral venous catheters can, therefore, remain in place as long as they are clinically required <TextLink reference="61"></TextLink>, <TextLink reference="243"></TextLink>. In children, peripheral access may be left for the total duration of intravenous administration and only be changed if complications arise <TextLink reference="245"></TextLink>, <TextLink reference="246"></TextLink>, <TextLink reference="247"></TextLink>, <TextLink reference="248"></TextLink>. The risk of phlebitis is lower when the cannula is placed on the back of the hand compared to venous access sites in the wrist or upper arm <TextLink reference="249"></TextLink>.</Pgraph> </TextBlock> <TextBlock linked="yes" name="Notes"> <MainHeadline>Notes</MainHeadline> <Pgraph>This article is part of the publication of the Guidelines on Parenteral Nutrition from the German Society for Nutritional Medicine (overview and corresponding address under <Hyperlink href="http://www.egms.de/en/journals/gms/2009-7/000086.shtml">http://www.egms.de/en/journals/gms/2009-7/000086.shtml</Hyperlink>).</Pgraph> <Pgraph>English version edited by Sabine Verwied-Jorky, Rashmi Mittal and Berthold Koletzko, Univ. of Munich Medical Centre, Munich, Germany.</Pgraph> </TextBlock> <References linked="yes"> <Reference refNo="1"> <RefAuthor>Krzywda EA</RefAuthor> <RefAuthor>Andris DA</RefAuthor> <RefAuthor>Edmiston CE</RefAuthor> <RefTitle>Catheter infections: Diagnosis, etiology, treatment and prevention</RefTitle> <RefYear>1999</RefYear> <RefJournal>Nutr Clin Pract</RefJournal> <RefPage>178</RefPage> <RefTotal>Krzywda EA, Andris DA, Edmiston CE. Catheter infections: Diagnosis, etiology, treatment and prevention. Nutr Clin Pract. 1999;14:178. DOI: 10.1177/088453369901400405</RefTotal> <RefLink>http://dx.doi.org/10.1177/088453369901400405</RefLink> </Reference> <Reference refNo="2"> <RefAuthor>Chung DH</RefAuthor> <RefAuthor>Ziegler MM</RefAuthor> <RefTitle>Central venous catheter access</RefTitle> <RefYear>1998</RefYear> <RefJournal>Nutrition</RefJournal> <RefPage>119-23</RefPage> <RefTotal>Chung DH, Ziegler MM. Central venous catheter access. Nutrition. 1998;14:119-23. DOI: 10.1016/S0899-9007(97)00228-1</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0899-9007(97)00228-1</RefLink> </Reference> <Reference refNo="3"> <RefAuthor>Meadows N</RefAuthor> <RefTitle>Monitoring and complications of parenteral nutrition</RefTitle> <RefYear>1998</RefYear> <RefJournal>Nutrition</RefJournal> <RefPage>806-8</RefPage> <RefTotal>Meadows N. Monitoring and complications of parenteral nutrition. Nutrition. 1998;14:806-8. DOI: 10.1016/S0899-9007(98)00089-6</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0899-9007(98)00089-6</RefLink> </Reference> <Reference refNo="4"> <RefAuthor>Lederle FA</RefAuthor> <RefAuthor>Parenti CM</RefAuthor> <RefAuthor>Berskow LC</RefAuthor> <RefAuthor>Ellingson KJ</RefAuthor> <RefTitle>The idle intravenous catheter</RefTitle> <RefYear>1992</RefYear> <RefJournal>Ann Intern Med</RefJournal> <RefPage>737-8</RefPage> <RefTotal>Lederle FA, Parenti CM, Berskow LC, Ellingson KJ. The idle intravenous catheter. Ann Intern Med. 1992;116(9):737-8.</RefTotal> </Reference> <Reference refNo="5"> <RefAuthor>Parenti CM</RefAuthor> <RefAuthor>Lederle FA</RefAuthor> <RefAuthor>Impola CL</RefAuthor> <RefAuthor>Peterson LR</RefAuthor> <RefTitle>Reduction of unnecessary intravenous catheter use; Internal medicine house staff participate in a successful quality improvement project</RefTitle> <RefYear>1994</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>1829-32</RefPage> <RefTotal>Parenti CM, Lederle FA, Impola CL, Peterson LR. Reduction of unnecessary intravenous catheter use; Internal medicine house staff participate in a successful quality improvement project. Arch Intern Med. 1994;154(16):1829-32.</RefTotal> </Reference> <Reference refNo="6"> <RefAuthor>Gebauer B</RefAuthor> <RefAuthor>Teichgräber UK</RefAuthor> <RefAuthor>Podrabsky P</RefAuthor> <RefAuthor>Beck A</RefAuthor> <RefAuthor>Wagner HJ</RefAuthor> <RefTitle>Ultraschall- und durchleuchtungs-gesteuerte Implantation peripher inserierter zentral-venöser Katheter (PICC) [Ultrasound- and Fluoroscopy-guided Implantation of Peripherally Inserted Central Venous Catheters (PICCs)]</RefTitle> <RefYear>2004</RefYear> <RefJournal>Fortschr Röntgenstr</RefJournal> <RefPage>386-91</RefPage> <RefTotal>Gebauer B, Teichgräber UK, Podrabsky P, Beck A, Wagner HJ. Ultraschall- und durchleuchtungs-gesteuerte Implantation peripher inserierter zentral-venöser Katheter (PICC) [Ultrasound- and Fluoroscopy-guided Implantation of Peripherally Inserted Central Venous Catheters (PICCs)]. Fortschr Röntgenstr. 2004;176:386-91. DOI: 10.1055/s-2004-812737</RefTotal> <RefLink>http://dx.doi.org/10.1055/s-2004-812737</RefLink> </Reference> <Reference refNo="7"> <RefAuthor>Duerksen DR</RefAuthor> <RefAuthor>Papineau N</RefAuthor> <RefAuthor>Siemens J</RefAuthor> <RefAuthor>Yaffe C</RefAuthor> <RefTitle>Peripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters</RefTitle> <RefYear>1999</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>85-9</RefPage> <RefTotal>Duerksen DR, Papineau N, Siemens J, Yaffe C. Peripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters. JPEN J Parenter Enteral Nutr. 1999;23:85-9. DOI: 10.1177/014860719902300285</RefTotal> <RefLink>http://dx.doi.org/10.1177/014860719902300285</RefLink> </Reference> <Reference refNo="8"> <RefAuthor>Kumar M</RefAuthor> <RefAuthor>Amin M</RefAuthor> <RefTitle>The peripherally inserted central venous catheter; friend or foe?</RefTitle> <RefYear>2004</RefYear> <RefJournal>Int J Oral Maxillofac Surg</RefJournal> <RefPage>201-4</RefPage> <RefTotal>Kumar M, Amin M. The peripherally inserted central venous catheter; friend or foe? Int J Oral Maxillofac Surg. 2004;33:201-4. DOI: 10.1054/ijom.2003.0464</RefTotal> <RefLink>http://dx.doi.org/10.1054/ijom.2003.0464</RefLink> </Reference> <Reference refNo="9"> <RefAuthor>Nessler R</RefAuthor> <RefTitle>Spezielle Punktionstechnik für "zentrale" Venen (Technik nach Seldinger oder indirekte Technik) [Special technique for the catheterization of "central" veins (Seldinger's or indirect technique)]</RefTitle> <RefYear>1978</RefYear> <RefJournal>Prakt Anaesth</RefJournal> <RefPage>99-102</RefPage> <RefTotal>Nessler R. Spezielle Punktionstechnik für "zentrale" Venen (Technik nach Seldinger oder indirekte Technik) [Special technique for the catheterization of "central" veins (Seldinger's or indirect technique)]. Prakt Anaesth. 1978;13:99-102.</RefTotal> </Reference> <Reference refNo="10"> <RefAuthor>Peters JL</RefAuthor> <RefAuthor>Armstrong R</RefAuthor> <RefTitle>Air embolism occurring as a complication of central venous catheterization</RefTitle> <RefYear>1978</RefYear> <RefJournal>Ann Surg</RefJournal> <RefPage>375-8</RefPage> <RefTotal>Peters JL, Armstrong R. Air embolism occurring as a complication of central venous catheterization. Ann Surg. 1978;187:375-8. DOI: 10.1097/00000658-197804000-00005</RefTotal> <RefLink>http://dx.doi.org/10.1097/00000658-197804000-00005</RefLink> </Reference> <Reference refNo="11"> <RefAuthor>Stow PJ</RefAuthor> <RefAuthor>Burrows FA</RefAuthor> <RefAuthor>Berthelsen PG</RefAuthor> <RefAuthor>Stöber H</RefAuthor> <RefAuthor>Durrant STS</RefAuthor> <RefAuthor>Rahemtulla A</RefAuthor> <RefTitle>Central venous catheterisation</RefTitle> <RefYear>1986</RefYear> <RefJournal>Lancet</RefJournal> <RefPage>974-5</RefPage> <RefTotal>Stow PJ, Burrows FA, Berthelsen PG, Stöber H, Durrant STS, Rahemtulla A, et al. Central venous catheterisation. Lancet. 1986;328:974-5. DOI: 10.1016/S0140-6736(86)90623-9</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0140-6736(86)90623-9</RefLink> </Reference> <Reference refNo="12"> <RefAuthor>Belani KG</RefAuthor> <RefAuthor>Buckley JJ</RefAuthor> <RefAuthor>Gordon JR</RefAuthor> <RefAuthor>Castaneda W</RefAuthor> <RefTitle>Percutaneous cervical central venous line placement: a comparison of the internal and external jugular vein routes</RefTitle> <RefYear>1980</RefYear> <RefJournal>Anesth Analg</RefJournal> <RefPage>40-4</RefPage> <RefTotal>Belani KG, Buckley JJ, Gordon JR, Castaneda W. Percutaneous cervical central venous line placement: a comparison of the internal and external jugular vein routes. Anesth Analg. 1980;59(1):40-4.</RefTotal> </Reference> <Reference refNo="13"> <RefAuthor>O'Grady NP</RefAuthor> <RefAuthor>Alexander M</RefAuthor> <RefAuthor>Dellinger EP</RefAuthor> <RefAuthor>Gerberding JL</RefAuthor> <RefAuthor>Heard SO</RefAuthor> <RefAuthor>Maki DG</RefAuthor> <RefAuthor>Masur H</RefAuthor> <RefAuthor>McCormick RD</RefAuthor> <RefAuthor>Mermel LA</RefAuthor> <RefAuthor>Pearson ML</RefAuthor> <RefAuthor>Raad II</RefAuthor> <RefAuthor>Randolph A</RefAuthor> <RefAuthor>Weinstein RA</RefAuthor> <RefTitle>Control and Prevention Guidelines for the prevention of intravascular catheter-related infections; Centers for Disease</RefTitle> <RefYear>2002</RefYear> <RefJournal>MMWR Recomm Rep</RefJournal> <RefPage>1-29</RefPage> <RefTotal>O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. Control and Prevention Guidelines for the prevention of intravascular catheter-related infections; Centers for Disease. MMWR Recomm Rep. 2002;51(RR-10):1-29.</RefTotal> </Reference> <Reference refNo="14"> <RefAuthor>Polderman KH</RefAuthor> <RefAuthor>Girbes AR</RefAuthor> <RefTitle>Central venous catheter use; Part 2: infectious complications</RefTitle> <RefYear>2002</RefYear> <RefJournal>Intensive Care Med</RefJournal> <RefPage>18-28</RefPage> <RefTotal>Polderman KH, Girbes AR. Central venous catheter use; Part 2: infectious complications. Intensive Care Med. 2002;28(1):18-28.</RefTotal> </Reference> <Reference refNo="15"> <RefAuthor>Raad I</RefAuthor> <RefAuthor>Umphrey J</RefAuthor> <RefAuthor>Khan A</RefAuthor> <RefAuthor>Truett LJ</RefAuthor> <RefAuthor>Bodey GP</RefAuthor> <RefTitle>The duration of placement as a predictor of peripheral and pulmonary arterial catheter infections</RefTitle> <RefYear>1993</RefYear> <RefJournal>J Hosp Infect</RefJournal> <RefPage>17-26</RefPage> <RefTotal>Raad I, Umphrey J, Khan A, Truett LJ, Bodey GP. The duration of placement as a predictor of peripheral and pulmonary arterial catheter infections. J Hosp Infect. 1993;23:17-26. DOI: 10.1016/0195-6701(93)90126-K</RefTotal> <RefLink>http://dx.doi.org/10.1016/0195-6701(93)90126-K</RefLink> </Reference> <Reference refNo="16"> <RefAuthor>Richet H</RefAuthor> <RefAuthor>Hubert B</RefAuthor> <RefAuthor>Nitemberg G</RefAuthor> <RefAuthor>Andremont A</RefAuthor> <RefAuthor>Buu-Hoi A</RefAuthor> <RefAuthor>Ourbak P</RefAuthor> <RefAuthor>Galicier C</RefAuthor> <RefAuthor>Veron M</RefAuthor> <RefAuthor>Boisivon A</RefAuthor> <RefAuthor>Bouvier AM</RefAuthor> <RefTitle>Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients</RefTitle> <RefYear>1990</RefYear> <RefJournal>J Clin Microbiol</RefJournal> <RefPage>2520-5</RefPage> <RefTotal>Richet H, Hubert B, Nitemberg G, Andremont A, Buu-Hoi A, Ourbak P, Galicier C, Veron M, Boisivon A, Bouvier AM, et al. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. J Clin Microbiol. 1990;28(11):2520-5.</RefTotal> </Reference> <Reference refNo="17"> <RefAuthor>Fuchs PC</RefAuthor> <RefAuthor>Gustafson ME</RefAuthor> <RefAuthor>King JT</RefAuthor> <RefAuthor>Goodall PT</RefAuthor> <RefTitle>Assessment of catheter-associated infection risk with the Hickman right atrial catheter</RefTitle> <RefYear>1984</RefYear> <RefJournal>Infect Control</RefJournal> <RefPage>226-30</RefPage> <RefTotal>Fuchs PC, Gustafson ME, King JT, Goodall PT. Assessment of catheter-associated infection risk with the Hickman right atrial catheter. Infect Control. 1984;5(5):226-30.</RefTotal> </Reference> <Reference refNo="18"> <RefAuthor>Thomas JH</RefAuthor> <RefAuthor>MacArthur RI</RefAuthor> <RefAuthor>Pierce GE</RefAuthor> <RefAuthor>Hermreck AS</RefAuthor> <RefTitle>Hickman-Broviac catheters: Indications and results</RefTitle> <RefYear>1980</RefYear> <RefJournal>Am J Surg</RefJournal> <RefPage>791-6</RefPage> <RefTotal>Thomas JH, MacArthur RI, Pierce GE, Hermreck AS. Hickman-Broviac catheters: Indications and results. Am J Surg. 1980;140:791-6. DOI: 10.1016/0002-9610(80)90119-1</RefTotal> <RefLink>http://dx.doi.org/10.1016/0002-9610(80)90119-1</RefLink> </Reference> <Reference refNo="19"> <RefAuthor>Snydman DR</RefAuthor> <RefAuthor>Murray SA</RefAuthor> <RefAuthor>Kornfeld SJ</RefAuthor> <RefAuthor>Majka JA</RefAuthor> <RefAuthor>Ellis CA</RefAuthor> <RefTitle>Total parenteral nutrition-related infections: Prospective epidemiologic study using semiquantitative methods</RefTitle> <RefYear>1982</RefYear> <RefJournal>Am J Med</RefJournal> <RefPage>695-9</RefPage> <RefTotal>Snydman DR, Murray SA, Kornfeld SJ, Majka JA, Ellis CA. Total parenteral nutrition-related infections: Prospective epidemiologic study using semiquantitative methods. Am J Med. 1982;73:695-9. DOI: 10.1016/0002-9343(82)90412-0</RefTotal> <RefLink>http://dx.doi.org/10.1016/0002-9343(82)90412-0</RefLink> </Reference> <Reference refNo="20"> <RefAuthor>Mermel LA</RefAuthor> <RefTitle>Prevention of intravascular catheter-related infections</RefTitle> <RefYear>2000</RefYear> <RefJournal>Ann Intern Med</RefJournal> <RefPage>391-402</RefPage> <RefTotal>Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med. 2000;132(5):391-402.</RefTotal> </Reference> <Reference refNo="21"> <RefAuthor>Bjarnason K</RefAuthor> <RefAuthor>Field J</RefAuthor> <RefAuthor>Weston V</RefAuthor> <RefAuthor>Stanga Z</RefAuthor> <RefTitle>Venesection for blood culture: trained nurses achieve same or lower contamination rates than doctors</RefTitle> <RefYear>2002</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>10</RefPage> <RefTotal>Bjarnason K, Field J, Weston V, Stanga Z. Venesection for blood culture: trained nurses achieve same or lower contamination rates than doctors. Clin Nutr. 2002;21:10.</RefTotal> </Reference> <Reference refNo="22"> <RefAuthor>O'Grady NP</RefAuthor> <RefAuthor>Alexander M</RefAuthor> <RefAuthor>Dellinger EP</RefAuthor> <RefAuthor>Gerberding JL</RefAuthor> <RefAuthor>Heard SO</RefAuthor> <RefAuthor>Maki DG</RefAuthor> <RefTitle>Guidelines for the prevention of intravascular catheter-related infections</RefTitle> <RefYear>2002</RefYear> <RefJournal>Am J Infect Control</RefJournal> <RefPage>476-89</RefPage> <RefTotal>O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2002;30:476-89. DOI: 10.1067/mic.2002.129427</RefTotal> <RefLink>http://dx.doi.org/10.1067/mic.2002.129427</RefLink> </Reference> <Reference refNo="23"> <RefAuthor>Hanna HA</RefAuthor> <RefAuthor>Raad I</RefAuthor> <RefTitle>Blood products: a significant risk factor for long-term catheter-related bloodstream infections in cancer patients</RefTitle> <RefYear>2001</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>165-6</RefPage> <RefTotal>Hanna HA, Raad I. Blood products: a significant risk factor for long-term catheter-related bloodstream infections in cancer patients. Infect Control Hosp Epidemiol. 2001;22:165-6. DOI: 10.1086/501885</RefTotal> <RefLink>http://dx.doi.org/10.1086/501885</RefLink> </Reference> <Reference refNo="24"> <RefAuthor>Barrett BB</RefAuthor> <RefAuthor>Andersen JW</RefAuthor> <RefAuthor>Anderson KC</RefAuthor> <RefTitle>Strategies for the avoidance of bacterial contamination of blood components</RefTitle> <RefYear>1993</RefYear> <RefJournal>Transfusion</RefJournal> <RefPage>228-33</RefPage> <RefTotal>Barrett BB, Andersen JW, Anderson KC. Strategies for the avoidance of bacterial contamination of blood components. Transfusion. 1993;33:228-33. DOI: 10.1046/j.1537-2995.1993.33393174449.x</RefTotal> <RefLink>http://dx.doi.org/10.1046/j.1537-2995.1993.33393174449.x</RefLink> </Reference> <Reference refNo="25"> <RefAuthor>Timsit JF</RefAuthor> <RefAuthor>Sebille V</RefAuthor> <RefAuthor>Farkas JC</RefAuthor> <RefAuthor>Misset B</RefAuthor> <RefAuthor>Martin JB</RefAuthor> <RefAuthor>Chevret S</RefAuthor> <RefTitle>Effect of subcutaneous tunneling on internal jugular catheter-related sepsis in critically ill patients: a prospective randomized multicenter study</RefTitle> <RefYear>1996</RefYear> <RefJournal>JAMA</RefJournal> <RefPage>1416-20</RefPage> <RefTotal>Timsit JF, Sebille V, Farkas JC, Misset B, Martin JB, Chevret S, et al. Effect of subcutaneous tunneling on internal jugular catheter-related sepsis in critically ill patients: a prospective randomized multicenter study. JAMA. 1996;276:1416-20.</RefTotal> </Reference> <Reference refNo="26"> <RefAuthor>Shaffer JL</RefAuthor> <RefAuthor>Bakker H</RefAuthor> <RefAuthor>Bozzetti F</RefAuthor> <RefAuthor>Ladefoged K</RefAuthor> <RefAuthor>Leon-Sanz M</RefAuthor> <RefAuthor>Messing B</RefAuthor> <RefTitle>A European survey on management of catheter-related complications in home parenteral nutrition</RefTitle> <RefYear>1997</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>42</RefPage> <RefTotal>Shaffer JL, Bakker H, Bozzetti F, Ladefoged K, Leon-Sanz M, Messing B, et al. A European survey on management of catheter-related complications in home parenteral nutrition. Clin Nutr. 1997;16:42. DOI: 10.1016/S0261-5614(97)80196-3</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0261-5614(97)80196-3</RefLink> </Reference> <Reference refNo="27"> <RefAuthor>Raad I</RefAuthor> <RefAuthor>Davis S</RefAuthor> <RefAuthor>Becker M</RefAuthor> <RefAuthor>Hohn D</RefAuthor> <RefAuthor>Houston D</RefAuthor> <RefAuthor>Umphrey J</RefAuthor> <RefTitle>Low infection rate and long durability of nontunneled silastic catheters. A safe and cost-effective alternative for long-term venous access</RefTitle> <RefYear>1993</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>1791-6</RefPage> <RefTotal>Raad I, Davis S, Becker M, Hohn D, Houston D, Umphrey J, et al. Low infection rate and long durability of nontunneled silastic catheters. A safe and cost-effective alternative for long-term venous access. Arch Intern Med. 1993;153:1791-6.</RefTotal> </Reference> <Reference refNo="28"> <RefAuthor>Chang L</RefAuthor> <RefAuthor>Tsai JS</RefAuthor> <RefAuthor>Huang SJ</RefAuthor> <RefAuthor>Shih CC</RefAuthor> <RefTitle>Evaluation of infectious complications of the implantable venous access system in a general oncologic population</RefTitle> <RefYear>2003</RefYear> <RefJournal>Am J Infect Control</RefJournal> <RefPage>34-9</RefPage> <RefTotal>Chang L, Tsai JS, Huang SJ, Shih CC. Evaluation of infectious complications of the implantable venous access system in a general oncologic population. Am J Infect Control. 2003;31:34-9. DOI: 10.1067/mic.2003.29</RefTotal> <RefLink>http://dx.doi.org/10.1067/mic.2003.29</RefLink> </Reference> <Reference refNo="29"> <RefAuthor>Raad I</RefAuthor> <RefAuthor>Hanna HA</RefAuthor> <RefAuthor>Awad A</RefAuthor> <RefAuthor>Alrahwan A</RefAuthor> <RefAuthor>Bivins C</RefAuthor> <RefAuthor>Khan A</RefAuthor> <RefTitle>Optimal frequency of changing intravenous administration sets: is it safe to prolong use beyond 72 hours?</RefTitle> <RefYear>2001</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>136-9</RefPage> <RefTotal>Raad I, Hanna HA, Awad A, Alrahwan A, Bivins C, Khan A, et al. Optimal frequency of changing intravenous administration sets: is it safe to prolong use beyond 72 hours? Infect Control Hosp Epidemiol. 2001;22:136-9. DOI: 10.1086/501879</RefTotal> <RefLink>http://dx.doi.org/10.1086/501879</RefLink> </Reference> <Reference refNo="30"> <RefAuthor>Maki DG</RefAuthor> <RefAuthor>Botticelli JT</RefAuthor> <RefAuthor>LeRoy ML</RefAuthor> <RefAuthor>Thielke TS</RefAuthor> <RefTitle>Prospective study of replacing administration sets for intravenous therapy at 48- vs 72-hour intervals. 72 hours is safe and cost-effective</RefTitle> <RefYear>1987</RefYear> <RefJournal>JAMA</RefJournal> <RefPage>1777-81</RefPage> <RefTotal>Maki DG, Botticelli JT, LeRoy ML, Thielke TS. Prospective study of replacing administration sets for intravenous therapy at 48- vs 72-hour intervals. 72 hours is safe and cost-effective. JAMA. 1987;258:1777-81.</RefTotal> </Reference> <Reference refNo="31"> <RefAuthor>Matlow AG</RefAuthor> <RefAuthor>Kitai I</RefAuthor> <RefAuthor>Kirpalani H</RefAuthor> <RefAuthor>Chapman NH</RefAuthor> <RefAuthor>Corey M</RefAuthor> <RefAuthor>Perlman M</RefAuthor> <RefTitle>A randomized trial of 72-versus 24-hour intravenous tubing set changes in newborns receiving lipid therapy</RefTitle> <RefYear>1999</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>487-93</RefPage> <RefTotal>Matlow AG, Kitai I, Kirpalani H, Chapman NH, Corey M, Perlman M, et al. A randomized trial of 72-versus 24-hour intravenous tubing set changes in newborns receiving lipid therapy. Infect Control Hosp Epidemiol. 1999;20:487-93. DOI: 10.1086/501657</RefTotal> <RefLink>http://dx.doi.org/10.1086/501657</RefLink> </Reference> <Reference refNo="32"> <RefAuthor>Sitges-Serra A</RefAuthor> <RefAuthor>Linares J</RefAuthor> <RefAuthor>Perez JL</RefAuthor> <RefAuthor>Jaurrieta E</RefAuthor> <RefAuthor>Lorente L</RefAuthor> <RefTitle>A randomized trial on the effect of tubing changes on hub contamination and catheter sepsis during parenteral nutrition</RefTitle> <RefYear>1985</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>322-5</RefPage> <RefTotal>Sitges-Serra A, Linares J, Perez JL, Jaurrieta E, Lorente L. A randomized trial on the effect of tubing changes on hub contamination and catheter sepsis during parenteral nutrition. JPEN J Parenter Enteral Nutr. 1985;9:322-5. DOI: 10.1177/0148607185009003322</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607185009003322</RefLink> </Reference> <Reference refNo="33"> <RefAuthor>Nanninga AG</RefAuthor> <RefAuthor>de Vries EG</RefAuthor> <RefAuthor>Willemse PH</RefAuthor> <RefAuthor>Oosterhuis BE</RefAuthor> <RefAuthor>Sleijfer DT</RefAuthor> <RefAuthor>Hoekstra HJ</RefAuthor> <RefTitle>Continuous infusion of chemotherapy on an outpatient basis via a totally implanted venous access port</RefTitle> <RefYear>1991</RefYear> <RefJournal>Eur J Cancer</RefJournal> <RefPage>147-9</RefPage> <RefTotal>Nanninga AG, de Vries EG, Willemse PH, Oosterhuis BE, Sleijfer DT, Hoekstra HJ, et al. Continuous infusion of chemotherapy on an outpatient basis via a totally implanted venous access port. Eur J Cancer. 1991;27(2):147-9.</RefTotal> </Reference> <Reference refNo="34"> <RefAuthor>Milani A</RefAuthor> <RefAuthor>Vernizzi S</RefAuthor> <RefAuthor>Passoni C</RefAuthor> <RefAuthor>Sociale O</RefAuthor> <RefAuthor>Macciola F</RefAuthor> <RefAuthor>Grimaldi C</RefAuthor> <RefTitle>Tempo di giacenza in situ dell'ago di huber in pazienti sottoposti a chemioterapia in infusione continua: risultati di uno studio di fase II [Huber needle in situ inpatients under continuous infusion chemotherapy: results of a study, Phase II]</RefTitle> <RefYear>2000</RefYear> <RefJournal>Prof Inferm</RefJournal> <RefPage>71-4</RefPage> <RefTotal>Milani A, Vernizzi S, Passoni C, Sociale O, Macciola F, Grimaldi C, et al. Tempo di giacenza in situ dell'ago di huber in pazienti sottoposti a chemioterapia in infusione continua: risultati di uno studio di fase II [Huber needle in situ inpatients under continuous infusion chemotherapy: results of a study, Phase II]. Prof Inferm. 2000;53:71-4.</RefTotal> </Reference> <Reference refNo="35"> <RefAuthor>Karamanoglu A</RefAuthor> <RefAuthor>Yumuk PF</RefAuthor> <RefAuthor>Gumus M</RefAuthor> <RefAuthor>Ekenel M</RefAuthor> <RefAuthor>Aliustaoglu M</RefAuthor> <RefAuthor>Selimen D</RefAuthor> <RefTitle>Port needles: do they need to be removed as frequently in infusional chemotherapy?</RefTitle> <RefYear>2003</RefYear> <RefJournal>J Infus Nurs</RefJournal> <RefPage>239-42</RefPage> <RefTotal>Karamanoglu A, Yumuk PF, Gumus M, Ekenel M, Aliustaoglu M, Selimen D, et al. Port needles: do they need to be removed as frequently in infusional chemotherapy? J Infus Nurs. 2003;26:239-42. DOI: 10.1097/00129804-200307000-00009</RefTotal> <RefLink>http://dx.doi.org/10.1097/00129804-200307000-00009</RefLink> </Reference> <Reference refNo="36"> <RefAuthor>Mühlebach S</RefAuthor> <RefAuthor>Fasolini F</RefAuthor> <RefTitle>10 Jahre Ernährungsteam am Kantonsspital Aarau (KSA): Aufgaben, Entwicklungen, Erfahrungen [The nutrition support team at the Kantonspital Aarau (KSA): Functions, development, and experiences over a ten years period]</RefTitle> <RefYear>2000</RefYear> <RefJournal>Viszeralchirurgie</RefJournal> <RefPage>69-71</RefPage> <RefTotal>Mühlebach S, Fasolini F. 10 Jahre Ernährungsteam am Kantonsspital Aarau (KSA): Aufgaben, Entwicklungen, Erfahrungen [The nutrition support team at the Kantonspital Aarau (KSA): Functions, development, and experiences over a ten years period]. Viszeralchirurgie. 2000;35:69-71. DOI: 10.1055/s-2000-11232</RefTotal> <RefLink>http://dx.doi.org/10.1055/s-2000-11232</RefLink> </Reference> <Reference refNo="37"> <RefAuthor>La Quaglia MP</RefAuthor> <RefAuthor>Lucas A</RefAuthor> <RefAuthor>Thaler HT</RefAuthor> <RefAuthor>Friedlander-Klar H</RefAuthor> <RefAuthor>Exelby PR</RefAuthor> <RefAuthor>Groeger JS</RefAuthor> <RefTitle>A prospective analysis of vascular access device-related infections in children</RefTitle> <RefYear>1992</RefYear> <RefJournal>J Pediatr Surg</RefJournal> <RefPage>840-2</RefPage> <RefTotal>La Quaglia MP, Lucas A, Thaler HT, Friedlander-Klar H, Exelby PR, Groeger JS. A prospective analysis of vascular access device-related infections in children. J Pediatr Surg. 1992;27:840-2. DOI: 10.1016/0022-3468(92)90379-L</RefTotal> <RefLink>http://dx.doi.org/10.1016/0022-3468(92)90379-L</RefLink> </Reference> <Reference refNo="38"> <RefAuthor>Miller K</RefAuthor> <RefAuthor>Buchanan GR</RefAuthor> <RefAuthor>Zappa S</RefAuthor> <RefAuthor>Cochran C</RefAuthor> <RefAuthor>Laufenberg J</RefAuthor> <RefAuthor>Medeiros D</RefAuthor> <RefTitle>Implantable venous access devices in children with hemophilia: a report of low infection rates</RefTitle> <RefYear>1998</RefYear> <RefJournal>J Pediatr</RefJournal> <RefPage>934-8</RefPage> <RefTotal>Miller K, Buchanan GR, Zappa S, Cochran C, Laufenberg J, Medeiros D, et al. Implantable venous access devices in children with hemophilia: a report of low infection rates. J Pediatr. 1998;132:934-8. DOI: 10.1016/S0022-3476(98)70386-5</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0022-3476(98)70386-5</RefLink> </Reference> <Reference refNo="39"> <RefAuthor>Chatzinikolaou I</RefAuthor> <RefAuthor>Zipf TF</RefAuthor> <RefAuthor>Hanna H</RefAuthor> <RefAuthor>Umphrey J</RefAuthor> <RefAuthor>Roberts WM</RefAuthor> <RefAuthor>Sherertz R</RefAuthor> <RefTitle>Minocycline-ethylenediaminetetraacetate lock solution for the prevention of implantable port infections in children with cancer</RefTitle> <RefYear>2003</RefYear> <RefJournal>Clin Infect Dis</RefJournal> <RefPage>116-9</RefPage> <RefTotal>Chatzinikolaou I, Zipf TF, Hanna H, Umphrey J, Roberts WM, Sherertz R, et al. Minocycline-ethylenediaminetetraacetate lock solution for the prevention of implantable port infections in children with cancer. Clin Infect Dis. 2003;36:116-9. DOI: 10.1086/344952</RefTotal> <RefLink>http://dx.doi.org/10.1086/344952</RefLink> </Reference> <Reference refNo="40"> <RefAuthor>Ivanov R</RefAuthor> <RefAuthor>Allen J</RefAuthor> <RefAuthor>Calvin JE</RefAuthor> <RefTitle>The incidence of major morbidity in critically ill patients managed with pulmonary artery catheters: a meta-analysis</RefTitle> <RefYear>2000</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>615-9</RefPage> <RefTotal>Ivanov R, Allen J, Calvin JE. The incidence of major morbidity in critically ill patients managed with pulmonary artery catheters: a meta-analysis. Crit Care Med. 2000;28:615-9. DOI: 0.1097/00003246-200003000-00002</RefTotal> <RefLink>http://dx.doi.org/0.1097/00003246-200003000-00002</RefLink> </Reference> <Reference refNo="41"> <RefAuthor>Ruesch S</RefAuthor> <RefAuthor>Walder B</RefAuthor> <RefAuthor>Tramer MR</RefAuthor> <RefTitle>Complications of central venous catheters: internal jugular versus subclavian access – a systematic review</RefTitle> <RefYear>2002</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>454-60</RefPage> <RefTotal>Ruesch S, Walder B, Tramer MR. Complications of central venous catheters: internal jugular versus subclavian access – a systematic review. Crit Care Med. 2002;30:454-60. DOI: 10.1097/00003246-200202000-00031</RefTotal> <RefLink>http://dx.doi.org/10.1097/00003246-200202000-00031</RefLink> </Reference> <Reference refNo="42"> <RefAuthor>Bansmer G</RefAuthor> <RefAuthor>Keith D</RefAuthor> <RefAuthor>Tesluk H</RefAuthor> <RefTitle>Complications following use of indwelling catheters of inferior vena cava</RefTitle> <RefYear>1958</RefYear> <RefJournal>J Am Med Assoc</RefJournal> <RefPage>1606-11</RefPage> <RefTotal>Bansmer G, Keith D, Tesluk H. Complications following use of indwelling catheters of inferior vena cava. J Am Med Assoc. 1958;167:1606-11.</RefTotal> </Reference> <Reference refNo="43"> <RefAuthor>Crane C</RefAuthor> <RefTitle>Venous interruption of septic thrombophlebitis</RefTitle> <RefYear>1960</RefYear> <RefJournal>N Engl J Med</RefJournal> <RefPage>947-51</RefPage> <RefTotal>Crane C. Venous interruption of septic thrombophlebitis. N Engl J Med. 1960;262:947-51.</RefTotal> </Reference> <Reference refNo="44"> <RefAuthor>Indar R</RefAuthor> <RefTitle>The dangers of indwelling polyethelene cannulae in deep veins</RefTitle> <RefYear>1959</RefYear> <RefJournal>Lancet</RefJournal> <RefPage>284-7</RefPage> <RefTotal>Indar R. The dangers of indwelling polyethelene cannulae in deep veins. Lancet. 1959;1:284-7. DOI: 10.1016/S0140-6736(59)90207-7</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0140-6736(59)90207-7</RefLink> </Reference> <Reference refNo="45"> <RefAuthor>Goetz AM</RefAuthor> <RefAuthor>Wagener MM</RefAuthor> <RefAuthor>Miller JM</RefAuthor> <RefAuthor>Muder RR</RefAuthor> <RefTitle>Risk of infection due to central venous catheters: effect of site of placement and catheter type</RefTitle> <RefYear>1998</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>842-5</RefPage> <RefTotal>Goetz AM, Wagener MM, Miller JM, Muder RR. Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol. 1998;19(11):842-5.</RefTotal> </Reference> <Reference refNo="46"> <RefAuthor>Joynt GM</RefAuthor> <RefAuthor>Kew J</RefAuthor> <RefAuthor>Gomersall CD</RefAuthor> <RefAuthor>Leung VY</RefAuthor> <RefAuthor>Liu EK</RefAuthor> <RefTitle>Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients</RefTitle> <RefYear>2000</RefYear> <RefJournal>Chest</RefJournal> <RefPage>178-83</RefPage> <RefTotal>Joynt GM, Kew J, Gomersall CD, Leung VY, Liu EK. Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients. Chest. 2000;117:178-83. DOI: 10.1378/chest.117.1.178</RefTotal> <RefLink>http://dx.doi.org/10.1378/chest.117.1.178</RefLink> </Reference> <Reference refNo="47"> <RefAuthor>Mian NZ</RefAuthor> <RefAuthor>Bayly R</RefAuthor> <RefAuthor>Schreck DM</RefAuthor> <RefAuthor>Besserman EB</RefAuthor> <RefAuthor>Richmand D</RefAuthor> <RefTitle>Incidence of deep venous thrombosis associated with femoral venous catheterization</RefTitle> <RefYear>1997</RefYear> <RefJournal>Acad Emerg Med</RefJournal> <RefPage>1118-21</RefPage> <RefTotal>Mian NZ, Bayly R, Schreck DM, Besserman EB, Richmand D. Incidence of deep venous thrombosis associated with femoral venous catheterization. Acad Emerg Med. 1997;4:1118-21. DOI: 10.1111/j.1553-2712.1997.tb03693.x</RefTotal> <RefLink>http://dx.doi.org/10.1111/j.1553-2712.1997.tb03693.x</RefLink> </Reference> <Reference refNo="48"> <RefAuthor>Durbec O</RefAuthor> <RefAuthor>Viviand X</RefAuthor> <RefAuthor>Potie F</RefAuthor> <RefAuthor>Vialet R</RefAuthor> <RefAuthor>Albanese J</RefAuthor> <RefAuthor>Martin C</RefAuthor> <RefTitle>A prospective evaluation of the use of femoral venous catheters in critically ill adults</RefTitle> <RefYear>1997</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>1986-9</RefPage> <RefTotal>Durbec O, Viviand X, Potie F, Vialet R, Albanese J, Martin C. A prospective evaluation of the use of femoral venous catheters in critically ill adults. Crit Care Med. 1997;25:1986-9. DOI: 10.1097/00003246-199712000-00014</RefTotal> <RefLink>http://dx.doi.org/10.1097/00003246-199712000-00014</RefLink> </Reference> <Reference refNo="49"> <RefAuthor>Merrer J</RefAuthor> <RefAuthor>De Jonghe B</RefAuthor> <RefAuthor>Golliot F</RefAuthor> <RefAuthor>Lefrant JY</RefAuthor> <RefAuthor>Raffy B</RefAuthor> <RefAuthor>Barre E</RefAuthor> <RefTitle>Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial</RefTitle> <RefYear>2001</RefYear> <RefJournal>JAMA</RefJournal> <RefPage>700-7</RefPage> <RefTotal>Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286:700-7. DOI: 10.1001/jama.286.6.700</RefTotal> <RefLink>http://dx.doi.org/10.1001/jama.286.6.700</RefLink> </Reference> <Reference refNo="50"> <RefAuthor>Trottier SJ</RefAuthor> <RefAuthor>Veremakis C</RefAuthor> <RefAuthor>O'Brien J</RefAuthor> <RefAuthor>Auer AI</RefAuthor> <RefTitle>Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial</RefTitle> <RefYear>1995</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>52-9</RefPage> <RefTotal>Trottier SJ, Veremakis C, O'Brien J, Auer AI. Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med. 1995;23:52-9. DOI: 10.1097/00003246-199501000-00011</RefTotal> <RefLink>http://dx.doi.org/10.1097/00003246-199501000-00011</RefLink> </Reference> <Reference refNo="51"> <RefAuthor>Harden JL</RefAuthor> <RefAuthor>Kemp L</RefAuthor> <RefAuthor>Mirtallo J</RefAuthor> <RefTitle>Femoral catheters increase risk of infection in total parenteral nutrition patients</RefTitle> <RefYear>1995</RefYear> <RefJournal>Nutr Clin Pract</RefJournal> <RefPage>60-6</RefPage> <RefTotal>Harden JL, Kemp L, Mirtallo J. Femoral catheters increase risk of infection in total parenteral nutrition patients. Nutr Clin Pract. 1995;10:60-6. DOI: 10.1177/011542659501000260</RefTotal> <RefLink>http://dx.doi.org/10.1177/011542659501000260</RefLink> </Reference> <Reference refNo="52"> <RefAuthor>Kemp L</RefAuthor> <RefAuthor>Burge J</RefAuthor> <RefAuthor>Choban P</RefAuthor> <RefAuthor>Harden J</RefAuthor> <RefAuthor>Mirtallo J</RefAuthor> <RefAuthor>Flancbaum L</RefAuthor> <RefTitle>The effect of catheter type and site on infection rates in total parenteral nutrition patients</RefTitle> <RefYear>1994</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>71-4</RefPage> <RefTotal>Kemp L, Burge J, Choban P, Harden J, Mirtallo J, Flancbaum L. The effect of catheter type and site on infection rates in total parenteral nutrition patients. JPEN J Parenter Enteral Nutr. 1994;18:71-4. DOI: 10.1177/014860719401800171</RefTotal> <RefLink>http://dx.doi.org/10.1177/014860719401800171</RefLink> </Reference> <Reference refNo="53"> <RefAuthor>Sznajder JI</RefAuthor> <RefAuthor>Zveibil FR</RefAuthor> <RefAuthor>Bitterman H</RefAuthor> <RefAuthor>Weiner P</RefAuthor> <RefAuthor>Bursztein S</RefAuthor> <RefTitle>Central vein catheterization. Failure and complication rates by three percutaneous approaches</RefTitle> <RefYear>1986</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>259-61</RefPage> <RefTotal>Sznajder JI, Zveibil FR, Bitterman H, Weiner P, Bursztein S. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med. 1986;146:259-61.</RefTotal> </Reference> <Reference refNo="54"> <RefAuthor>Mermel L</RefAuthor> <RefTitle>Central venous catheter-related infections and their prevention: is there enough evidence to recommend tunneling for short-term use?</RefTitle> <RefYear>1998</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>1315-6</RefPage> <RefTotal>Mermel L. Central venous catheter-related infections and their prevention: is there enough evidence to recommend tunneling for short-term use? Crit Care Med. 1998;26:1315-6. DOI: 10.1097/00003246-199808000-00011</RefTotal> <RefLink>http://dx.doi.org/10.1097/00003246-199808000-00011</RefLink> </Reference> <Reference refNo="55"> <RefAuthor>Mermel LA</RefAuthor> <RefAuthor>McCormick RD</RefAuthor> <RefAuthor>Springman SR</RefAuthor> <RefAuthor>Maki DG</RefAuthor> <RefTitle>The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping</RefTitle> <RefYear>1991</RefYear> <RefJournal>Am J Med</RefJournal> <RefPage>197S-205S</RefPage> <RefTotal>Mermel LA, McCormick RD, Springman SR, Maki DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med. 1991;91:197S-205S. DOI: 10.1016/0002-9343(91)90369-9</RefTotal> <RefLink>http://dx.doi.org/10.1016/0002-9343(91)90369-9</RefLink> </Reference> <Reference refNo="56"> <RefAuthor>Heard SO</RefAuthor> <RefAuthor>Wagle M</RefAuthor> <RefAuthor>Vijayakumar E</RefAuthor> <RefAuthor>McLean S</RefAuthor> <RefAuthor>Brueggemann A</RefAuthor> <RefAuthor>Napolitano LM</RefAuthor> <RefTitle>Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia</RefTitle> <RefYear>1998</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>81-7</RefPage> <RefTotal>Heard SO, Wagle M, Vijayakumar E, McLean S, Brueggemann A, Napolitano LM, et al. Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia. Arch Intern Med. 1998;158:81-7. DOI: 10.1001/archinte.158.1.81</RefTotal> <RefLink>http://dx.doi.org/10.1001/archinte.158.1.81</RefLink> </Reference> <Reference refNo="57"> <RefAuthor>Richet H</RefAuthor> <RefAuthor>Hubert B</RefAuthor> <RefAuthor>Nitemberg G</RefAuthor> <RefAuthor>Andremont A</RefAuthor> <RefAuthor>Buu-Hoi A</RefAuthor> <RefAuthor>Ourbak P</RefAuthor> <RefAuthor>Galicier C</RefAuthor> <RefAuthor>Veron M</RefAuthor> <RefAuthor>Boisivon A</RefAuthor> <RefAuthor>Bouvier AM</RefAuthor> <RefTitle>Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients</RefTitle> <RefYear>1990</RefYear> <RefJournal>J Clin Microbiol</RefJournal> <RefPage>2520-5</RefPage> <RefTotal>Richet H, Hubert B, Nitemberg G, Andremont A, Buu-Hoi A, Ourbak P, Galicier C, Veron M, Boisivon A, Bouvier AM, et al. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. J Clin Microbiol. 1990;28(11):2520-5.</RefTotal> </Reference> <Reference refNo="58"> <RefAuthor>Richards B</RefAuthor> <RefAuthor>Chaboyer W</RefAuthor> <RefAuthor>Bladen T</RefAuthor> <RefAuthor>Schluter PJ</RefAuthor> <RefTitle>Effect of central venous catheter type on infections: a prospective clinical trial</RefTitle> <RefYear>2003</RefYear> <RefJournal>J Hosp Infect</RefJournal> <RefPage>10-7</RefPage> <RefTotal>Richards B, Chaboyer W, Bladen T, Schluter PJ. Effect of central venous catheter type on infections: a prospective clinical trial. J Hosp Infect. 2003;54:10-7. DOI: 10.1016/S0195-6701(03)00071-9</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0195-6701(03)00071-9</RefLink> </Reference> <Reference refNo="59"> <RefAuthor>Macdonald S</RefAuthor> <RefAuthor>Watt AJ</RefAuthor> <RefAuthor>McNally D</RefAuthor> <RefAuthor>Edwards RD</RefAuthor> <RefAuthor>Moss JG</RefAuthor> <RefTitle>Comparison of technical success and outcome of tunneled catheters inserted via the jugular and subclavian approaches</RefTitle> <RefYear>2000</RefYear> <RefJournal>J Vasc Interv Radiol</RefJournal> <RefPage>225-31</RefPage> <RefTotal>Macdonald S, Watt AJ, McNally D, Edwards RD, Moss JG. Comparison of technical success and outcome of tunneled catheters inserted via the jugular and subclavian approaches. J Vasc Interv Radiol. 2000;11:225-31. DOI: 10.1016/S1051-0443(07)61470-5</RefTotal> <RefLink>http://dx.doi.org/10.1016/S1051-0443(07)61470-5</RefLink> </Reference> <Reference refNo="60"> <RefAuthor>Rosen M</RefAuthor> <RefAuthor>Latto IP</RefAuthor> <RefAuthor>Shang Ng W</RefAuthor> <RefTitle></RefTitle> <RefYear>1992</RefYear> <RefBookTitle>Handbook of percutaneous central venous catheterisation</RefBookTitle> <RefPage></RefPage> <RefTotal>Rosen M, Latto IP, Shang Ng W, editors. Handbook of percutaneous central venous catheterisation. London, Toronto, Philadelphia, Marrickville: WB Saunders; 1992.</RefTotal> </Reference> <Reference refNo="61"> <RefAuthor>Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut</RefAuthor> <RefTitle>Prävention Gefäßkatheterassoziierter Infektionen - Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (RKI)</RefTitle> <RefYear>2002</RefYear> <RefJournal>Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz</RefJournal> <RefPage>904-27</RefPage> <RefTotal>Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut. Prävention Gefäßkatheterassoziierter Infektionen - Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (RKI). Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz. 2002;45:904-27. DOI: 10.1007/s00103-002-0499-8</RefTotal> <RefLink>http://dx.doi.org/10.1007/s00103-002-0499-8</RefLink> </Reference> <Reference refNo="62"> <RefAuthor>Fletcher SJ</RefAuthor> <RefAuthor>Bodenham AR</RefAuthor> <RefTitle>Safe placement of central venous catheters: where should the tip of the catheter lie?</RefTitle> <RefYear>2000</RefYear> <RefJournal>Br J Anaesth</RefJournal> <RefPage>188-91</RefPage> <RefTotal>Fletcher SJ, Bodenham AR. Safe placement of central venous catheters: where should the tip of the catheter lie? Br J Anaesth. 2000;85:188-91. DOI: 10.1093/bja/85.2.188</RefTotal> <RefLink>http://dx.doi.org/10.1093/bja/85.2.188</RefLink> </Reference> <Reference refNo="63"> <RefAuthor>Bozzetti F</RefAuthor> <RefAuthor>Mariani L</RefAuthor> <RefAuthor>Bertinet DB</RefAuthor> <RefAuthor>Chiavenna G</RefAuthor> <RefAuthor>Crose N</RefAuthor> <RefAuthor>De Cicco M</RefAuthor> <RefTitle>Central venous catheter (CVC) complications in 447 pts on home parenteral nutrition (HPN)</RefTitle> <RefYear>2001</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>31</RefPage> <RefTotal>Bozzetti F, Mariani L, Bertinet DB, Chiavenna G, Crose N, De Cicco M, et al. Central venous catheter (CVC) complications in 447 pts on home parenteral nutrition (HPN). Clin Nutr. 2001;20(1):31.</RefTotal> </Reference> <Reference refNo="64"> <RefAuthor>Bozzetti F</RefAuthor> <RefAuthor>Mariani L</RefAuthor> <RefAuthor>Bertinet DB</RefAuthor> <RefAuthor>Chiavenna G</RefAuthor> <RefAuthor>Crose N</RefAuthor> <RefAuthor>De Cicco M</RefAuthor> <RefTitle>Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days</RefTitle> <RefYear>2002</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>475-85</RefPage> <RefTotal>Bozzetti F, Mariani L, Bertinet DB, Chiavenna G, Crose N, De Cicco M, et al. Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days. Clin Nutr. 2002;21:475-85. DOI: 10.1054/clnu.2002.0578</RefTotal> <RefLink>http://dx.doi.org/10.1054/clnu.2002.0578</RefLink> </Reference> <Reference refNo="65"> <RefAuthor>Cowl CT</RefAuthor> <RefAuthor>Weinstock JV</RefAuthor> <RefAuthor>Al Jurf A</RefAuthor> <RefAuthor>Ephgrave K</RefAuthor> <RefAuthor>Murray JA</RefAuthor> <RefAuthor>Dillon K</RefAuthor> <RefTitle>Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters</RefTitle> <RefYear>2000</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>237-43</RefPage> <RefTotal>Cowl CT, Weinstock JV, Al Jurf A, Ephgrave K, Murray JA, Dillon K. Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters. Clin Nutr. 2000;19:237-43. DOI: 10.1054/clnu.2000.0103</RefTotal> <RefLink>http://dx.doi.org/10.1054/clnu.2000.0103</RefLink> </Reference> <Reference refNo="66"> <RefAuthor>Duerksen DR</RefAuthor> <RefAuthor>Papineau N</RefAuthor> <RefAuthor>Siemens J</RefAuthor> <RefAuthor>Yaffe C</RefAuthor> <RefTitle>Peripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters</RefTitle> <RefYear>1999</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>85-9</RefPage> <RefTotal>Duerksen DR, Papineau N, Siemens J, Yaffe C. Peripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters. JPEN J Parenter Enteral Nutr. 1999;23:85-9. DOI: 10.1177/014860719902300285</RefTotal> <RefLink>http://dx.doi.org/10.1177/014860719902300285</RefLink> </Reference> <Reference refNo="67"> <RefAuthor>Smith JR</RefAuthor> <RefAuthor>Friedell ML</RefAuthor> <RefAuthor>Cheatham ML</RefAuthor> <RefAuthor>Martin SP</RefAuthor> <RefAuthor>Cohen MJ</RefAuthor> <RefAuthor>Horowitz JD</RefAuthor> <RefTitle>Peripherally inserted central catheters revisited</RefTitle> <RefYear>1998</RefYear> <RefJournal>Am J Surg</RefJournal> <RefPage>208-211</RefPage> <RefTotal>Smith JR, Friedell ML, Cheatham ML, Martin SP, Cohen MJ, Horowitz JD. Peripherally inserted central catheters revisited. Am J Surg 1998; 176: 208-211. DOI: 10.1016/S0002-9610(98)00121-4</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0002-9610(98)00121-4</RefLink> </Reference> <Reference refNo="68"> <RefAuthor>Ng PK</RefAuthor> <RefAuthor>Ault MJ</RefAuthor> <RefAuthor>Ellrodt AG</RefAuthor> <RefAuthor>Maldonado L</RefAuthor> <RefTitle>Peripherally inserted central catheters in general medicine</RefTitle> <RefYear>1997</RefYear> <RefJournal>Mayo Clin Proc</RefJournal> <RefPage>225-33</RefPage> <RefTotal>Ng PK, Ault MJ, Ellrodt AG, Maldonado L. Peripherally inserted central catheters in general medicine. Mayo Clin Proc. 1997;72:225-33. DOI: 10.4065/72.3.225</RefTotal> <RefLink>http://dx.doi.org/10.4065/72.3.225</RefLink> </Reference> <Reference refNo="69"> <RefAuthor>Venkataraman ST</RefAuthor> <RefAuthor>Thomson AE</RefAuthor> <RefAuthor>Orr RA</RefAuthor> <RefTitle>Femoral vascular catheterisation in critically ill infants and children</RefTitle> <RefYear>1997</RefYear> <RefJournal>Clin Pediatr</RefJournal> <RefPage>311-9</RefPage> <RefTotal>Venkataraman ST, Thomson AE, Orr RA. Femoral vascular catheterisation in critically ill infants and children. Clin Pediatr. 1997;36:311-9. DOI: 10.1177/000992289703600601</RefTotal> <RefLink>http://dx.doi.org/10.1177/000992289703600601</RefLink> </Reference> <Reference refNo="70"> <RefAuthor>Goldstein AM</RefAuthor> <RefAuthor>Weber JM</RefAuthor> <RefAuthor>Sheridan RL</RefAuthor> <RefTitle>Femoral venous access is safe in burned children: an analysis of 224 catheters</RefTitle> <RefYear>1997</RefYear> <RefJournal>J Pediatr</RefJournal> <RefPage>442-6</RefPage> <RefTotal>Goldstein AM, Weber JM, Sheridan RL. Femoral venous access is safe in burned children: an analysis of 224 catheters. J Pediatr. 1997;130:442-6. DOI: 10.1016/S0022-3476(97)70208-7</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0022-3476(97)70208-7</RefLink> </Reference> <Reference refNo="71"> <RefAuthor>Stenzel JP</RefAuthor> <RefAuthor>Green TP</RefAuthor> <RefAuthor>Fuhrman BP</RefAuthor> <RefAuthor>Carlson PE</RefAuthor> <RefAuthor>Marchessault RP</RefAuthor> <RefTitle>Percutaneous femoral venous catheterizations: a prospective study of complications</RefTitle> <RefYear>1989</RefYear> <RefJournal>J Pediatr</RefJournal> <RefPage>411-5</RefPage> <RefTotal>Stenzel JP, Green TP, Fuhrman BP, Carlson PE, Marchessault RP. Percutaneous femoral venous catheterizations: a prospective study of complications. J Pediatr. 1989;114:411-5. DOI: 10.1016/S0022-3476(89)80559-1</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0022-3476(89)80559-1</RefLink> </Reference> <Reference refNo="72"> <RefAuthor>Pomp A</RefAuthor> <RefAuthor>Caldwell MD</RefAuthor> <RefAuthor>Field J</RefAuthor> <RefAuthor>Feitelson M</RefAuthor> <RefAuthor>Varella L</RefAuthor> <RefAuthor>Albina J</RefAuthor> <RefTitle>Seldinger technique for central venous catheter insertions, a prospective study of 200 cases</RefTitle> <RefYear>1987</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>103</RefPage> <RefTotal>Pomp A, Caldwell MD, Field J, Feitelson M, Varella L, Albina J. Seldinger technique for central venous catheter insertions, a prospective study of 200 cases . Clin Nutr. 1987;6:103.</RefTotal> </Reference> <Reference refNo="73"> <RefAuthor>Miller JA</RefAuthor> <RefAuthor>Singireddy S</RefAuthor> <RefAuthor>Maldjian P</RefAuthor> <RefAuthor>Baker SR</RefAuthor> <RefTitle>A reevaluation of the radiographically detectable complications of percutaneous venous access lines inserted by four subcutaneous approaches</RefTitle> <RefYear>1999</RefYear> <RefJournal>Am Surg</RefJournal> <RefPage>125-30</RefPage> <RefTotal>Miller JA, Singireddy S, Maldjian P, Baker SR. A reevaluation of the radiographically detectable complications of percutaneous venous access lines inserted by four subcutaneous approaches. Am Surg. 1999;65(2):125-30.</RefTotal> </Reference> <Reference refNo="74"> <RefAuthor>Fisher KL</RefAuthor> <RefAuthor>Leung AN</RefAuthor> <RefTitle>Radiographic appearance of central venous catheters</RefTitle> <RefYear>1996</RefYear> <RefJournal>AJR Am J Roentgenol</RefJournal> <RefPage>329-37</RefPage> <RefTotal>Fisher KL, Leung AN. Radiographic appearance of central venous catheters. AJR Am J Roentgenol. 1996;166(2):329-37.</RefTotal> </Reference> <Reference refNo="75"> <RefAuthor>Caridi JG</RefAuthor> <RefAuthor>West JH</RefAuthor> <RefAuthor>Stavropoulos SW</RefAuthor> <RefAuthor>Hawkins IF Jr</RefAuthor> <RefTitle>Internal jugular and upper extremity central venous access in interventional radiology: is a postprocedure chest radiograph necessary?</RefTitle> <RefYear>2000</RefYear> <RefJournal>AJR Am J Roentgenol</RefJournal> <RefPage>363-6</RefPage> <RefTotal>Caridi JG, West JH, Stavropoulos SW, Hawkins IF Jr. Internal jugular and upper extremity central venous access in interventional radiology: is a postprocedure chest radiograph necessary? AJR Am J Roentgenol. 2000;174:363-6.</RefTotal> </Reference> <Reference refNo="76"> <RefAuthor>Randolph AG</RefAuthor> <RefAuthor>Cook DJ</RefAuthor> <RefAuthor>Gonzales CA</RefAuthor> <RefAuthor>Pribble CG</RefAuthor> <RefTitle>Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature</RefTitle> <RefYear>1996</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>2053-8</RefPage> <RefTotal>Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med. 1996;24:2053-8. DOI: 10.1097/00003246-199612000-00020</RefTotal> <RefLink>http://dx.doi.org/10.1097/00003246-199612000-00020</RefLink> </Reference> <Reference refNo="77"> <RefAuthor>Brass P</RefAuthor> <RefAuthor>Volk O</RefAuthor> <RefAuthor>Leben J</RefAuthor> <RefAuthor>Schregel W</RefAuthor> <RefTitle>Zentralvenöse Punktion – nur noch mit Ultraschall? [Central Venous Cannulation – Always with Ultrasound Support?]</RefTitle> <RefYear>2001</RefYear> <RefJournal>Anasthesiol Intensivmed Notfallmed Schmerzther</RefJournal> <RefPage>619-27</RefPage> <RefTotal>Brass P, Volk O, Leben J, Schregel W. Zentralvenöse Punktion – nur noch mit Ultraschall? [Central Venous Cannulation – Always with Ultrasound Support?]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2001;36:619-27. DOI: 10.1055/s-2001-17671</RefTotal> <RefLink>http://dx.doi.org/10.1055/s-2001-17671</RefLink> </Reference> <Reference refNo="78"> <RefAuthor>Keenan SP</RefAuthor> <RefTitle>Use of ultrasound to place central lines</RefTitle> <RefYear>2002</RefYear> <RefJournal>J Crit Care</RefJournal> <RefPage>126-37</RefPage> <RefTotal>Keenan SP. Use of ultrasound to place central lines. J Crit Care. 2002;17:126-37. DOI: 10.1053/jcrc.2002.34364</RefTotal> <RefLink>http://dx.doi.org/10.1053/jcrc.2002.34364</RefLink> </Reference> <Reference refNo="79"> <RefAuthor>Wagner HJ</RefAuthor> <RefAuthor>Teichgräber U</RefAuthor> <RefAuthor>Gebauer B</RefAuthor> <RefAuthor>Kalinowski M</RefAuthor> <RefTitle>Die transjugulare Implantation venoser Portkathetersysteme [Transjugular implantation of venous port catheter systems]</RefTitle> <RefYear>2003</RefYear> <RefJournal>Röfo</RefJournal> <RefPage>1539-44</RefPage> <RefTotal>Wagner HJ, Teichgräber U, Gebauer B, Kalinowski M. Die transjugulare Implantation venoser Portkathetersysteme [Transjugular implantation of venous port catheter systems]. Röfo. 2003;175:1539-44.</RefTotal> </Reference> <Reference refNo="80"> <RefAuthor>Hind D</RefAuthor> <RefAuthor>Calvert N</RefAuthor> <RefAuthor>McWilliams R</RefAuthor> <RefAuthor>Davidson A</RefAuthor> <RefAuthor>Paisley S</RefAuthor> <RefAuthor>Beverley C</RefAuthor> <RefTitle>Ultrasonic locating devices for central venous cannulation: meta-analysis</RefTitle> <RefYear>2003</RefYear> <RefJournal>BMJ</RefJournal> <RefPage>361</RefPage> <RefTotal>Hind D, Calvert N, McWilliams R, Davidson A, Paisley S, Beverley C, et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ 2003; 327: 361 DOI: 10.1136/bmj.327.7411.361</RefTotal> <RefLink>http://dx.doi.org/10.1136/bmj.327.7411.361</RefLink> </Reference> <Reference refNo="81"> <RefAuthor>Oguzkurt L</RefAuthor> <RefAuthor>Tercan F</RefAuthor> <RefAuthor>Kara G</RefAuthor> <RefAuthor>Torun D</RefAuthor> <RefAuthor>Kizilkilic O</RefAuthor> <RefAuthor>Yildirim T</RefAuthor> <RefTitle>US-guided placement of temporary internal jugular vein catheters: immediate technical success and complications in normal and high-risk patients</RefTitle> <RefYear>2005</RefYear> <RefJournal>Eur J Radiol</RefJournal> <RefPage>125-9</RefPage> <RefTotal>Oguzkurt L, Tercan F, Kara G, Torun D, Kizilkilic O, Yildirim T. US-guided placement of temporary internal jugular vein catheters: immediate technical success and complications in normal and high-risk patients. Eur J Radiol. 2005;55:125-9. DOI: 10.1016/j.ejrad.2004.10.004</RefTotal> <RefLink>http://dx.doi.org/10.1016/j.ejrad.2004.10.004</RefLink> </Reference> <Reference refNo="82"> <RefAuthor>Schäfer M</RefAuthor> <RefAuthor>Reinhart K</RefAuthor> <RefTitle>Die Plazierung von zentralen Venenkathetern mit Hilfe der intraatrialen EKG-Ableitung [Placement of central venous catheters using intra-arterial ECG recording]</RefTitle> <RefYear>1993</RefYear> <RefJournal>Zentralbl Chir</RefJournal> <RefPage>432-5</RefPage> <RefTotal>Schäfer M, Reinhart K. Die Plazierung von zentralen Venenkathetern mit Hilfe der intraatrialen EKG-Ableitung [Placement of central venous catheters using intra-arterial ECG recording]. Zentralbl Chir. 1993;118:432-5.</RefTotal> </Reference> <Reference refNo="83"> <RefAuthor>McGee WT</RefAuthor> <RefAuthor>Mallory DL</RefAuthor> <RefAuthor>Johans TG</RefAuthor> <RefTitle>Safe placement of central venous catheters is facilitated using right atrial electrocardiography</RefTitle> <RefYear>1988</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>434</RefPage> <RefTotal>McGee WT, Mallory DL, Johans TG, et al. Safe placement of central venous catheters is facilitated using right atrial electrocardiography. Crit Care Med. 1988;16:434. DOI: 10.1097/00003246-198804000-00151</RefTotal> <RefLink>http://dx.doi.org/10.1097/00003246-198804000-00151</RefLink> </Reference> <Reference refNo="84"> <RefAuthor>Fritz KW</RefAuthor> <RefAuthor>Gras C</RefAuthor> <RefAuthor>Logemann F</RefAuthor> <RefAuthor>Kirchhoff K</RefAuthor> <RefTitle>Die Positionierung des zentral-venosen Katheters mit Hilfe des intraatrialen EKG [Positioning the central venous catheter using intra-atrial ECG]</RefTitle> <RefYear>1991</RefYear> <RefJournal>Anaesthesiol Reanim</RefJournal> <RefPage>399-402</RefPage> <RefTotal>Fritz KW, Gras C, Logemann F, Kirchhoff K. Die Positionierung des zentral-venosen Katheters mit Hilfe des intraatrialen EKG [Positioning the central venous catheter using intra-atrial ECG]. Anaesthesiol Reanim. 1991;16(6):399-402.</RefTotal> </Reference> <Reference refNo="85"> <RefAuthor>Nakatani K</RefAuthor> <RefAuthor>Nishikawa K</RefAuthor> <RefAuthor>Funao T</RefAuthor> <RefAuthor>Ikeda Y</RefAuthor> <RefAuthor>Nakasuji K</RefAuthor> <RefAuthor>Iida Y</RefAuthor> <RefTitle>Accurate placement of central venous catheter - ECG-guided method vs patient height method</RefTitle> <RefYear>2002</RefYear> <RefJournal>Masui</RefJournal> <RefPage>34-8</RefPage> <RefTotal>Nakatani K, Nishikawa K, Funao T, Ikeda Y, Nakasuji K, Iida Y, et al. Accurate placement of central venous catheter - ECG-guided method vs patient height method. Masui. 2002;51(1):34-8.</RefTotal> </Reference> <Reference refNo="86"> <RefAuthor>Madias JE</RefAuthor> <RefTitle>Intracardiac (superior vena cava/right atrial) ECGs using saline solution as the conductive medium for the proper positioning of the Shiley hemodialysis catheter: is it not time to forgo the postinsertion chest radiograph?</RefTitle> <RefYear>2003</RefYear> <RefJournal>Chest</RefJournal> <RefPage>2363-7</RefPage> <RefTotal>Madias JE. Intracardiac (superior vena cava/right atrial) ECGs using saline solution as the conductive medium for the proper positioning of the Shiley hemodialysis catheter: is it not time to forgo the postinsertion chest radiograph? Chest. 2003;124:2363-7. DOI: 10.1378/chest.124.6.2363</RefTotal> <RefLink>http://dx.doi.org/10.1378/chest.124.6.2363</RefLink> </Reference> <Reference refNo="87"> <RefAuthor>Madias JE</RefAuthor> <RefTitle>Intracardiac electrocardiography via a "saline-filled central venous catheter electrocardiographic lead": a historical perspective</RefTitle> <RefYear>2004</RefYear> <RefJournal>J Electrocardiol</RefJournal> <RefPage>83-8</RefPage> <RefTotal>Madias JE. Intracardiac electrocardiography via a "saline-filled central venous catheter electrocardiographic lead": a historical perspective. J Electrocardiol. 2004;37:83-8. DOI: 10.1016/j.jelectrocard.2004.01.011</RefTotal> <RefLink>http://dx.doi.org/10.1016/j.jelectrocard.2004.01.011</RefLink> </Reference> <Reference refNo="88"> <RefAuthor>Schummer W</RefAuthor> <RefAuthor>Herrmann S</RefAuthor> <RefAuthor>Schummer C</RefAuthor> <RefAuthor>Funke F</RefAuthor> <RefAuthor>Steenbeck J</RefAuthor> <RefAuthor>Fuchs J</RefAuthor> <RefTitle>Intra-atrial ECG is not a reliable method for positioning left internal jugular vein catheters</RefTitle> <RefYear>2003</RefYear> <RefJournal>Br J Anaesth</RefJournal> <RefPage>481-6</RefPage> <RefTotal>Schummer W, Herrmann S, Schummer C, Funke F, Steenbeck J, Fuchs J, et al. Intra-atrial ECG is not a reliable method for positioning left internal jugular vein catheters. Br J Anaesth. 2003;91:481-6. DOI: 10.1093/bja/aeg208</RefTotal> <RefLink>http://dx.doi.org/10.1093/bja/aeg208</RefLink> </Reference> <Reference refNo="89"> <RefAuthor>Watters VA</RefAuthor> <RefAuthor>Grant JP</RefAuthor> <RefTitle>Use of electrocardiogram to position right atrial catheters during surgery</RefTitle> <RefYear>1997</RefYear> <RefJournal>Ann Surg</RefJournal> <RefPage>165-71</RefPage> <RefTotal>Watters VA, Grant JP. Use of electrocardiogram to position right atrial catheters during surgery. Ann Surg. 1997;225:165-71. DOI: 10.1097/00000658-199702000-00004</RefTotal> <RefLink>http://dx.doi.org/10.1097/00000658-199702000-00004</RefLink> </Reference> <Reference refNo="90"> <RefAuthor>Chu KS</RefAuthor> <RefAuthor>Hsu JH</RefAuthor> <RefAuthor>Wang SS</RefAuthor> <RefAuthor>Tang CS</RefAuthor> <RefAuthor>Cheng KI</RefAuthor> <RefAuthor>Wang CK</RefAuthor> <RefTitle>Accurate central venous port-A catheter placement: intravenous electrocardiography and surface landmark techniques compared by using transesophageal echocardiography</RefTitle> <RefYear>2004</RefYear> <RefJournal>Anesth Analg</RefJournal> <RefPage>910-4</RefPage> <RefTotal>Chu KS, Hsu JH, Wang SS, Tang CS, Cheng KI, Wang CK, et al. Accurate central venous port-A catheter placement: intravenous electrocardiography and surface landmark techniques compared by using transesophageal echocardiography. Anesth Analg. 2004;98:910-4. DOI: 10.1213/01.ANE.0000105865.94157.4C</RefTotal> <RefLink>http://dx.doi.org/10.1213/01.ANE.0000105865.94157.4C</RefLink> </Reference> <Reference refNo="91"> <RefAuthor>Madan M</RefAuthor> <RefAuthor>Shah MV</RefAuthor> <RefAuthor>Alexander DJ</RefAuthor> <RefAuthor>Taylor C</RefAuthor> <RefAuthor>McMahon MJ</RefAuthor> <RefTitle>Right atrial electrocardiography: a technique for the placement of central venous catheters for chemotherapy or intravenous nutrition</RefTitle> <RefYear>1994</RefYear> <RefJournal>Br J Surg</RefJournal> <RefPage>1604-5</RefPage> <RefTotal>Madan M, Shah MV, Alexander DJ, Taylor C, McMahon MJ. Right atrial electrocardiography: a technique for the placement of central venous catheters for chemotherapy or intravenous nutrition. Br J Surg. 1994;81:1604-5. DOI: 10.1002/bjs.1800811113</RefTotal> <RefLink>http://dx.doi.org/10.1002/bjs.1800811113</RefLink> </Reference> <Reference refNo="92"> <RefAuthor>McGee WT</RefAuthor> <RefAuthor>Ackerman BL</RefAuthor> <RefAuthor>Rouben LR</RefAuthor> <RefAuthor>Prasad VM</RefAuthor> <RefAuthor>Bandi V</RefAuthor> <RefAuthor>Mallory DL</RefAuthor> <RefTitle>Accurate placement of central venous catheters: a prospective, randomized, multicenter trial</RefTitle> <RefYear>1993</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>1118-23</RefPage> <RefTotal>McGee WT, Ackerman BL, Rouben LR, Prasad VM, Bandi V, Mallory DL. Accurate placement of central venous catheters: a prospective, randomized, multicenter trial. Crit Care Med. 1993;21(8):1118-23.</RefTotal> </Reference> <Reference refNo="93"> <RefAuthor>Corsten SA</RefAuthor> <RefAuthor>van Dijk B</RefAuthor> <RefAuthor>Bakker NC</RefAuthor> <RefAuthor>de Lange JJ</RefAuthor> <RefAuthor>Scheffer GJ</RefAuthor> <RefTitle>Central venous catheter placement using the ECG-guided Cavafix-Certodyn SD catheter</RefTitle> <RefYear>1994</RefYear> <RefJournal>J Clin Anesth</RefJournal> <RefPage>469-72</RefPage> <RefTotal>Corsten SA, van Dijk B, Bakker NC, de Lange JJ, Scheffer GJ. Central venous catheter placement using the ECG-guided Cavafix-Certodyn SD catheter. J Clin Anesth. 1994;6:469-72. DOI: 10.1016/0952-8180(94)90086-8</RefTotal> <RefLink>http://dx.doi.org/10.1016/0952-8180(94)90086-8</RefLink> </Reference> <Reference refNo="94"> <RefAuthor>Nachnani GH</RefAuthor> <RefAuthor>Lessin LS</RefAuthor> <RefAuthor>Motomiya T</RefAuthor> <RefAuthor>Jensen WN</RefAuthor> <RefTitle>Scanning electron microscopy of thrombogenesis on vascular catheter surfaces</RefTitle> <RefYear>1972</RefYear> <RefJournal>N Engl J Med</RefJournal> <RefPage>139-40</RefPage> <RefTotal>Nachnani GH, Lessin LS, Motomiya T, Jensen WN. Scanning electron microscopy of thrombogenesis on vascular catheter surfaces. N Engl J Med. 1972;286(3):139-40.</RefTotal> </Reference> <Reference refNo="95"> <RefAuthor>Stillman RM</RefAuthor> <RefAuthor>Soliman F</RefAuthor> <RefAuthor>Garcia L</RefAuthor> <RefAuthor>Sawyer PN</RefAuthor> <RefTitle>Etiology of catheter-associated sepsis; Correlation with thrombogenicity</RefTitle> <RefYear>1977</RefYear> <RefJournal>Arch Surg</RefJournal> <RefPage>1497-9</RefPage> <RefTotal>Stillman RM, Soliman F, Garcia L, Sawyer PN. Etiology of catheter-associated sepsis; Correlation with thrombogenicity. Arch Surg. 1977;112:1497-9.</RefTotal> </Reference> <Reference refNo="96"> <RefAuthor>Borow M</RefAuthor> <RefAuthor>Crowley JG</RefAuthor> <RefTitle>Evaluation of central venous catheter thrombogenicity</RefTitle> <RefYear>1985</RefYear> <RefJournal>Acta Anaesthesiol Scand Suppl</RefJournal> <RefPage>59-64</RefPage> <RefTotal>Borow M, Crowley JG. Evaluation of central venous catheter thrombogenicity. Acta Anaesthesiol Scand Suppl. 1985;81:59-64. DOI: 10.1111/j.1399-6576.1985.tb02329.x</RefTotal> <RefLink>http://dx.doi.org/10.1111/j.1399-6576.1985.tb02329.x</RefLink> </Reference> <Reference refNo="97"> <RefAuthor>Sheth NK</RefAuthor> <RefAuthor>Franson TR</RefAuthor> <RefAuthor>Rose HD</RefAuthor> <RefAuthor>Buckmire FL</RefAuthor> <RefAuthor>Cooper JA</RefAuthor> <RefAuthor>Sohnle PG</RefAuthor> <RefTitle>Colonization of bacteria on polyvinyl chloride and Teflon intravascular catheters in hospitalized patients</RefTitle> <RefYear>1983</RefYear> <RefJournal>J Clin Microbiol</RefJournal> <RefPage>1061-3</RefPage> <RefTotal>Sheth NK, Franson TR, Rose HD, Buckmire FL, Cooper JA, Sohnle PG. Colonization of bacteria on polyvinyl chloride and Teflon intravascular catheters in hospitalized patients. J Clin Microbiol. 1983;18(5):1061-3.</RefTotal> </Reference> <Reference refNo="98"> <RefAuthor>Maki DG</RefAuthor> <RefAuthor>Ringer M</RefAuthor> <RefTitle>Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters; Gauze, a transparent polyurethane dressing, and an iodophor-transparent dressing</RefTitle> <RefYear>1987</RefYear> <RefJournal>JAMA</RefJournal> <RefPage>2396-403</RefPage> <RefTotal>Maki DG, Ringer M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters; Gauze, a transparent polyurethane dressing, and an iodophor-transparent dressing. JAMA. 1987;258(17):2396-403.</RefTotal> </Reference> <Reference refNo="99"> <RefAuthor>Maki DG</RefAuthor> <RefAuthor>Ringer M</RefAuthor> <RefTitle>Risk factors for infusion-related phlebitis with small peripheral venous catheters; A randomized controlled trial</RefTitle> <RefYear>1991</RefYear> <RefJournal>Ann Intern Med</RefJournal> <RefPage>845-54</RefPage> <RefTotal>Maki DG, Ringer M. Risk factors for infusion-related phlebitis with small peripheral venous catheters; A randomized controlled trial. Ann Intern Med. 1991;114(10):845-54.</RefTotal> </Reference> <Reference refNo="100"> <RefAuthor>Locci R</RefAuthor> <RefAuthor>Peters G</RefAuthor> <RefAuthor>Pulverer G</RefAuthor> <RefTitle>Microbial colonization of prosthetic devices; IV: Scanning electron microscopy of intravenous catheters invaded by yeasts</RefTitle> <RefYear>1981</RefYear> <RefJournal>Zentralbl Bakteriol Mikrobiol Hyg B</RefJournal> <RefPage>419-24</RefPage> <RefTotal>Locci R, Peters G, Pulverer G. Microbial colonization of prosthetic devices; IV: Scanning electron microscopy of intravenous catheters invaded by yeasts. Zentralbl Bakteriol Mikrobiol Hyg B. 1981;173(6):419-24.</RefTotal> </Reference> <Reference refNo="101"> <RefAuthor>Locci R</RefAuthor> <RefAuthor>Peters G</RefAuthor> <RefAuthor>Pulverer G</RefAuthor> <RefTitle>Microbial colonization of prosthetic devices; I: Microtopographical characteristics of intravenous catheters as detected by scanning electron microscopy</RefTitle> <RefYear>1981</RefYear> <RefJournal>Zentralbl Bakteriol Mikrobiol Hyg B</RefJournal> <RefPage>285-92</RefPage> <RefTotal>Locci R, Peters G, Pulverer G. Microbial colonization of prosthetic devices; I: Microtopographical characteristics of intravenous catheters as detected by scanning electron microscopy. Zentralbl Bakteriol Mikrobiol Hyg B. 1981;173(5):285-92.</RefTotal> </Reference> <Reference refNo="102"> <RefAuthor>Branchini ML</RefAuthor> <RefAuthor>Pfaller MA</RefAuthor> <RefAuthor>Rhine-Chalberg J</RefAuthor> <RefAuthor>Frempong T</RefAuthor> <RefAuthor>Isenberg HD</RefAuthor> <RefTitle>Genotypic variation and slime production among blood and catheter isolates of Candida parapsilosis</RefTitle> <RefYear>1994</RefYear> <RefJournal>J Clin Microbiol</RefJournal> <RefPage>452-6</RefPage> <RefTotal>Branchini ML, Pfaller MA, Rhine-Chalberg J, Frempong T, Isenberg HD. Genotypic variation and slime production among blood and catheter isolates of Candida parapsilosis. J Clin Microbiol. 1994;32(2):452-6.</RefTotal> </Reference> <Reference refNo="103"> <RefAuthor>Marin MG</RefAuthor> <RefAuthor>Lee JC</RefAuthor> <RefAuthor>Skurnick JH</RefAuthor> <RefTitle>Prevention of nosocomial bloodstream infections: effectiveness of antimicrobial-impregnated and heparin-bonded central venous catheters</RefTitle> <RefYear>2000</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>3332-8</RefPage> <RefTotal>Marin MG, Lee JC, Skurnick JH. Prevention of nosocomial bloodstream infections: effectiveness of antimicrobial-impregnated and heparin-bonded central venous catheters. Crit Care Med. 2000;28:3332-8. DOI: 10.1097/00003246-200009000-00035</RefTotal> <RefLink>http://dx.doi.org/10.1097/00003246-200009000-00035</RefLink> </Reference> <Reference refNo="104"> <RefAuthor>Carrasco MN</RefAuthor> <RefAuthor>Bueno A</RefAuthor> <RefAuthor>de las Cuerus C</RefAuthor> <RefAuthor>Jimenez S</RefAuthor> <RefAuthor>Salinas I</RefAuthor> <RefAuthor>Sartorius A</RefAuthor> <RefTitle>Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients</RefTitle> <RefYear>2004</RefYear> <RefJournal>Intensive Care Med</RefJournal> <RefPage>633-8</RefPage> <RefTotal>Carrasco MN, Bueno A, de las Cuerus C, Jimenez S, Salinas I, Sartorius A, et al. Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients. Intensive Care Med. 2004;30:633-8. DOI: 10.1007/s00134-003-2093-4</RefTotal> <RefLink>http://dx.doi.org/10.1007/s00134-003-2093-4</RefLink> </Reference> <Reference refNo="105"> <RefAuthor>Foley PL</RefAuthor> <RefAuthor>Barthel CH</RefAuthor> <RefAuthor>Brausa HR</RefAuthor> <RefTitle>Effect of covalently bound heparin coating on patency and biocompatibility of long-term indwelling catheters in the rat jugular vein</RefTitle> <RefYear>2002</RefYear> <RefJournal>Comp Med</RefJournal> <RefPage>243-8</RefPage> <RefTotal>Foley PL, Barthel CH, Brausa HR. Effect of covalently bound heparin coating on patency and biocompatibility of long-term indwelling catheters in the rat jugular vein. Comp Med. 2002;52(3):243-8.</RefTotal> </Reference> <Reference refNo="106"> <RefAuthor>Nasuno A</RefAuthor> <RefAuthor>Matsubara T</RefAuthor> <RefAuthor>Hori T</RefAuthor> <RefAuthor>Higuchi K</RefAuthor> <RefAuthor>Tsuchida K</RefAuthor> <RefAuthor>Mezaki T</RefAuthor> <RefTitle>Acute pulmonary thromboembolism induced by prophylactic heparin use and a heparin-coated catheter: a case of heparin-induced thrombocytopenia and thrombosis syndrome</RefTitle> <RefYear>2003</RefYear> <RefJournal>Circ J</RefJournal> <RefPage>96-8</RefPage> <RefTotal>Nasuno A, Matsubara T, Hori T, Higuchi K, Tsuchida K, Mezaki T, et al. Acute pulmonary thromboembolism induced by prophylactic heparin use and a heparin-coated catheter: a case of heparin-induced thrombocytopenia and thrombosis syndrome. Circ J. 2003;67:96-8. DOI: 10.1253/circj.67.96</RefTotal> <RefLink>http://dx.doi.org/10.1253/circj.67.96</RefLink> </Reference> <Reference refNo="107"> <RefAuthor>Laster JL</RefAuthor> <RefAuthor>Nichols WK</RefAuthor> <RefAuthor>Silver D</RefAuthor> <RefTitle>Thrombocytopenia associated with heparin-coated catheters in patients with heparin-associated antiplatelet antibodies</RefTitle> <RefYear>1989</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>2285-7</RefPage> <RefTotal>Laster JL, Nichols WK, Silver D. Thrombocytopenia associated with heparin-coated catheters in patients with heparin-associated antiplatelet antibodies. Arch Intern Med. 1989;149:2285-7.</RefTotal> </Reference> <Reference refNo="108"> <RefAuthor>Tokars JI</RefAuthor> <RefAuthor>Cookson ST</RefAuthor> <RefAuthor>McArthur MA</RefAuthor> <RefAuthor>Boyer CL</RefAuthor> <RefAuthor>McGeer AJ</RefAuthor> <RefAuthor>Jarvis WR</RefAuthor> <RefTitle>Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy</RefTitle> <RefYear>1999</RefYear> <RefJournal>Ann Intern Med</RefJournal> <RefPage>340-7</RefPage> <RefTotal>Tokars JI, Cookson ST, McArthur MA, Boyer CL, McGeer AJ, Jarvis WR. Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy. Ann Intern Med. 1999;131(5):340-7.</RefTotal> </Reference> <Reference refNo="109"> <RefAuthor>Gil RT</RefAuthor> <RefAuthor>Kruse JA</RefAuthor> <RefAuthor>Thill-Baharozian MC</RefAuthor> <RefAuthor>Carlson RW</RefAuthor> <RefTitle>Triple- vs single-lumen central venous catheters; A prospective study in a critically ill population</RefTitle> <RefYear>1989</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>1139-43</RefPage> <RefTotal>Gil RT, Kruse JA, Thill-Baharozian MC, Carlson RW. Triple- vs single-lumen central venous catheters; A prospective study in a critically ill population. Arch Intern Med. 1989;149:1139-43.</RefTotal> </Reference> <Reference refNo="110"> <RefAuthor>Hilton E</RefAuthor> <RefAuthor>Haslett TM</RefAuthor> <RefAuthor>Borenstein MT</RefAuthor> <RefAuthor>Tucci V</RefAuthor> <RefAuthor>Isenberg HD</RefAuthor> <RefAuthor>Singer C</RefAuthor> <RefTitle>Central catheter infections: single- versus triple-lumen catheters. Influence of guide wires on infection rates when used for replacement of catheters</RefTitle> <RefYear>1988</RefYear> <RefJournal>Am J Med</RefJournal> <RefPage>667-72</RefPage> <RefTotal>Hilton E, Haslett TM, Borenstein MT, Tucci V, Isenberg HD, Singer C. Central catheter infections: single- versus triple-lumen catheters. Influence of guide wires on infection rates when used for replacement of catheters. Am J Med. 1988;84:667-72. DOI: 10.1016/0002-9343(88)90102-7</RefTotal> <RefLink>http://dx.doi.org/10.1016/0002-9343(88)90102-7</RefLink> </Reference> <Reference refNo="111"> <RefAuthor>McCarthy MC</RefAuthor> <RefAuthor>Shives JK</RefAuthor> <RefAuthor>Robison RJ</RefAuthor> <RefAuthor>Broadie TA</RefAuthor> <RefTitle>Prospective evaluation of single and triple lumen catheters in total parenteral nutrition</RefTitle> <RefYear>1987</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>259-62</RefPage> <RefTotal>McCarthy MC, Shives JK, Robison RJ, Broadie TA. Prospective evaluation of single and triple lumen catheters in total parenteral nutrition. JPEN J Parenter Enteral Nutr. 1987;11:259-62. DOI: 10.1177/0148607187011003259</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607187011003259</RefLink> </Reference> <Reference refNo="112"> <RefAuthor>Pemberton LB</RefAuthor> <RefAuthor>Lyman B</RefAuthor> <RefAuthor>Lander V</RefAuthor> <RefAuthor>Covinsky J</RefAuthor> <RefTitle>Sepsis from triple- vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients</RefTitle> <RefYear>1986</RefYear> <RefJournal>Arch Surg</RefJournal> <RefPage>591-4</RefPage> <RefTotal>Pemberton LB, Lyman B, Lander V, Covinsky J. Sepsis from triple- vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients. Arch Surg. 1986;121:591-4.</RefTotal> </Reference> <Reference refNo="113"> <RefAuthor>Ma TY</RefAuthor> <RefAuthor>Yoshinaka R</RefAuthor> <RefAuthor>Banaag A</RefAuthor> <RefAuthor>Johnson B</RefAuthor> <RefAuthor>Davis S</RefAuthor> <RefAuthor>Berman SM</RefAuthor> <RefTitle>Total parenteral nutrition via multilumen catheters does not increase the risk of catheter-related sepsis: a randomized, prospective study</RefTitle> <RefYear>1998</RefYear> <RefJournal>Clin Infect Dis</RefJournal> <RefPage>500-3</RefPage> <RefTotal>Ma TY, Yoshinaka R, Banaag A, Johnson B, Davis S, Berman SM. Total parenteral nutrition via multilumen catheters does not increase the risk of catheter-related sepsis: a randomized, prospective study. Clin Infect Dis. 1998;27:500-3. DOI: 10.1086/514687</RefTotal> <RefLink>http://dx.doi.org/10.1086/514687</RefLink> </Reference> <Reference refNo="114"> <RefAuthor>Savage AP</RefAuthor> <RefAuthor>Picard M</RefAuthor> <RefAuthor>Hopkins CC</RefAuthor> <RefAuthor>Malt RA</RefAuthor> <RefTitle>Complications and survival of multilumen central venous catheters used for total parenteral nutrition</RefTitle> <RefYear>1993</RefYear> <RefJournal>Br J Surg</RefJournal> <RefPage>1287-90</RefPage> <RefTotal>Savage AP, Picard M, Hopkins CC, Malt RA. Complications and survival of multilumen central venous catheters used for total parenteral nutrition. Br J Surg. 1993;80:1287-90. DOI: 10.1002/bjs.1800801021</RefTotal> <RefLink>http://dx.doi.org/10.1002/bjs.1800801021</RefLink> </Reference> <Reference refNo="115"> <RefAuthor>Manglano R</RefAuthor> <RefAuthor>Martin M</RefAuthor> <RefTitle>Safety of triple lumen catheters in the critically ill</RefTitle> <RefYear>1991</RefYear> <RefJournal>Am Surg</RefJournal> <RefPage>370-2</RefPage> <RefTotal>Manglano R, Martin M. Safety of triple lumen catheters in the critically ill. Am Surg. 1991;57(6):370-2.</RefTotal> </Reference> <Reference refNo="116"> <RefAuthor>Attar A</RefAuthor> <RefAuthor>Messing B</RefAuthor> <RefTitle>Evidence-based prevention of catheter infection during parenteral nutrition</RefTitle> <RefYear>2001</RefYear> <RefJournal>Curr Opin Clin Nutr Metab Care</RefJournal> <RefPage>211-8</RefPage> <RefTotal>Attar A, Messing B. Evidence-based prevention of catheter infection during parenteral nutrition. Curr Opin Clin Nutr Metab Care. 2001;4:211-8. DOI: 10.1097/00075197-200105000-00008</RefTotal> <RefLink>http://dx.doi.org/10.1097/00075197-200105000-00008</RefLink> </Reference> <Reference refNo="117"> <RefAuthor>Raad II</RefAuthor> <RefAuthor>Hohn DC</RefAuthor> <RefAuthor>Gilbreath BJ</RefAuthor> <RefAuthor>Suleiman N</RefAuthor> <RefAuthor>Hill LA</RefAuthor> <RefAuthor>Bruso PA</RefAuthor> <RefAuthor>Marts K</RefAuthor> <RefAuthor>Mansfield PF</RefAuthor> <RefAuthor>Bodey GP</RefAuthor> <RefTitle>Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion</RefTitle> <RefYear>1994</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>231-8</RefPage> <RefTotal>Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, Marts K, Mansfield PF, Bodey GP. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol. 1994;15(4 Pt 1):231-8.</RefTotal> </Reference> <Reference refNo="118"> <RefAuthor>Maki DG</RefAuthor> <RefAuthor>Ringer M</RefAuthor> <RefAuthor>Alvarado CJ</RefAuthor> <RefTitle>Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters</RefTitle> <RefYear>1991</RefYear> <RefJournal>Lancet</RefJournal> <RefPage>339-43</RefPage> <RefTotal>Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet. 1991;338:339-43. DOI: 10.1016/0140-6736(91)90479-9</RefTotal> <RefLink>http://dx.doi.org/10.1016/0140-6736(91)90479-9</RefLink> </Reference> <Reference refNo="119"> <RefAuthor>Alonso-Echanove J</RefAuthor> <RefAuthor>Edwards JR</RefAuthor> <RefAuthor>Richards MJ</RefAuthor> <RefAuthor>Brennan P</RefAuthor> <RefAuthor>Venezia RA</RefAuthor> <RefAuthor>Keen J</RefAuthor> <RefTitle>Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units</RefTitle> <RefYear>2003</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>916-25</RefPage> <RefTotal>Alonso-Echanove J, Edwards JR, Richards MJ, Brennan P, Venezia RA, Keen J, et al. Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infect Control Hosp Epidemiol. 2003;24:916-25. DOI: 10.1086/502160</RefTotal> <RefLink>http://dx.doi.org/10.1086/502160</RefLink> </Reference> <Reference refNo="120"> <RefAuthor>Abi-Said D</RefAuthor> <RefAuthor>Raad I</RefAuthor> <RefAuthor>Umphrey J</RefAuthor> <RefAuthor>Gonzalez V</RefAuthor> <RefAuthor>Richardson D</RefAuthor> <RefAuthor>Marts K</RefAuthor> <RefTitle>Infusion therapy team and dressing changes of central venous catheters</RefTitle> <RefYear>1999</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>101-5</RefPage> <RefTotal>Abi-Said D, Raad I, Umphrey J, Gonzalez V, Richardson D, Marts K, et al. Infusion therapy team and dressing changes of central venous catheters. Infect Control Hosp Epidemiol. 1999;20:101-5. DOI: 10.1086/501597</RefTotal> <RefLink>http://dx.doi.org/10.1086/501597</RefLink> </Reference> <Reference refNo="121"> <RefAuthor>Humar A</RefAuthor> <RefAuthor>Ostromecki A</RefAuthor> <RefAuthor>Direnfeld J</RefAuthor> <RefAuthor>Marshall JC</RefAuthor> <RefAuthor>Lazar N</RefAuthor> <RefAuthor>Houston PC</RefAuthor> <RefTitle>Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection</RefTitle> <RefYear>2000</RefYear> <RefJournal>Clin Infect Dis</RefJournal> <RefPage>1001-7</RefPage> <RefTotal>Humar A, Ostromecki A, Direnfeld J, Marshall JC, Lazar N, Houston PC, et al. Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection. Clin Infect Dis. 2000;31:1001-7. DOI: 10.1086/318145</RefTotal> <RefLink>http://dx.doi.org/10.1086/318145</RefLink> </Reference> <Reference refNo="122"> <RefAuthor>Garland JS</RefAuthor> <RefAuthor>Buck RK</RefAuthor> <RefAuthor>Maloney P</RefAuthor> <RefAuthor>Durkin DM</RefAuthor> <RefAuthor>Toth-Lloyd S</RefAuthor> <RefAuthor>Duffy M</RefAuthor> <RefTitle>Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial</RefTitle> <RefYear>1995</RefYear> <RefJournal>Pediatr Infect Dis J</RefJournal> <RefPage>510-6</RefPage> <RefTotal>Garland JS, Buck RK, Maloney P, Durkin DM, Toth-Lloyd S, Duffy M, et al. Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial. Pediatr Infect Dis J. 1995;14:510-6. DOI: 10.1097/00006454-199506000-00008</RefTotal> <RefLink>http://dx.doi.org/10.1097/00006454-199506000-00008</RefLink> </Reference> <Reference refNo="123"> <RefAuthor>Safdar N</RefAuthor> <RefAuthor>Kluger DM</RefAuthor> <RefAuthor>Maki DG</RefAuthor> <RefTitle>A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies</RefTitle> <RefYear>2002</RefYear> <RefJournal>Medicine (Baltimore)</RefJournal> <RefPage>466-79</RefPage> <RefTotal>Safdar N, Kluger DM, Maki DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore). 2002;81:466-79. DOI: 10.1097/00005792-200211000-00007</RefTotal> <RefLink>http://dx.doi.org/10.1097/00005792-200211000-00007</RefLink> </Reference> <Reference refNo="124"> <RefAuthor>Ranson MR</RefAuthor> <RefAuthor>Oppenheim BA</RefAuthor> <RefAuthor>Jackson A</RefAuthor> <RefAuthor>Kamthan AG</RefAuthor> <RefAuthor>Scarffe JH</RefAuthor> <RefTitle>Double-blind placebo controlled study of vancomycin prophylaxis for central venous catheter insertion in cancer patients</RefTitle> <RefYear>1990</RefYear> <RefJournal>J Hosp Infect</RefJournal> <RefPage>95-102</RefPage> <RefTotal>Ranson MR, Oppenheim BA, Jackson A, Kamthan AG, Scarffe JH. Double-blind placebo controlled study of vancomycin prophylaxis for central venous catheter insertion in cancer patients. J Hosp Infect. 1990;15:95-102. DOI: 10.1016/0195-6701(90)90025-J</RefTotal> <RefLink>http://dx.doi.org/10.1016/0195-6701(90)90025-J</RefLink> </Reference> <Reference refNo="125"> <RefAuthor>Ljungman P</RefAuthor> <RefAuthor>Hagglund H</RefAuthor> <RefAuthor>Bjorkstrand B</RefAuthor> <RefAuthor>Lonnqvist B</RefAuthor> <RefAuthor>Ringden O</RefAuthor> <RefTitle>Peroperative teicoplanin for prevention of gram-positive infections in neutropenic patients with indwelling central venous catheters: a randomized, controlled study</RefTitle> <RefYear>1997</RefYear> <RefJournal>Support Care Cancer</RefJournal> <RefPage>485-8</RefPage> <RefTotal>Ljungman P, Hagglund H, Bjorkstrand B, Lonnqvist B, Ringden O. Peroperative teicoplanin for prevention of gram-positive infections in neutropenic patients with indwelling central venous catheters: a randomized, controlled study. Support Care Cancer. 1997;5:485-8. DOI: 10.1007/s005200050117</RefTotal> <RefLink>http://dx.doi.org/10.1007/s005200050117</RefLink> </Reference> <Reference refNo="126"> <RefAuthor>Do AN</RefAuthor> <RefAuthor>Ray BJ</RefAuthor> <RefAuthor>Banerjee SN</RefAuthor> <RefAuthor>Illian AF</RefAuthor> <RefAuthor>Barnett BJ</RefAuthor> <RefAuthor>Pham MH</RefAuthor> <RefAuthor>et al</RefAuthor> <RefTitle>Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting</RefTitle> <RefYear>1999</RefYear> <RefJournal>J Infect Dis</RefJournal> <RefPage>442-8</RefPage> <RefTotal>Do AN, Ray BJ, Banerjee SN, Illian AF, Barnett BJ, Pham MH, et al. Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting. J Infect Dis. 1999;179:442-8. DOI: 10.1086/314592</RefTotal> <RefLink>http://dx.doi.org/10.1086/314592</RefLink> </Reference> <Reference refNo="127"> <RefAuthor>Gosbell IB</RefAuthor> <RefTitle>Central venous catheter related sepsis: epidemiology, pathogenesis, diagnosis, treatment and prevention</RefTitle> <RefYear>1994</RefYear> <RefJournal>Intensive Care World</RefJournal> <RefPage>54-9</RefPage> <RefTotal>Gosbell IB. Central venous catheter related sepsis: epidemiology, pathogenesis, diagnosis, treatment and prevention. Intensive Care World. 1994;11:54-9.</RefTotal> </Reference> <Reference refNo="128"> <RefAuthor>Hoffmann KK</RefAuthor> <RefAuthor>Weber DJ</RefAuthor> <RefAuthor>Samsa GP</RefAuthor> <RefAuthor>Rutala WA</RefAuthor> <RefTitle>Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks</RefTitle> <RefYear>1992</RefYear> <RefJournal>JAMA</RefJournal> <RefPage>2072-6</RefPage> <RefTotal>Hoffmann KK, Weber DJ, Samsa GP, Rutala WA. Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks. JAMA. 1992;267:2072-6.</RefTotal> </Reference> <Reference refNo="129"> <RefAuthor>Maki DG</RefAuthor> <RefAuthor>Stolz SS</RefAuthor> <RefAuthor>Wheeler S</RefAuthor> <RefAuthor>Mermel LA</RefAuthor> <RefTitle>A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management</RefTitle> <RefYear>1994</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>1729-37</RefPage> <RefTotal>Maki DG, Stolz SS, Wheeler S, Mermel LA. A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med. 1994;22(11):1729-37.</RefTotal> </Reference> <Reference refNo="130"> <RefAuthor>Bijma R</RefAuthor> <RefAuthor>Girbes AR</RefAuthor> <RefAuthor>Kleijer DJ</RefAuthor> <RefAuthor>Zwaveling JH</RefAuthor> <RefTitle>Preventing central venous catheter-related infection in a surgical intensive-care unit</RefTitle> <RefYear>1999</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>618-20</RefPage> <RefTotal>Bijma R, Girbes AR, Kleijer DJ, Zwaveling JH. Preventing central venous catheter-related infection in a surgical intensive-care unit. Infect Control Hosp Epidemiol. 1999;20:618-20. DOI: 10.1086/501682</RefTotal> <RefLink>http://dx.doi.org/10.1086/501682</RefLink> </Reference> <Reference refNo="131"> <RefAuthor>Laura R</RefAuthor> <RefAuthor>Degl'Innocenti M</RefAuthor> <RefAuthor>Mocali M</RefAuthor> <RefAuthor>Alberani F</RefAuthor> <RefAuthor>Boschi S</RefAuthor> <RefAuthor>Giraudi A</RefAuthor> <RefTitle>Comparison of two different time interval protocols for central venous catheter dressing in bone marrow transplant patients: results of a randomized, multicenter study; The Italian Nurse Bone Marrow Transplant Group (GITMO)</RefTitle> <RefYear>2000</RefYear> <RefJournal>Haematologica</RefJournal> <RefPage>275-9</RefPage> <RefTotal>Laura R, Degl'Innocenti M, Mocali M, Alberani F, Boschi S, Giraudi A, et al. Comparison of two different time interval protocols for central venous catheter dressing in bone marrow transplant patients: results of a randomized, multicenter study; The Italian Nurse Bone Marrow Transplant Group (GITMO). Haematologica. 2000;85(3):275-9.</RefTotal> </Reference> <Reference refNo="132"> <RefAuthor>Madeo M</RefAuthor> <RefAuthor>Martin CR</RefAuthor> <RefAuthor>Turner C</RefAuthor> <RefAuthor>Kirkby V</RefAuthor> <RefAuthor>Thompson DR</RefAuthor> <RefTitle>A randomized trial comparing Arglaes (a transparent dressing containing silver ions) to Tegaderm (a transparent polyurethane dressing) for dressing peripheral arterial catheters and central vascular catheters</RefTitle> <RefYear>1998</RefYear> <RefJournal>Intensive Crit Care Nurs</RefJournal> <RefPage>187-91</RefPage> <RefTotal>Madeo M, Martin CR, Turner C, Kirkby V, Thompson DR. A randomized trial comparing Arglaes (a transparent dressing containing silver ions) to Tegaderm (a transparent polyurethane dressing) for dressing peripheral arterial catheters and central vascular catheters. Intensive Crit Care Nurs. 1998;14:187-91. DOI: 10.1016/S0964-3397(98)80512-0</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0964-3397(98)80512-0</RefLink> </Reference> <Reference refNo="133"> <RefAuthor>Armstrong CW</RefAuthor> <RefAuthor>Mayhall CG</RefAuthor> <RefAuthor>Miller KB</RefAuthor> <RefAuthor>Newsome HH Jr</RefAuthor> <RefAuthor>Sugerman HJ</RefAuthor> <RefAuthor>Dalton H</RefAuthor> <RefTitle>Prospective study of catheter replacement and other risk factors for infection of hyperalimentation catheters</RefTitle> <RefYear>1986</RefYear> <RefJournal>J Infect Dis</RefJournal> <RefPage>808-16</RefPage> <RefTotal>Armstrong CW, Mayhall CG, Miller KB, Newsome HH Jr, Sugerman HJ, Dalton HP, et al. Prospective study of catheter replacement and other risk factors for infection of hyperalimentation catheters. J Infect Dis. 1986;154(5):808-16.</RefTotal> </Reference> <Reference refNo="134"> <RefAuthor>Nehme AE</RefAuthor> <RefTitle>Nutritional support of the hospitalized patient; The team concept</RefTitle> <RefYear>1980</RefYear> <RefJournal>JAMA</RefJournal> <RefPage>1906-8</RefPage> <RefTotal>Nehme AE. Nutritional support of the hospitalized patient; The team concept. JAMA. 1980;243(19):1906-8.</RefTotal> </Reference> <Reference refNo="135"> <RefAuthor>Soifer NE</RefAuthor> <RefAuthor>Borzak S</RefAuthor> <RefAuthor>Edlin BR</RefAuthor> <RefAuthor>Weinstein RA</RefAuthor> <RefTitle>Prevention of peripheral venous catheter complications with an intravenous therapy team: a randomized controlled trial</RefTitle> <RefYear>1998</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>473-7</RefPage> <RefTotal>Soifer NE, Borzak S, Edlin BR, Weinstein RA. Prevention of peripheral venous catheter complications with an intravenous therapy team: a randomized controlled trial. Arch Intern Med. 1998;158:473-7. DOI: 10.1001/archinte.158.5.473</RefTotal> <RefLink>http://dx.doi.org/10.1001/archinte.158.5.473</RefLink> </Reference> <Reference refNo="136"> <RefAuthor>Tomford JW</RefAuthor> <RefAuthor>Hershey CO</RefAuthor> <RefTitle>The iv therapy team: impact on patient care and costs of hospitalization</RefTitle> <RefYear>1985</RefYear> <RefJournal>NITA</RefJournal> <RefPage>387-9</RefPage> <RefTotal>Tomford JW, Hershey CO. The iv therapy team: impact on patient care and costs of hospitalization. NITA. 1985;8(5):387-9.</RefTotal> </Reference> <Reference refNo="137"> <RefAuthor>Sherertz RJ</RefAuthor> <RefAuthor>Ely EW</RefAuthor> <RefAuthor>Westbrook DM</RefAuthor> <RefAuthor>Gledhill KS</RefAuthor> <RefAuthor>Streed SA</RefAuthor> <RefAuthor>Kiger B</RefAuthor> <RefTitle>Education of physicians-in-training can decrease the risk for vascular catheter infection</RefTitle> <RefYear>2000</RefYear> <RefJournal>Ann Intern Med</RefJournal> <RefPage>641-8</RefPage> <RefTotal>Sherertz RJ, Ely EW, Westbrook DM, Gledhill KS, Streed SA, Kiger B, et al. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med. 2000;132(8):641-8.</RefTotal> </Reference> <Reference refNo="138"> <RefAuthor>Ryan JA Jr</RefAuthor> <RefAuthor>Abel RM</RefAuthor> <RefAuthor>Abbott WM</RefAuthor> <RefAuthor>Hopkins CC</RefAuthor> <RefAuthor>Chesney TM</RefAuthor> <RefAuthor>Colley R</RefAuthor> <RefAuthor>Phillips K</RefAuthor> <RefAuthor>Fischer J</RefAuthor> <RefTitle>Catheter complications in total parenteral nutrition; A prospective study of 200 consecutive patients</RefTitle> <RefYear>1974</RefYear> <RefJournal>N Engl J Med</RefJournal> <RefPage>757-61</RefPage> <RefTotal>Ryan JA Jr, Abel RM, Abbott WM, Hopkins CC, Chesney TM, Colley R, Phillips K, Fischer J. Catheter complications in total parenteral nutrition; A prospective study of 200 consecutive patients. N Engl J Med. 1974;290(14):757-61.</RefTotal> </Reference> <Reference refNo="139"> <RefAuthor>Sanders RA</RefAuthor> <RefAuthor>Sheldon GF</RefAuthor> <RefTitle>Septic complications of total parenteral nutrition; A five year experience</RefTitle> <RefYear>1976</RefYear> <RefJournal>Am J Surg</RefJournal> <RefPage>214-20</RefPage> <RefTotal>Sanders RA, Sheldon GF. Septic complications of total parenteral nutrition; A five year experience. Am J Surg. 1976;132:214-20. DOI: 10.1016/0002-9610(76)90050-7</RefTotal> <RefLink>http://dx.doi.org/10.1016/0002-9610(76)90050-7</RefLink> </Reference> <Reference refNo="140"> <RefAuthor>Murphy LM</RefAuthor> <RefAuthor>Lipman TO</RefAuthor> <RefTitle>Central venous catheter care in parenteral nutrition: a review</RefTitle> <RefYear>1987</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>190-201</RefPage> <RefTotal>Murphy LM, Lipman TO. Central venous catheter care in parenteral nutrition: a review. JPEN J Parenter Enteral Nutr. 1987;11:190-201. DOI: 10.1177/0148607187011002190</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607187011002190</RefLink> </Reference> <Reference refNo="141"> <RefAuthor>Eggimann P</RefAuthor> <RefAuthor>Harbarth S</RefAuthor> <RefAuthor>Constantin MN</RefAuthor> <RefAuthor>Touveneau S</RefAuthor> <RefAuthor>Chevrolet JC</RefAuthor> <RefAuthor>Pittet D</RefAuthor> <RefTitle>Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care</RefTitle> <RefYear>2000</RefYear> <RefJournal>Lancet</RefJournal> <RefPage>1864-8</RefPage> <RefTotal>Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet. 2000;355:1864-8. DOI: 10.1016/S0140-6736(00)02291-1</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0140-6736(00)02291-1</RefLink> </Reference> <Reference refNo="142"> <RefAuthor>Safdar N</RefAuthor> <RefAuthor>Maki DG</RefAuthor> <RefTitle>The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters</RefTitle> <RefYear>2004</RefYear> <RefJournal>Intensive Care Med</RefJournal> <RefPage>62-7</RefPage> <RefTotal>Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med. 2004;30:62-7. DOI: 10.1007/s00134-003-2045-z</RefTotal> <RefLink>http://dx.doi.org/10.1007/s00134-003-2045-z</RefLink> </Reference> <Reference refNo="143"> <RefAuthor>Cook D</RefAuthor> <RefAuthor>Randolph A</RefAuthor> <RefAuthor>Kernerman P</RefAuthor> <RefAuthor>Cupido C</RefAuthor> <RefAuthor>King D</RefAuthor> <RefAuthor>Soukup C</RefAuthor> <RefTitle>Central venous catheter replacement strategies: a systematic review of the literature</RefTitle> <RefYear>1997</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>1417-24</RefPage> <RefTotal>Cook D, Randolph A, Kernerman P, Cupido C, King D, Soukup C, et al. Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med. 1997;25:1417-24. DOI: 10.1097/00003246-199708000-00033</RefTotal> <RefLink>http://dx.doi.org/10.1097/00003246-199708000-00033</RefLink> </Reference> <Reference refNo="144"> <RefAuthor>Maki DG</RefAuthor> <RefAuthor>Stolz SM</RefAuthor> <RefAuthor>Wheeler S</RefAuthor> <RefAuthor>Mermel LA</RefAuthor> <RefTitle>Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter; A randomized, controlled trial</RefTitle> <RefYear>1997</RefYear> <RefJournal>Ann Intern Med:</RefJournal> <RefPage>257-66</RefPage> <RefTotal>Maki DG, Stolz SM, Wheeler S, Mermel LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter; A randomized, controlled trial. Ann Intern Med: 1997;127(4):257-66.</RefTotal> </Reference> <Reference refNo="145"> <RefAuthor>Fraenkel D</RefAuthor> <RefAuthor>Rickard C</RefAuthor> <RefAuthor>Thomas P</RefAuthor> <RefAuthor>Faoagali J</RefAuthor> <RefAuthor>George N</RefAuthor> <RefAuthor>Ware R</RefAuthor> <RefTitle>A prospective, randomized trial of rifampicin-minocycline-coated and silver-platinum-carbon-impregnated central venous catheters</RefTitle> <RefYear>2006</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>668-75</RefPage> <RefTotal>Fraenkel D, Rickard C, Thomas P, Faoagali J, George N, Ware R. A prospective, randomized trial of rifampicin-minocycline-coated and silver-platinum-carbon-impregnated central venous catheters. Crit Care Med. 2006;34:668-75. DOI: 10.1097/01.CCM.0000201404.05523.34</RefTotal> <RefLink>http://dx.doi.org/10.1097/01.CCM.0000201404.05523.34</RefLink> </Reference> <Reference refNo="146"> <RefAuthor>Veenstra DL</RefAuthor> <RefAuthor>Saint S</RefAuthor> <RefAuthor>Saha S</RefAuthor> <RefAuthor>Lumley T</RefAuthor> <RefAuthor>Sullivan SD</RefAuthor> <RefTitle>Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis</RefTitle> <RefYear>1999</RefYear> <RefJournal>JAMA</RefJournal> <RefPage>261-7</RefPage> <RefTotal>Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. JAMA. 1999;281:261-7. DOI: 10.1001/jama.281.3.261</RefTotal> <RefLink>http://dx.doi.org/10.1001/jama.281.3.261</RefLink> </Reference> <Reference refNo="147"> <RefAuthor>Jaeger K</RefAuthor> <RefAuthor>Zenz S</RefAuthor> <RefAuthor>Juttner B</RefAuthor> <RefAuthor>Ruschulte H</RefAuthor> <RefAuthor>Kuse E</RefAuthor> <RefAuthor>Heine J</RefAuthor> <RefTitle>Reduction of catheter-related infections in neutropenic patients: a prospective controlled randomized trial using a chlorhexidine and silver sulfadiazine-impregnated central venous catheter</RefTitle> <RefYear>2005</RefYear> <RefJournal>Ann Hematol</RefJournal> <RefPage>258-62</RefPage> <RefTotal>Jaeger K, Zenz S, Juttner B, Ruschulte H, Kuse E, Heine J, et al. Reduction of catheter-related infections in neutropenic patients: a prospective controlled randomized trial using a chlorhexidine and silver sulfadiazine-impregnated central venous catheter. Ann Hematol. 2005;84:258-62. DOI: 10.1007/s00277-004-0972-6</RefTotal> <RefLink>http://dx.doi.org/10.1007/s00277-004-0972-6</RefLink> </Reference> <Reference refNo="148"> <RefAuthor>Khare MD</RefAuthor> <RefAuthor>Bukhari SS</RefAuthor> <RefAuthor>Swann A</RefAuthor> <RefAuthor>Spiers P</RefAuthor> <RefAuthor>McLaren I</RefAuthor> <RefAuthor>Myers J</RefAuthor> <RefTitle>Reduction of catheter-related colonisation by the use of a silver zeolite-impregnated central vascular catheter in adult critical care</RefTitle> <RefYear>2007</RefYear> <RefJournal>J Infect</RefJournal> <RefPage>146-50</RefPage> <RefTotal>Khare MD, Bukhari SS, Swann A, Spiers P, McLaren I, Myers J. Reduction of catheter-related colonisation by the use of a silver zeolite-impregnated central vascular catheter in adult critical care. J Infect. 2007;54(2):146-50. DOI: 10.1016/j.jinf.2006.03.002</RefTotal> <RefLink>http://dx.doi.org/10.1016/j.jinf.2006.03.002</RefLink> </Reference> <Reference refNo="149"> <RefAuthor>Benezra D</RefAuthor> <RefAuthor>Kiehn TE</RefAuthor> <RefAuthor>Gold JW</RefAuthor> <RefAuthor>Brown AE</RefAuthor> <RefAuthor>Turnbull AD</RefAuthor> <RefAuthor>Armstrong D</RefAuthor> <RefTitle>Prospective study of infections in indwelling central venous catheters using quantitative blood cultures</RefTitle> <RefYear>1988</RefYear> <RefJournal>Am J Med</RefJournal> <RefPage>495-8</RefPage> <RefTotal>Benezra D, Kiehn TE, Gold JW, Brown AE, Turnbull AD, Armstrong D. Prospective study of infections in indwelling central venous catheters using quantitative blood cultures. Am J Med. 1988;85(4):495-8.</RefTotal> </Reference> <Reference refNo="150"> <RefAuthor>Darouiche RO</RefAuthor> <RefAuthor>Raad II</RefAuthor> <RefAuthor>Heard SO</RefAuthor> <RefAuthor>Thornby JI</RefAuthor> <RefAuthor>Wenker OC</RefAuthor> <RefAuthor>Gabrielli A</RefAuthor> <RefTitle>A comparison of two antimicrobial-impregnated central venous catheters; Catheter Study Group</RefTitle> <RefYear>1999</RefYear> <RefJournal>N Engl J Med</RefJournal> <RefPage>1-8</RefPage> <RefTotal>Darouiche RO, Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A, et al. A comparison of two antimicrobial-impregnated central venous catheters; Catheter Study Group. N Engl J Med. 1999;340:1-8. DOI: 10.1056/NEJM199901073400101</RefTotal> <RefLink>http://dx.doi.org/10.1056/NEJM199901073400101</RefLink> </Reference> <Reference refNo="151"> <RefAuthor>Hanna HA</RefAuthor> <RefAuthor>Raad II</RefAuthor> <RefAuthor>Hackett B</RefAuthor> <RefAuthor>Wallace SK</RefAuthor> <RefAuthor>Price KJ</RefAuthor> <RefAuthor>Coyle DE</RefAuthor> <RefTitle>Antibiotic-impregnated catheters associated with significant decrease in nosocomial and multidrug-resistant bacteremias in critically ill patients</RefTitle> <RefYear>2003</RefYear> <RefJournal>Chest</RefJournal> <RefPage>1030-8</RefPage> <RefTotal>Hanna HA, Raad II, Hackett B, Wallace SK, Price KJ, Coyle DE, et al. Antibiotic-impregnated catheters associated with significant decrease in nosocomial and multidrug-resistant bacteremias in critically ill patients. Chest. 2003;124:1030-8. DOI: 10.1378/chest.124.3.1030</RefTotal> <RefLink>http://dx.doi.org/10.1378/chest.124.3.1030</RefLink> </Reference> <Reference refNo="152"> <RefAuthor>Leon C</RefAuthor> <RefAuthor>Ruiz-Santana S</RefAuthor> <RefAuthor>Rello J</RefAuthor> <RefAuthor>de la Torre MV</RefAuthor> <RefAuthor>Valles J</RefAuthor> <RefAuthor>Alvarez-Lerma F</RefAuthor> <RefTitle>Benefits of minocycline and rifampin-impregnated central venous catheters; A prospective, randomized, double-blind, controlled, multicenter trial</RefTitle> <RefYear>2004</RefYear> <RefJournal>Intensive Care Med</RefJournal> <RefPage>1891-9</RefPage> <RefTotal>Leon C, Ruiz-Santana S, Rello J, de la Torre MV, Valles J, Alvarez-Lerma F, et al. Benefits of minocycline and rifampin-impregnated central venous catheters; A prospective, randomized, double-blind, controlled, multicenter trial. Intensive Care Med. 2004;30(10):1891-9. DOI: 10.1007/s00134-004-2378-2</RefTotal> <RefLink>http://dx.doi.org/10.1007/s00134-004-2378-2</RefLink> </Reference> <Reference refNo="153"> <RefAuthor>Yucel N</RefAuthor> <RefAuthor>Lefering R</RefAuthor> <RefAuthor>Maegele M</RefAuthor> <RefAuthor>Max M</RefAuthor> <RefAuthor>Rossaint R</RefAuthor> <RefAuthor>Koch A</RefAuthor> <RefTitle>Reduced colonization and infection with miconazole-rifampicin modified central venous catheters: a randomized controlled clinical trial</RefTitle> <RefYear>2004</RefYear> <RefJournal>J Antimicrob Chemother</RefJournal> <RefPage>1109-15</RefPage> <RefTotal>Yucel N, Lefering R, Maegele M, Max M, Rossaint R, Koch A, et al. Reduced colonization and infection with miconazole-rifampicin modified central venous catheters: a randomized controlled clinical trial. J Antimicrob Chemother. 2004;54:1109-15. DOI: 10.1093/jac/dkh483</RefTotal> <RefLink>http://dx.doi.org/10.1093/jac/dkh483</RefLink> </Reference> <Reference refNo="154"> <RefAuthor>Collin GR</RefAuthor> <RefTitle>Decreasing catheter colonization through the use of an antiseptic-impregnated catheter: a continuous quality improvement project</RefTitle> <RefYear>1999</RefYear> <RefJournal>Chest</RefJournal> <RefPage>1632-40</RefPage> <RefTotal>Collin GR. Decreasing catheter colonization through the use of an antiseptic-impregnated catheter: a continuous quality improvement project. Chest. 1999;115:1632-40. DOI: 10.1378/chest.115.6.1632</RefTotal> <RefLink>http://dx.doi.org/10.1378/chest.115.6.1632</RefLink> </Reference> <Reference refNo="155"> <RefAuthor>Boswald M</RefAuthor> <RefAuthor>Lugauer S</RefAuthor> <RefAuthor>Regenfus A</RefAuthor> <RefAuthor>Braun GG</RefAuthor> <RefAuthor>Martus P</RefAuthor> <RefAuthor>Geis C</RefAuthor> <RefTitle>Reduced rates of catheter-associated infection by use of a new silver-impregnated central venous catheter</RefTitle> <RefYear>1999</RefYear> <RefJournal>Infection</RefJournal> <RefPage>S56-S60</RefPage> <RefTotal>Boswald M, Lugauer S, Regenfus A, Braun GG, Martus P, Geis C, et al. Reduced rates of catheter-associated infection by use of a new silver-impregnated central venous catheter. Infection. 1999;27 Suppl 1:S56-S60. DOI: 10.1007/BF02561621</RefTotal> <RefLink>http://dx.doi.org/10.1007/BF02561621</RefLink> </Reference> <Reference refNo="156"> <RefAuthor>Rupp ME</RefAuthor> <RefAuthor>Lisco SJ</RefAuthor> <RefAuthor>Lipsett PA</RefAuthor> <RefAuthor>Perl TM</RefAuthor> <RefAuthor>Keating K</RefAuthor> <RefAuthor>Civetta JM</RefAuthor> <RefTitle>Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial</RefTitle> <RefYear>2005</RefYear> <RefJournal>Ann Intern Med</RefJournal> <RefPage>570-80</RefPage> <RefTotal>Rupp ME, Lisco SJ, Lipsett PA, Perl TM, Keating K, Civetta JM, et al. Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial. Ann Intern Med. 2005;143(8):570-80.</RefTotal> </Reference> <Reference refNo="157"> <RefAuthor>Veenstra DL</RefAuthor> <RefAuthor>Saint S</RefAuthor> <RefAuthor>Sullivan SD</RefAuthor> <RefTitle>Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection</RefTitle> <RefYear>1999</RefYear> <RefJournal>JAMA</RefJournal> <RefPage>554-60</RefPage> <RefTotal>Veenstra DL, Saint S, Sullivan SD. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA. 1999;282:554-60. DOI: 10.1001/jama.282.6.554</RefTotal> <RefLink>http://dx.doi.org/10.1001/jama.282.6.554</RefLink> </Reference> <Reference refNo="158"> <RefAuthor>Arenas-Marquez H</RefAuthor> <RefAuthor>Anaya-Prado R</RefAuthor> <RefAuthor>Barrera-Zepeda LM</RefAuthor> <RefAuthor>Gonzalez-Ojeda A</RefAuthor> <RefTitle>Complications of central venous catheters</RefTitle> <RefYear>2001</RefYear> <RefJournal>Curr Opin Clin Nutr Metab Care</RefJournal> <RefPage>207-10</RefPage> <RefTotal>Arenas-Marquez H, Anaya-Prado R, Barrera-Zepeda LM, Gonzalez-Ojeda A. Complications of central venous catheters. Curr Opin Clin Nutr Metab Care. 2001;4:207-10. DOI: 10.1097/00075197-200105000-00007</RefTotal> <RefLink>http://dx.doi.org/10.1097/00075197-200105000-00007</RefLink> </Reference> <Reference refNo="159"> <RefAuthor>Bennegard K</RefAuthor> <RefAuthor>Curelaru I</RefAuthor> <RefAuthor>Gustavsson B</RefAuthor> <RefAuthor>Linder LE</RefAuthor> <RefAuthor>Zachrisson BF</RefAuthor> <RefTitle>Material thrombogenicity in central venous catheterization; I: A comparison between uncoated and heparin-coated, long antebrachial, polyethylene catheters</RefTitle> <RefYear>1982</RefYear> <RefJournal>Acta Anaesthesiol Scand</RefJournal> <RefPage>112-20</RefPage> <RefTotal>Bennegard K, Curelaru I, Gustavsson B, Linder LE, Zachrisson BF. Material thrombogenicity in central venous catheterization; I: A comparison between uncoated and heparin-coated, long antebrachial, polyethylene catheters. Acta Anaesthesiol Scand. 1982;26:112-20. DOI: 10.1111/j.1399-6576.1982.tb01736.x</RefTotal> <RefLink>http://dx.doi.org/10.1111/j.1399-6576.1982.tb01736.x</RefLink> </Reference> <Reference refNo="160"> <RefAuthor>Mollenholt P</RefAuthor> <RefAuthor>Eriksson I</RefAuthor> <RefAuthor>Andersson T</RefAuthor> <RefTitle>Thrombogenicity of pulmonary-artery catheters</RefTitle> <RefYear>1987</RefYear> <RefJournal>Intensive Care Med</RefJournal> <RefPage>57-9</RefPage> <RefTotal>Mollenholt P, Eriksson I, Andersson T. Thrombogenicity of pulmonary-artery catheters. Intensive Care Med. 1987;13:57-9. DOI: 10.1007/BF00263559</RefTotal> <RefLink>http://dx.doi.org/10.1007/BF00263559</RefLink> </Reference> <Reference refNo="161"> <RefAuthor>Bern MM</RefAuthor> <RefAuthor>Lokich JJ</RefAuthor> <RefAuthor>Wallach SR</RefAuthor> <RefAuthor>Bothe A Jr</RefAuthor> <RefAuthor>Benotti PN</RefAuthor> <RefAuthor>Arkin CF</RefAuthor> <RefTitle>Very low doses of warfarin can prevent thrombosis in central venous catheters; A randomized prospective trial</RefTitle> <RefYear>1990</RefYear> <RefJournal>Ann Intern Med</RefJournal> <RefPage>423-8</RefPage> <RefTotal>Bern MM, Lokich JJ, Wallach SR, Bothe A Jr, Benotti PN, Arkin CF, et al. Very low doses of warfarin can prevent thrombosis in central venous catheters; A randomized prospective trial. Ann Intern Med. 1990;112:423-8.</RefTotal> </Reference> <Reference refNo="162"> <RefAuthor>Boraks P</RefAuthor> <RefAuthor>Seale J</RefAuthor> <RefAuthor>Price J</RefAuthor> <RefAuthor>Bass G</RefAuthor> <RefAuthor>Ethell M</RefAuthor> <RefAuthor>Keeling D</RefAuthor> <RefTitle>Prevention of central venous catheter associated thrombosis using minidose warfarin in patients with haematological malignancies</RefTitle> <RefYear>1998</RefYear> <RefJournal>Br J Haematol</RefJournal> <RefPage>483-6</RefPage> <RefTotal>Boraks P, Seale J, Price J, Bass G, Ethell M, Keeling D, et al. Prevention of central venous catheter associated thrombosis using minidose warfarin in patients with haematological malignancies. Br J Haematol. 1998;101:483-6. DOI: 10.1046/j.1365-2141.1998.00732.x</RefTotal> <RefLink>http://dx.doi.org/10.1046/j.1365-2141.1998.00732.x</RefLink> </Reference> <Reference refNo="163"> <RefAuthor>Couban S</RefAuthor> <RefAuthor>Goodyear M</RefAuthor> <RefAuthor>Burnell M</RefAuthor> <RefAuthor>Dolan S</RefAuthor> <RefAuthor>Wasi P</RefAuthor> <RefAuthor>Barnes D</RefAuthor> <RefTitle>Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter-associated thrombosis in patients with cancer</RefTitle> <RefYear>2005</RefYear> <RefJournal>J Clin Oncol</RefJournal> <RefPage>4063-9</RefPage> <RefTotal>Couban S, Goodyear M, Burnell M, Dolan S, Wasi P, Barnes D, et al. Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter-associated thrombosis in patients with cancer. J Clin Oncol. 2005;23:4063-9. DOI: 10.1200/JCO.2005.10.192</RefTotal> <RefLink>http://dx.doi.org/10.1200/JCO.2005.10.192</RefLink> </Reference> <Reference refNo="164"> <RefAuthor>Klerk CP</RefAuthor> <RefAuthor>Smorenburg SM</RefAuthor> <RefAuthor>Buller HR</RefAuthor> <RefTitle>Thrombosis prophylaxis in patient populations with a central venous catheter: a systematic review</RefTitle> <RefYear>2003</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>1913-21</RefPage> <RefTotal>Klerk CP, Smorenburg SM, Buller HR. Thrombosis prophylaxis in patient populations with a central venous catheter: a systematic review. Arch Intern Med. 2003;163:1913-21. DOI: 10.1001/archinte.163.16.1913</RefTotal> <RefLink>http://dx.doi.org/10.1001/archinte.163.16.1913</RefLink> </Reference> <Reference refNo="165"> <RefAuthor>Verso M</RefAuthor> <RefAuthor>Agnelli G</RefAuthor> <RefAuthor>Bertoglio S</RefAuthor> <RefAuthor>Di Somma FC</RefAuthor> <RefAuthor>Paoletti F</RefAuthor> <RefAuthor>Ageno W</RefAuthor> <RefTitle>Enoxaparin for the prevention of venous thromboembolism associated with central vein catheter: a double-blind, placebo-controlled, randomized study in cancer patients</RefTitle> <RefYear>2005</RefYear> <RefJournal>J Clin Oncol</RefJournal> <RefPage>4057-62</RefPage> <RefTotal>Verso M, Agnelli G, Bertoglio S, Di Somma FC, Paoletti F, Ageno W, et al. Enoxaparin for the prevention of venous thromboembolism associated with central vein catheter: a double-blind, placebo-controlled, randomized study in cancer patients. J Clin Oncol. 2005;23:4057-62. DOI: 10.1200/JCO.2005.06.084</RefTotal> <RefLink>http://dx.doi.org/10.1200/JCO.2005.06.084</RefLink> </Reference> <Reference refNo="166"> <RefAuthor>Bethune K</RefAuthor> <RefAuthor>Allwood M</RefAuthor> <RefAuthor>Grainger C</RefAuthor> <RefAuthor>Wormleighton C</RefAuthor> <RefTitle>Use of filters during the preparation and administration of parenteral nutrition: position paper and guidelines prepared by a British pharmaceutical nutrition group working party</RefTitle> <RefYear>2001</RefYear> <RefJournal>Nutrition</RefJournal> <RefPage>403-8</RefPage> <RefTotal>Bethune K, Allwood M, Grainger C, Wormleighton C. Use of filters during the preparation and administration of parenteral nutrition: position paper and guidelines prepared by a British pharmaceutical nutrition group working party. Nutrition. 2001;17:403-8. DOI: 10.1016/S0899-9007(01)00536-6</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0899-9007(01)00536-6</RefLink> </Reference> <Reference refNo="167"> <RefAuthor>Lumpkin MM</RefAuthor> <RefTitle>Safety alert: hazards of precipitation associated with parenteral nutrition</RefTitle> <RefYear>1994</RefYear> <RefJournal>Am J Hosp Pharm</RefJournal> <RefPage>1427-8</RefPage> <RefTotal>Lumpkin MM. Safety alert: hazards of precipitation associated with parenteral nutrition. Am J Hosp Pharm. 1994;51(11):1427-8.</RefTotal> </Reference> <Reference refNo="168"> <RefAuthor>Ball PA</RefAuthor> <RefAuthor>Bethune KM</RefAuthor> <RefAuthor>Fox JC</RefAuthor> <RefAuthor>et al</RefAuthor> <RefTitle>Particulate contamination in parenteral nutrition solutions, still cause for concern</RefTitle> <RefYear>1999</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>14</RefPage> <RefTotal>Ball PA, Bethune KM, Fox JC, et al. Particulate contamination in parenteral nutrition solutions, still cause for concern. Clin Nutr. 1999;18:14.</RefTotal> </Reference> <Reference refNo="169"> <RefAuthor>Ball PA</RefAuthor> <RefTitle>Intravenous in-line filters: filtering the evidence</RefTitle> <RefYear>2003</RefYear> <RefJournal>Curr Opin Clin Nutr Metab Care</RefJournal> <RefPage>319-25</RefPage> <RefTotal>Ball PA. Intravenous in-line filters: filtering the evidence. Curr Opin Clin Nutr Metab Care. 2003;6:319-25. DOI: 10.1097/00075197-200305000-00009</RefTotal> <RefLink>http://dx.doi.org/10.1097/00075197-200305000-00009</RefLink> </Reference> <Reference refNo="170"> <RefAuthor>Newall F</RefAuthor> <RefAuthor>Ranson K</RefAuthor> <RefAuthor>Robertson J</RefAuthor> <RefTitle>Use of in-line filters in pediatric intravenous therapy</RefTitle> <RefYear>1998</RefYear> <RefJournal>J Intraven Nurs</RefJournal> <RefPage>166-70</RefPage> <RefTotal>Newall F, Ranson K, Robertson J. Use of in-line filters in pediatric intravenous therapy. J Intraven Nurs. 1998;21(3):166-70.</RefTotal> </Reference> <Reference refNo="171"> <RefAuthor>Krzywda EA</RefAuthor> <RefTitle>Predisposing factors, prevention, and management of central venous catheter occlusions</RefTitle> <RefYear>1999</RefYear> <RefJournal>J Intraven Nurs</RefJournal> <RefPage>S11-7</RefPage> <RefTotal>Krzywda EA. Predisposing factors, prevention, and management of central venous catheter occlusions. J Intraven Nurs. 1999;22(6 Suppl):S11-7.</RefTotal> </Reference> <Reference refNo="172"> <RefAuthor>Monturo CA</RefAuthor> <RefAuthor>Dickerson RN</RefAuthor> <RefAuthor>Mullen JL</RefAuthor> <RefTitle>Efficacy of thrombolytic therapy for occlusion of long-term catheters</RefTitle> <RefYear>1990</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>312-4</RefPage> <RefTotal>Monturo CA, Dickerson RN, Mullen JL. Efficacy of thrombolytic therapy for occlusion of long-term catheters. JPEN J Parenter Enteral Nutr. 1990;14:312-4. DOI: 10.1177/0148607190014003312</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607190014003312</RefLink> </Reference> <Reference refNo="173"> <RefAuthor>Gale GB</RefAuthor> <RefAuthor>O'Connor DM</RefAuthor> <RefAuthor>Chu JY</RefAuthor> <RefAuthor>Stanley D</RefAuthor> <RefTitle>Restoring patency of thrombosed catheters with cryopreserved urokinase</RefTitle> <RefYear>1984</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>298-9</RefPage> <RefTotal>Gale GB, O'Connor DM, Chu JY, Stanley D. Restoring patency of thrombosed catheters with cryopreserved urokinase. JPEN J Parenter Enteral Nutr. 1984;8:298-9. DOI: 10.1177/0148607184008003298</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607184008003298</RefLink> </Reference> <Reference refNo="174"> <RefAuthor>Fraschini G</RefAuthor> <RefAuthor>Jadeja J</RefAuthor> <RefAuthor>Lawson M</RefAuthor> <RefAuthor>Holmes FA</RefAuthor> <RefAuthor>Carrasco HC</RefAuthor> <RefAuthor>Wallace S</RefAuthor> <RefTitle>Local infusion of urokinase for the lysis of thrombosis associated with permanent central venous catheters in cancer patients</RefTitle> <RefYear>1987</RefYear> <RefJournal>J Clin Oncol</RefJournal> <RefPage>672-8</RefPage> <RefTotal>Fraschini G, Jadeja J, Lawson M, Holmes FA, Carrasco HC, Wallace S. Local infusion of urokinase for the lysis of thrombosis associated with permanent central venous catheters in cancer patients. J Clin Oncol. 1987;5(4):672-8.</RefTotal> </Reference> <Reference refNo="175"> <RefAuthor>Rumsey KA</RefAuthor> <RefAuthor>Richardson DK</RefAuthor> <RefTitle>Management of infection and occlusion associated with vascular access devices</RefTitle> <RefYear>1995</RefYear> <RefJournal>Semin Oncol Nurs</RefJournal> <RefPage>174-83</RefPage> <RefTotal>Rumsey KA, Richardson DK. Management of infection and occlusion associated with vascular access devices. Semin Oncol Nurs. 1995;11:174-83. DOI: 10.1016/S0749-2081(95)80027-1</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0749-2081(95)80027-1</RefLink> </Reference> <Reference refNo="176"> <RefAuthor>Camp-Sorrell D</RefAuthor> <RefTitle>Implantable ports: everything you always wanted to know</RefTitle> <RefYear>1992</RefYear> <RefJournal>J Intraven Nurs</RefJournal> <RefPage>262-73</RefPage> <RefTotal>Camp-Sorrell D. Implantable ports: everything you always wanted to know. J Intraven Nurs. 1992;15(5):262-73.</RefTotal> </Reference> <Reference refNo="177"> <RefAuthor>Main J</RefAuthor> <RefAuthor>Pennington CR</RefAuthor> <RefTitle>Catheter blockage with lipid during long term parenteral nutrition</RefTitle> <RefYear>1984</RefYear> <RefJournal>Br Med J</RefJournal> <RefPage>734</RefPage> <RefTotal>Main J, Pennington CR. Catheter blockage with lipid during long term parenteral nutrition. Br Med J. 1984;289:734.</RefTotal> </Reference> <Reference refNo="178"> <RefAuthor>Pennington CR</RefAuthor> <RefAuthor>Pithie AD</RefAuthor> <RefTitle>Ethanol lock in the management of catheter occlusion</RefTitle> <RefYear>1987</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>507-8</RefPage> <RefTotal>Pennington CR, Pithie AD. Ethanol lock in the management of catheter occlusion. JPEN J Parenter Enteral Nutr. 1987;11:507-8. DOI: 10.1177/0148607187011005507</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607187011005507</RefLink> </Reference> <Reference refNo="179"> <RefAuthor>Mühlebach S</RefAuthor> <RefTitle>Was der praktizierende Arzt vom Umgang mit Infusionen wissen muss [What the practicing physician must know about giving infusions?]</RefTitle> <RefYear>2001</RefYear> <RefJournal>Praxis (Bern 1994)</RefJournal> <RefPage>546-8</RefPage> <RefTotal>Mühlebach S. Was der praktizierende Arzt vom Umgang mit Infusionen wissen muss [What the practicing physician must know about giving infusions?]. Praxis (Bern 1994). 2001;90(13):546-8.</RefTotal> </Reference> <Reference refNo="180"> <RefAuthor>Allwood MC</RefAuthor> <RefAuthor>Kearney MC</RefAuthor> <RefTitle>Compatibility and stability of additives in parenteral nutrition admixtures</RefTitle> <RefYear>1998</RefYear> <RefJournal>Nutrition</RefJournal> <RefPage>697-706</RefPage> <RefTotal>Allwood MC, Kearney MC. Compatibility and stability of additives in parenteral nutrition admixtures. Nutrition. 1998;14:697-706. DOI: 10.1016/S0899-9007(98)00063-X</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0899-9007(98)00063-X</RefLink> </Reference> <Reference refNo="181"> <RefAuthor>Stennett DJ</RefAuthor> <RefAuthor>Gerwick WH</RefAuthor> <RefAuthor>Egging PK</RefAuthor> <RefAuthor>Christensen JM</RefAuthor> <RefTitle>Precipitate analysis from an indwelling total parenteral nutrition catheter</RefTitle> <RefYear>1988</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>88-92</RefPage> <RefTotal>Stennett DJ, Gerwick WH, Egging PK, Christensen JM. Precipitate analysis from an indwelling total parenteral nutrition catheter. JPEN J Parenter Enteral Nutr. 1988;12:88-92. DOI: 10.1177/014860718801200188</RefTotal> <RefLink>http://dx.doi.org/10.1177/014860718801200188</RefLink> </Reference> <Reference refNo="182"> <RefAuthor>Shulman RJ</RefAuthor> <RefAuthor>Reed T</RefAuthor> <RefAuthor>Pitre D</RefAuthor> <RefAuthor>Laine L</RefAuthor> <RefTitle>Use of hydrochloric acid to clear obstructed central venous catheters</RefTitle> <RefYear>1988</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>509-10</RefPage> <RefTotal>Shulman RJ, Reed T, Pitre D, Laine L. Use of hydrochloric acid to clear obstructed central venous catheters. JPEN J Parenter Enteral Nutr. 1988;12:509-10. DOI: 10.1177/0148607188012005509</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607188012005509</RefLink> </Reference> <Reference refNo="183"> <RefAuthor>Duffy LF</RefAuthor> <RefAuthor>Kerzner B</RefAuthor> <RefAuthor>Gebus V</RefAuthor> <RefAuthor>Dice J</RefAuthor> <RefTitle>Treatment of central venous catheter occlusions with hydrochloric acid</RefTitle> <RefYear>1989</RefYear> <RefJournal>J Pediatr</RefJournal> <RefPage>1002-4</RefPage> <RefTotal>Duffy LF, Kerzner B, Gebus V, Dice J. Treatment of central venous catheter occlusions with hydrochloric acid. J Pediatr. 1989;114:1002-4. DOI: 10.1016/S0022-3476(89)80449-4</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0022-3476(89)80449-4</RefLink> </Reference> <Reference refNo="184"> <RefAuthor>Goodwin ML</RefAuthor> <RefTitle>Using sodium bicarbonate to clear a medication precipitate from a central venous catheter</RefTitle> <RefYear>1991</RefYear> <RefJournal>J Vasc Access N</RefJournal> <RefPage>23</RefPage> <RefTotal>Goodwin ML. Using sodium bicarbonate to clear a medication precipitate from a central venous catheter. J Vasc Access N. 1991;1:23.</RefTotal> </Reference> <Reference refNo="185"> <RefAuthor>Holcombe BJ</RefAuthor> <RefAuthor>Forloines-Lynn S</RefAuthor> <RefAuthor>Garmhausen LW</RefAuthor> <RefTitle>Restoring patency of long-term central venous access devices</RefTitle> <RefYear>1992</RefYear> <RefJournal>J Intraven Nurs</RefJournal> <RefPage>36-41</RefPage> <RefTotal>Holcombe BJ, Forloines-Lynn S, Garmhausen LW. Restoring patency of long-term central venous access devices. J Intraven Nurs. 1992;15(1):36-41.</RefTotal> </Reference> <Reference refNo="186"> <RefAuthor>Siegman-Igra Y</RefAuthor> <RefAuthor>Anglim AM</RefAuthor> <RefAuthor>Shapiro DE</RefAuthor> <RefAuthor>Adal KA</RefAuthor> <RefAuthor>Strain BA</RefAuthor> <RefAuthor>Farr BM</RefAuthor> <RefTitle>Diagnosis of vascular catheter-related bloodstream infection: a meta-analysis</RefTitle> <RefYear>1997</RefYear> <RefJournal>J Clin Microbiol</RefJournal> <RefPage>928-36</RefPage> <RefTotal>Siegman-Igra Y, Anglim AM, Shapiro DE, Adal KA, Strain BA, Farr BM. Diagnosis of vascular catheter-related bloodstream infection: a meta-analysis. J Clin Microbiol. 1997;35(4):928-36.</RefTotal> </Reference> <Reference refNo="187"> <RefAuthor>Mermel LA</RefAuthor> <RefAuthor>Farr BM</RefAuthor> <RefAuthor>Sherertz RJ</RefAuthor> <RefAuthor>Raad II</RefAuthor> <RefAuthor>O'Grady N</RefAuthor> <RefAuthor>Harris JS</RefAuthor> <RefTitle>Guidelines for the management of intravascular catheter-related infections</RefTitle> <RefYear>2001</RefYear> <RefJournal>Clin Infect Dis</RefJournal> <RefPage>1249-72</RefPage> <RefTotal>Mermel LA, Farr BM, Sherertz RJ, Raad II, O'Grady N, Harris JS, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis. 2001;32:1249-72. DOI: 10.1086/320001</RefTotal> <RefLink>http://dx.doi.org/10.1086/320001</RefLink> </Reference> <Reference refNo="188"> <RefAuthor>Raad II</RefAuthor> <RefAuthor>Hanna HA</RefAuthor> <RefTitle>Intravascular catheter-related infections: new horizons and recent advances</RefTitle> <RefYear>2002</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>871-8</RefPage> <RefTotal>Raad II, Hanna HA. Intravascular catheter-related infections: new horizons and recent advances. Arch Intern Med. 2002;162:871-8. DOI: 10.1001/archinte.162.8.871</RefTotal> <RefLink>http://dx.doi.org/10.1001/archinte.162.8.871</RefLink> </Reference> <Reference refNo="189"> <RefAuthor>Rijnders BJ</RefAuthor> <RefAuthor>Peetermans WE</RefAuthor> <RefAuthor>Verwaest C</RefAuthor> <RefAuthor>Wilmer A</RefAuthor> <RefAuthor>Van Wijngaerden E</RefAuthor> <RefTitle>Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial</RefTitle> <RefYear>2004</RefYear> <RefJournal>Intensive Care Med</RefJournal> <RefPage>1073-80</RefPage> <RefTotal>Rijnders BJ, Peetermans WE, Verwaest C, Wilmer A, Van Wijngaerden E. Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial. Intensive Care Med. 2004;30:1073-80. DOI: 10.1007/s00134-004-2212-x</RefTotal> <RefLink>http://dx.doi.org/10.1007/s00134-004-2212-x</RefLink> </Reference> <Reference refNo="190"> <RefAuthor>Krzywda EA</RefAuthor> <RefAuthor>Edmiston CE Jr</RefAuthor> <RefTitle>Central venous catheter infections: Clinical aspects of microbial etiology and pathogenesis</RefTitle> <RefYear>2002</RefYear> <RefJournal>J Infus Nurs</RefJournal> <RefPage>29-35</RefPage> <RefTotal>Krzywda EA, Edmiston CE Jr. Central venous catheter infections: Clinical aspects of microbial etiology and pathogenesis. J Infus Nurs. 2002;25:29-35. DOI: 10.1097/00129804-200201000-00006</RefTotal> <RefLink>http://dx.doi.org/10.1097/00129804-200201000-00006</RefLink> </Reference> <Reference refNo="191"> <RefAuthor>Forchielli ML</RefAuthor> <RefAuthor>Gura K</RefAuthor> <RefAuthor>Anessi-Pessina E</RefAuthor> <RefAuthor>Richardson D</RefAuthor> <RefAuthor>Cai W</RefAuthor> <RefAuthor>Lo CW</RefAuthor> <RefTitle>Success rates and cost-effectiveness of antibiotic combinations for initial treatment of central-venous-line infections during total parenteral nutrition</RefTitle> <RefYear>2000</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>119-25</RefPage> <RefTotal>Forchielli ML, Gura K, Anessi-Pessina E, Richardson D, Cai W, Lo CW. Success rates and cost-effectiveness of antibiotic combinations for initial treatment of central-venous-line infections during total parenteral nutrition. JPEN J Parenter Enteral Nutr. 2000;24:119-25. DOI: 10.1177/0148607100024002119</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607100024002119</RefLink> </Reference> <Reference refNo="192"> <RefAuthor>Sitges-Serra A</RefAuthor> <RefAuthor>Girvent M</RefAuthor> <RefTitle>Catheter-related bloodstream infections</RefTitle> <RefYear>1999</RefYear> <RefJournal>World J Surg</RefJournal> <RefPage>589-95</RefPage> <RefTotal>Sitges-Serra A, Girvent M. Catheter-related bloodstream infections. World J Surg. 1999;23:589-95. DOI: 10.1007/PL00012352</RefTotal> <RefLink>http://dx.doi.org/10.1007/PL00012352</RefLink> </Reference> <Reference refNo="193"> <RefAuthor>Raad I</RefAuthor> <RefAuthor>Hanna HA</RefAuthor> <RefAuthor>Alakech B</RefAuthor> <RefAuthor>Chatzinikolaou I</RefAuthor> <RefAuthor>Johnson MM</RefAuthor> <RefAuthor>Tarrand J</RefAuthor> <RefTitle>Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections</RefTitle> <RefYear>2004</RefYear> <RefJournal>Ann Intern Med</RefJournal> <RefPage>18-25</RefPage> <RefTotal>Raad I, Hanna HA, Alakech B, Chatzinikolaou I, Johnson MM, Tarrand J. Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections. Ann Intern Med. 2004;140(1):18-25.</RefTotal> </Reference> <Reference refNo="194"> <RefAuthor>Dobbins BM</RefAuthor> <RefAuthor>Catton JA</RefAuthor> <RefAuthor>Kite P</RefAuthor> <RefAuthor>McMahon MJ</RefAuthor> <RefAuthor>Wilcox MH</RefAuthor> <RefTitle>Each lumen is a potential source of central venous catheter-related bloodstream infection</RefTitle> <RefYear>2003</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>1688-90</RefPage> <RefTotal>Dobbins BM, Catton JA, Kite P, McMahon MJ, Wilcox MH. Each lumen is a potential source of central venous catheter-related bloodstream infection. Crit Care Med. 2003;31:1688-90. DOI: 10.1097/01.CCM.0000063257.04633.AE</RefTotal> <RefLink>http://dx.doi.org/10.1097/01.CCM.0000063257.04633.AE</RefLink> </Reference> <Reference refNo="195"> <RefAuthor>Raad I</RefAuthor> <RefAuthor>Davis S</RefAuthor> <RefAuthor>Becker M</RefAuthor> <RefAuthor>Hohn D</RefAuthor> <RefAuthor>Houston D</RefAuthor> <RefAuthor>Umphrey J</RefAuthor> <RefTitle>Low infection rate and long durability of nontunneled silastic catheters: A safe and cost-effective alternative for long-term venous access</RefTitle> <RefYear>1993</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>1791-6</RefPage> <RefTotal>Raad I, Davis S, Becker M, Hohn D, Houston D, Umphrey J, et al. Low infection rate and long durability of nontunneled silastic catheters: A safe and cost-effective alternative for long-term venous access. Arch Intern Med. 1993;153:1791-6.</RefTotal> </Reference> <Reference refNo="196"> <RefAuthor>Mayhall CG</RefAuthor> <RefTitle>Diagnosis and management of infections of implantable devices used for prolonged venous access</RefTitle> <RefYear>1992</RefYear> <RefJournal>Curr Clin Top Infect Dis</RefJournal> <RefPage>83-110</RefPage> <RefTotal>Mayhall CG. Diagnosis and management of infections of implantable devices used for prolonged venous access. Curr Clin Top Infect Dis. 1992;12:83-110.</RefTotal> </Reference> <Reference refNo="197"> <RefAuthor>Hodge D</RefAuthor> <RefAuthor>Puntis JW</RefAuthor> <RefTitle>Diagnosis, prevention, and management of catheter related bloodstream infection during long term parenteral nutrition</RefTitle> <RefYear>2002</RefYear> <RefJournal>Arch Dis Child Fetal Neonatal Ed</RefJournal> <RefPage>F21-4</RefPage> <RefTotal>Hodge D, Puntis JW. Diagnosis, prevention, and management of catheter related bloodstream infection during long term parenteral nutrition. Arch Dis Child Fetal Neonatal Ed. 2002;87:F21-4. DOI: 10.1136/fn.87.1.F21</RefTotal> <RefLink>http://dx.doi.org/10.1136/fn.87.1.F21</RefLink> </Reference> <Reference refNo="198"> <RefAuthor>Sherertz RJ</RefAuthor> <RefAuthor>Heard SO</RefAuthor> <RefAuthor>Raad II</RefAuthor> <RefTitle>Diagnosis of triple-lumen catheter infection: comparison of roll plate, sonication, and flushing methodologies</RefTitle> <RefYear>1997</RefYear> <RefJournal>J Clin Microbiol</RefJournal> <RefPage>641-6</RefPage> <RefTotal>Sherertz RJ, Heard SO, Raad II. Diagnosis of triple-lumen catheter infection: comparison of roll plate, sonication, and flushing methodologies. J Clin Microbiol. 1997;35(3):641-6.</RefTotal> </Reference> <Reference refNo="199"> <RefAuthor>Fidalgo S</RefAuthor> <RefAuthor>Vázquez F</RefAuthor> <RefAuthor>Mendoza MC</RefAuthor> <RefAuthor>Pérez F</RefAuthor> <RefAuthor>Méndez FJ</RefAuthor> <RefTitle>Bacteremia due to Staphylococcus epidermidis: microbiologic, epidemiologic, clinical, and prognostic features</RefTitle> <RefYear>1990</RefYear> <RefJournal>Rev Infect Dis</RefJournal> <RefPage>520-28</RefPage> <RefTotal>Fidalgo S, Vázquez F, Mendoza MC, Pérez F, Méndez FJ. Bacteremia due to Staphylococcus epidermidis: microbiologic, epidemiologic, clinical, and prognostic features. Rev Infect Dis. 1990;12(3):520-28.</RefTotal> </Reference> <Reference refNo="200"> <RefAuthor>Pollack PF</RefAuthor> <RefAuthor>Kadden M</RefAuthor> <RefAuthor>Byrne WJ</RefAuthor> <RefAuthor>Fonkalsrud EW</RefAuthor> <RefAuthor>Ament ME</RefAuthor> <RefTitle>One hundred patient years' experience with the Broviac silastic catheter for central venous nutrition</RefTitle> <RefYear>1981</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>32-6</RefPage> <RefTotal>Pollack PF, Kadden M, Byrne WJ, Fonkalsrud EW, Ament ME. One hundred patient years' experience with the Broviac silastic catheter for central venous nutrition. JPEN J Parenter Enteral Nutr. 1981;5:32-6. DOI: 10.1177/014860718100500132</RefTotal> <RefLink>http://dx.doi.org/10.1177/014860718100500132</RefLink> </Reference> <Reference refNo="201"> <RefAuthor>Raad I</RefAuthor> <RefAuthor>Narro J</RefAuthor> <RefAuthor>Khan A</RefAuthor> <RefAuthor>Tarrand J</RefAuthor> <RefAuthor>Vartivarian S</RefAuthor> <RefAuthor>Bodey GP</RefAuthor> <RefTitle>Serious complications of vascular catheter-related Staphylococcus aureus bacteremia in cancer patients</RefTitle> <RefYear>1992</RefYear> <RefJournal>Eur J Clin Microbiol Infect Dis</RefJournal> <RefPage>675-82</RefPage> <RefTotal>Raad I, Narro J, Khan A, Tarrand J, Vartivarian S, Bodey GP. Serious complications of vascular catheter-related Staphylococcus aureus bacteremia in cancer patients. Eur J Clin Microbiol Infect Dis. 1992;11:675-82. DOI: 10.1007/BF01989970</RefTotal> <RefLink>http://dx.doi.org/10.1007/BF01989970</RefLink> </Reference> <Reference refNo="202"> <RefAuthor>Raad I</RefAuthor> <RefAuthor>Davis S</RefAuthor> <RefAuthor>Khan A</RefAuthor> <RefAuthor>Tarrand J</RefAuthor> <RefAuthor>Elting L</RefAuthor> <RefAuthor>Bodey GP</RefAuthor> <RefTitle>Impact of central venous catheter removal on the recurrence of catheter-related coagulase-negative staphylococcal bacteremia</RefTitle> <RefYear>1992</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>215-21</RefPage> <RefTotal>Raad I, Davis S, Khan A, Tarrand J, Elting L, Bodey GP. Impact of central venous catheter removal on the recurrence of catheter-related coagulase-negative staphylococcal bacteremia. Infect Control Hosp Epidemiol. 1992;13(4):215-21.</RefTotal> </Reference> <Reference refNo="203"> <RefAuthor>Malanoski GJ</RefAuthor> <RefAuthor>Samore MH</RefAuthor> <RefAuthor>Pefanis A</RefAuthor> <RefAuthor>Karchmer AW</RefAuthor> <RefTitle>Staphylococcus aureus catheter-associated bacteremia: Minimal effective therapy and unusual infectious complications associated with arterial sheath catheters</RefTitle> <RefYear>1995</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>1161-6</RefPage> <RefTotal>Malanoski GJ, Samore MH, Pefanis A, Karchmer AW. Staphylococcus aureus catheter-associated bacteremia: Minimal effective therapy and unusual infectious complications associated with arterial sheath catheters. Arch Intern Med. 1995;155:1161-6.</RefTotal> </Reference> <Reference refNo="204"> <RefAuthor>Rose HD</RefAuthor> <RefTitle>Venous catheter-associated candidemia</RefTitle> <RefYear>1978</RefYear> <RefJournal>Am J Med Sci</RefJournal> <RefPage>265-9</RefPage> <RefTotal>Rose HD. Venous catheter-associated candidemia. Am J Med Sci. 1978;275:265-9. DOI: 10.1097/00000441-197805000-00004</RefTotal> <RefLink>http://dx.doi.org/10.1097/00000441-197805000-00004</RefLink> </Reference> <Reference refNo="205"> <RefAuthor>Krzywda EA</RefAuthor> <RefAuthor>Gotoff R</RefAuthor> <RefAuthor>Andris DA</RefAuthor> <RefAuthor>Marciniak TF</RefAuthor> <RefAuthor>Edmiston D</RefAuthor> <RefAuthor>Quebbeman E</RefAuthor> <RefTitle>Antibiotic lock treatment (ALT): impact on catheter salvage and cost savings</RefTitle> <RefYear>1995</RefYear> <RefBookTitle>Program and Abstracts of the 35th Interscience Conference of Antimicrobial Agents and Chemotherapy</RefBookTitle> <RefPage></RefPage> <RefTotal>Krzywda EA, Gotoff R, Andris DA, Marciniak TF, Edmiston D, Quebbeman E. Antibiotic lock treatment (ALT): impact on catheter salvage and cost savings. In: Program and Abstracts of the 35th Interscience Conference of Antimicrobial Agents and Chemotherapy; San Francisco, California; 1995.</RefTotal> </Reference> <Reference refNo="206"> <RefAuthor>Capedvila J</RefAuthor> <RefAuthor>Segarra A</RefAuthor> <RefAuthor>Planes A</RefAuthor> <RefAuthor>Gasser I</RefAuthor> <RefAuthor>Gavalda J</RefAuthor> <RefAuthor>Pahissa A</RefAuthor> <RefTitle>Long-term follow-up of patients with catheter-related sepsis (CRS) treated without catheter removal</RefTitle> <RefYear>1995</RefYear> <RefBookTitle>Program and Abstracts of the 35th Interscience Conference of Antimicrobial Agents and Chemotherapy</RefBookTitle> <RefPage></RefPage> <RefTotal>Capedvila J, Segarra A, Planes A, Gasser I, Gavalda J, Pahissa A. Long-term follow-up of patients with catheter-related sepsis (CRS) treated without catheter removal. In: Program and Abstracts of the 35th Interscience Conference of Antimicrobial Agents and Chemotherapy; San Francisco, California; 1995.</RefTotal> </Reference> <Reference refNo="207"> <RefAuthor>Strinden WD</RefAuthor> <RefAuthor>Helgerson RB</RefAuthor> <RefAuthor>Maki DG</RefAuthor> <RefTitle>Candida septic thrombosis of the great central veins associated with central catheters. Clinical features and management</RefTitle> <RefYear>1985</RefYear> <RefJournal>Ann Surg</RefJournal> <RefPage>653-8</RefPage> <RefTotal>Strinden WD, Helgerson RB, Maki DG. Candida septic thrombosis of the great central veins associated with central catheters. Clinical features and management. Ann Surg. 1985;202:653-8. DOI: 10.1097/00000658-198511000-00019</RefTotal> <RefLink>http://dx.doi.org/10.1097/00000658-198511000-00019</RefLink> </Reference> <Reference refNo="208"> <RefAuthor>Raviglione MC</RefAuthor> <RefAuthor>Battan R</RefAuthor> <RefAuthor>Pablos-Mendez A</RefAuthor> <RefAuthor>Aceves-Casillas P</RefAuthor> <RefAuthor>Mullen MP</RefAuthor> <RefAuthor>Taranta A</RefAuthor> <RefTitle>Infections associated with Hickman catheters in patients with acquired immunodeficiency syndrome</RefTitle> <RefYear>1989</RefYear> <RefJournal>Am J Med</RefJournal> <RefPage>780-6</RefPage> <RefTotal>Raviglione MC, Battan R, Pablos-Mendez A, Aceves-Casillas P, Mullen MP, Taranta A. Infections associated with Hickman catheters in patients with acquired immunodeficiency syndrome. Am J Med. 1989;86:780-6. DOI: 10.1016/0002-9343(89)90473-7</RefTotal> <RefLink>http://dx.doi.org/10.1016/0002-9343(89)90473-7</RefLink> </Reference> <Reference refNo="209"> <RefAuthor>Dugdale DC</RefAuthor> <RefAuthor>Ramsey PG</RefAuthor> <RefTitle>Staphylococcus aureus bacteremia in patients with Hickman catheters</RefTitle> <RefYear>1990</RefYear> <RefJournal>Am J Med</RefJournal> <RefPage>137-41</RefPage> <RefTotal>Dugdale DC, Ramsey PG. Staphylococcus aureus bacteremia in patients with Hickman catheters. Am J Med. 1990;89:137-41. DOI: 10.1016/0002-9343(90)90290-T</RefTotal> <RefLink>http://dx.doi.org/10.1016/0002-9343(90)90290-T</RefLink> </Reference> <Reference refNo="210"> <RefAuthor>Lecciones JA</RefAuthor> <RefAuthor>Lee JW</RefAuthor> <RefAuthor>Navarro EE</RefAuthor> <RefAuthor>Witebsky FG</RefAuthor> <RefAuthor>Marshall D</RefAuthor> <RefAuthor>Steinberg SM</RefAuthor> <RefAuthor>Pizzo PA</RefAuthor> <RefAuthor>Walsh TJ</RefAuthor> <RefTitle>Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes</RefTitle> <RefYear>1992</RefYear> <RefJournal>Clin Infect Dis</RefJournal> <RefPage>875-83</RefPage> <RefTotal>Lecciones JA, Lee JW, Navarro EE, Witebsky FG, Marshall D, Steinberg SM, Pizzo PA, Walsh TJ. Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes. Clin Infect Dis. 1992;14(4):875-83.</RefTotal> </Reference> <Reference refNo="211"> <RefAuthor>O'Grady NP</RefAuthor> <RefAuthor>Barie PS</RefAuthor> <RefAuthor>Bartlett J</RefAuthor> <RefAuthor>Bleck T</RefAuthor> <RefAuthor>Garvey G</RefAuthor> <RefAuthor>Jacobi J</RefAuthor> <RefTitle>Practice parameters for evaluating new fever in critically ill adult patients; Task Force of the American College of Critical Care Medicine of the Society of Critical Care Medicine in collaboration with the Infectious Disease Society of America</RefTitle> <RefYear>1998</RefYear> <RefJournal>Crit Care Med</RefJournal> <RefPage>392-408</RefPage> <RefTotal>O'Grady NP, Barie PS, Bartlett J, Bleck T, Garvey G, Jacobi J, et al. Practice parameters for evaluating new fever in critically ill adult patients; Task Force of the American College of Critical Care Medicine of the Society of Critical Care Medicine in collaboration with the Infectious Disease Society of America. Crit Care Med. 1998;26:392-408. DOI: 10.1097/00003246-199802000-00046</RefTotal> <RefLink>http://dx.doi.org/10.1097/00003246-199802000-00046</RefLink> </Reference> <Reference refNo="212"> <RefAuthor>Messing B</RefAuthor> <RefAuthor>Peitra-Cohen S</RefAuthor> <RefAuthor>Debure A</RefAuthor> <RefAuthor>Beliah M</RefAuthor> <RefAuthor>Bernier JJ</RefAuthor> <RefTitle>Antibiotic-lock technique: a new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients</RefTitle> <RefYear>1988</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>185-9</RefPage> <RefTotal>Messing B, Peitra-Cohen S, Debure A, Beliah M, Bernier JJ. Antibiotic-lock technique: a new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients. JPEN J Parenter Enteral Nutr. 1988;12:185-9. DOI: 10.1177/0148607188012002185</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607188012002185</RefLink> </Reference> <Reference refNo="213"> <RefAuthor>Andris DA</RefAuthor> <RefAuthor>Krzywda EA</RefAuthor> <RefAuthor>Edmiston CE</RefAuthor> <RefAuthor>Krepel CJ</RefAuthor> <RefAuthor>Gohr CM</RefAuthor> <RefTitle>Elimination of intraluminal colonization by antibiotic lock in silicone vascular catheters</RefTitle> <RefYear>1998</RefYear> <RefJournal>Nutrition</RefJournal> <RefPage>427-32</RefPage> <RefTotal>Andris DA, Krzywda EA, Edmiston CE, Krepel CJ, Gohr CM. Elimination of intraluminal colonization by antibiotic lock in silicone vascular catheters. Nutrition. 1998;14:427-32. DOI: 10.1016/S0899-9007(98)00013-6</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0899-9007(98)00013-6</RefLink> </Reference> <Reference refNo="214"> <RefAuthor>Krzywda EA</RefAuthor> <RefAuthor>Andris DA</RefAuthor> <RefAuthor>Edmiston CE Jr</RefAuthor> <RefAuthor>Quebbeman EJ</RefAuthor> <RefTitle>Treatment of Hickman catheter sepsis using antibiotic lock technique</RefTitle> <RefYear>1995</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>596-8</RefPage> <RefTotal>Krzywda EA, Andris DA, Edmiston CE Jr, Quebbeman EJ. Treatment of Hickman catheter sepsis using antibiotic lock technique. Infect Control Hosp Epidemiol. 1995;16(10):596-8.</RefTotal> </Reference> <Reference refNo="215"> <RefAuthor>Guggenbichler JP</RefAuthor> <RefAuthor>Berchtold D</RefAuthor> <RefAuthor>Allerberger F</RefAuthor> <RefAuthor>Bonatti H</RefAuthor> <RefAuthor>Hager J</RefAuthor> <RefAuthor>Pfaller W</RefAuthor> <RefTitle>In vitro and in vivo effect of antibiotics on catheters colonized by staphylococci</RefTitle> <RefYear>1992</RefYear> <RefJournal>Eur J Clin Microbiol Infect Dis</RefJournal> <RefPage>408-15</RefPage> <RefTotal>Guggenbichler JP, Berchtold D, Allerberger F, Bonatti H, Hager J, Pfaller W, et al. In vitro and in vivo effect of antibiotics on catheters colonized by staphylococci. Eur J Clin Microbiol Infect Dis. 1992;11:408-15. DOI: 10.1007/BF01961855</RefTotal> <RefLink>http://dx.doi.org/10.1007/BF01961855</RefLink> </Reference> <Reference refNo="216"> <RefAuthor>Rao JS</RefAuthor> <RefAuthor>O'Meara A</RefAuthor> <RefAuthor>Harvey T</RefAuthor> <RefAuthor>Breatnach F</RefAuthor> <RefTitle>A new approach to the management of Broviac catheter infection</RefTitle> <RefYear>1992</RefYear> <RefJournal>J Hosp Infect</RefJournal> <RefPage>109-16</RefPage> <RefTotal>Rao JS, O'Meara A, Harvey T, Breatnach F. A new approach to the management of Broviac catheter infection. J Hosp Infect. 1992;22:109-16. DOI: 10.1016/0195-6701(92)90094-3</RefTotal> <RefLink>http://dx.doi.org/10.1016/0195-6701(92)90094-3</RefLink> </Reference> <Reference refNo="217"> <RefAuthor>Benoit JL</RefAuthor> <RefAuthor>Carandang G</RefAuthor> <RefAuthor>Sitrin M</RefAuthor> <RefAuthor>Arnow PM</RefAuthor> <RefTitle>Intraluminal antibiotic treatment of central venous catheter infections in patients receiving parenteral nutrition at home</RefTitle> <RefYear>1995</RefYear> <RefJournal>Clin Infect Dis</RefJournal> <RefPage>1286-8</RefPage> <RefTotal>Benoit JL, Carandang G, Sitrin M, Arnow PM. Intraluminal antibiotic treatment of central venous catheter infections in patients receiving parenteral nutrition at home. Clin Infect Dis. 1995;21(5):1286-8.</RefTotal> </Reference> <Reference refNo="218"> <RefAuthor>Messing B</RefAuthor> <RefAuthor>Man F</RefAuthor> <RefAuthor>Colimon R</RefAuthor> <RefAuthor>Thuillier F</RefAuthor> <RefAuthor>Beliah M</RefAuthor> <RefTitle>Antibiotic-lock technique is an effective treatment of bacterial catheter-related sepsis during parenteral nutrition</RefTitle> <RefYear>1990</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>220-5</RefPage> <RefTotal>Messing B, Man F, Colimon R, Thuillier F, Beliah M. Antibiotic-lock technique is an effective treatment of bacterial catheter-related sepsis during parenteral nutrition. Clin Nutr. 1990;9:220-5. DOI: 10.1016/0261-5614(90)90023-L</RefTotal> <RefLink>http://dx.doi.org/10.1016/0261-5614(90)90023-L</RefLink> </Reference> <Reference refNo="219"> <RefAuthor>Gaillard JL</RefAuthor> <RefAuthor>Merlino R</RefAuthor> <RefAuthor>Pajot N</RefAuthor> <RefAuthor>Goulet O</RefAuthor> <RefAuthor>Fauchere JL</RefAuthor> <RefAuthor>Ricour C</RefAuthor> <RefTitle>Conventional and nonconventional modes of vancomycin administration to decontaminate the internal surface of catheters colonized with coagulase-negative staphylococci</RefTitle> <RefYear>1990</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>593-7</RefPage> <RefTotal>Gaillard JL, Merlino R, Pajot N, Goulet O, Fauchere JL, Ricour C, et al. Conventional and nonconventional modes of vancomycin administration to decontaminate the internal surface of catheters colonized with coagulase-negative staphylococci. JPEN J Parenter Enteral Nutr. 1990;14:593-7. DOI: 10.1177/0148607190014006593</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607190014006593</RefLink> </Reference> <Reference refNo="220"> <RefAuthor>Schwartz C</RefAuthor> <RefAuthor>Henrickson KJ</RefAuthor> <RefAuthor>Roghmann K</RefAuthor> <RefAuthor>Powell K</RefAuthor> <RefTitle>Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin-susceptible organisms</RefTitle> <RefYear>1990</RefYear> <RefJournal>J Clin Oncol</RefJournal> <RefPage>1591-7</RefPage> <RefTotal>Schwartz C, Henrickson KJ, Roghmann K, Powell K. Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin-susceptible organisms. J Clin Oncol. 1990;8(9):1591-7.</RefTotal> </Reference> <Reference refNo="221"> <RefAuthor>Henrickson KJ</RefAuthor> <RefAuthor>Axtell RA</RefAuthor> <RefAuthor>Hoover SM</RefAuthor> <RefAuthor>Kuhn SM</RefAuthor> <RefAuthor>Pritchett J</RefAuthor> <RefAuthor>Kehl SC</RefAuthor> <RefAuthor>Klein JP</RefAuthor> <RefTitle>Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: A randomized, multicenter, double-blind trial</RefTitle> <RefYear>2000</RefYear> <RefJournal>J Clin Oncol</RefJournal> <RefPage>1269-78</RefPage> <RefTotal>Henrickson KJ, Axtell RA, Hoover SM, Kuhn SM, Pritchett J, Kehl SC, Klein JP. Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: A randomized, multicenter, double-blind trial. J Clin Oncol. 2000;18(6):1269-78.</RefTotal> </Reference> <Reference refNo="222"> <RefAuthor>Payne-James JJ</RefAuthor> <RefAuthor>Khawaja HT</RefAuthor> <RefTitle>First choice for total parenteral nutrition: the peripheral route</RefTitle> <RefYear>1993</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>468-78</RefPage> <RefTotal>Payne-James JJ, Khawaja HT. First choice for total parenteral nutrition: the peripheral route. JPEN J Parenter Enteral Nutr. 1993;17:468-78. DOI: 10.1177/0148607193017005468</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607193017005468</RefLink> </Reference> <Reference refNo="223"> <RefAuthor>Hansell DT</RefAuthor> <RefTitle>Intravenous nutrition: the central or peripheral route?</RefTitle> <RefYear>1989</RefYear> <RefJournal>Int Ther Clin Mon</RefJournal> <RefPage>184-90</RefPage> <RefTotal>Hansell DT. Intravenous nutrition: the central or peripheral route? Int Ther Clin Mon. 1989;6/7:184-90.</RefTotal> </Reference> <Reference refNo="224"> <RefAuthor>Couse N</RefAuthor> <RefAuthor>Pickford LR</RefAuthor> <RefAuthor>Mitchell CJ</RefAuthor> <RefAuthor>Macfie J</RefAuthor> <RefTitle>Total parenteral nutrition by peripheral vein - Substitute or supplement to the central venous route? A prospective trial</RefTitle> <RefYear>1993</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>213-6</RefPage> <RefTotal>Couse N, Pickford LR, Mitchell CJ, Macfie J. Total parenteral nutrition by peripheral vein - Substitute or supplement to the central venous route? A prospective trial. Clin Nutr. 1993;12:213-6. DOI: 10.1016/0261-5614(93)90017-X</RefTotal> <RefLink>http://dx.doi.org/10.1016/0261-5614(93)90017-X</RefLink> </Reference> <Reference refNo="225"> <RefAuthor>Everitt NJ</RefAuthor> <RefAuthor>Wong C</RefAuthor> <RefAuthor>McMahon MJ</RefAuthor> <RefTitle>Peripheral infusion as the route of choice for intravenous nutrition: a prospective two year study</RefTitle> <RefYear>1996</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>69-74</RefPage> <RefTotal>Everitt NJ, Wong C, McMahon MJ. Peripheral infusion as the route of choice for intravenous nutrition: a prospective two year study. Clin Nutr. 1996;15:69-74. DOI: 10.1016/S0261-5614(96)80022-7</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0261-5614(96)80022-7</RefLink> </Reference> <Reference refNo="226"> <RefAuthor>Kohlhardt SR</RefAuthor> <RefAuthor>Smith RC</RefAuthor> <RefAuthor>Wright CR</RefAuthor> <RefAuthor>Sucic KA</RefAuthor> <RefTitle>Fine-bore peripheral catheters versus central venous catheters for delivery of intravenous nutrition</RefTitle> <RefYear>1992</RefYear> <RefJournal>Nutrition</RefJournal> <RefPage>412-7</RefPage> <RefTotal>Kohlhardt SR, Smith RC, Wright CR, Sucic KA. Fine-bore peripheral catheters versus central venous catheters for delivery of intravenous nutrition. Nutrition. 1992;8(6):412-7.</RefTotal> </Reference> <Reference refNo="227"> <RefAuthor>Everitt NJ</RefAuthor> <RefAuthor>Madan M</RefAuthor> <RefAuthor>Alexander DJ</RefAuthor> <RefAuthor>McMahon MJ</RefAuthor> <RefTitle>Fine bore silicone rubber and polyurethane catheters for the delivery of complete intravenous nutrition via a peripheral vein</RefTitle> <RefYear>1993</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>261-5</RefPage> <RefTotal>Everitt NJ, Madan M, Alexander DJ, McMahon MJ. Fine bore silicone rubber and polyurethane catheters for the delivery of complete intravenous nutrition via a peripheral vein. Clin Nutr. 1993;12:261-5. DOI: 10.1016/0261-5614(93)90043-4</RefTotal> <RefLink>http://dx.doi.org/10.1016/0261-5614(93)90043-4</RefLink> </Reference> <Reference refNo="228"> <RefAuthor>Timmer JG</RefAuthor> <RefAuthor>Schipper HG</RefAuthor> <RefTitle>Peripheral venous nutrition: the equal relevance of volume load and osmolarity in relation to phlebitis</RefTitle> <RefYear>1991</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>71-5</RefPage> <RefTotal>Timmer JG, Schipper HG. Peripheral venous nutrition: the equal relevance of volume load and osmolarity in relation to phlebitis. Clin Nutr. 1991;10:71-5. DOI: 10.1016/0261-5614(91)90090-Y</RefTotal> <RefLink>http://dx.doi.org/10.1016/0261-5614(91)90090-Y</RefLink> </Reference> <Reference refNo="229"> <RefAuthor>Kuwahara T</RefAuthor> <RefAuthor>Asanami S</RefAuthor> <RefAuthor>Tamura T</RefAuthor> <RefAuthor>Kaneda S</RefAuthor> <RefTitle>Effects of pH and osmolality on phlebitic potential of infusion solutions for peripheral parenteral nutrition</RefTitle> <RefYear>1998</RefYear> <RefJournal>J Toxicol Sci</RefJournal> <RefPage>77-85</RefPage> <RefTotal>Kuwahara T, Asanami S, Tamura T, Kaneda S. Effects of pH and osmolality on phlebitic potential of infusion solutions for peripheral parenteral nutrition. J Toxicol Sci. 1998;23(1):77-85.</RefTotal> </Reference> <Reference refNo="230"> <RefAuthor>Kuwahara T</RefAuthor> <RefAuthor>Asanami S</RefAuthor> <RefAuthor>Kubo S</RefAuthor> <RefTitle>Experimental infusion phlebitis: tolerance osmolality of peripheral venous endothelial cells</RefTitle> <RefYear>1998</RefYear> <RefJournal>Nutrition</RefJournal> <RefPage>496-501</RefPage> <RefTotal>Kuwahara T, Asanami S, Kubo S. Experimental infusion phlebitis: tolerance osmolality of peripheral venous endothelial cells. Nutrition. 1998;14:496-501. DOI: 10.1016/S0899-9007(98)00037-9</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0899-9007(98)00037-9</RefLink> </Reference> <Reference refNo="231"> <RefAuthor>Gazitua R</RefAuthor> <RefAuthor>Wilson K</RefAuthor> <RefAuthor>Bistrian BR</RefAuthor> <RefAuthor>Blackburn GL</RefAuthor> <RefTitle>Factors determiningperipheral vein tolerance to amino acid infusions</RefTitle> <RefYear>1979</RefYear> <RefJournal>Arch Surg</RefJournal> <RefPage>897-900</RefPage> <RefTotal>Gazitua R, Wilson K, Bistrian BR, Blackburn GL. Factors determiningperipheral vein tolerance to amino acid infusions. Arch Surg. 1979;114:897-900.</RefTotal> </Reference> <Reference refNo="232"> <RefAuthor>Isaacs JW</RefAuthor> <RefAuthor>Millikan WJ</RefAuthor> <RefAuthor>Stackhouse J</RefAuthor> <RefAuthor>Hersh T</RefAuthor> <RefAuthor>Rudman D</RefAuthor> <RefTitle>Parenteral nutrition of adults with a 900 milliosmolar solution via peripheral veins</RefTitle> <RefYear>1977</RefYear> <RefJournal>Am J Clin Nutr</RefJournal> <RefPage>552-9</RefPage> <RefTotal>Isaacs JW, Millikan WJ, Stackhouse J, Hersh T, Rudman D. Parenteral nutrition of adults with a 900 milliosmolar solution via peripheral veins. Am J Clin Nutr. 1977;30(4):552-9.</RefTotal> </Reference> <Reference refNo="233"> <RefAuthor>Acra SA</RefAuthor> <RefAuthor>Rollins C</RefAuthor> <RefTitle>Principles and guidelines for parenteral nutrition in children</RefTitle> <RefYear>1999</RefYear> <RefJournal>Pediatr Ann</RefJournal> <RefPage>113-20</RefPage> <RefTotal>Acra SA, Rollins C. Principles and guidelines for parenteral nutrition in children. Pediatr Ann. 1999;28(2):113-20.</RefTotal> </Reference> <Reference refNo="234"> <RefAuthor>Kane KF</RefAuthor> <RefAuthor>Cologiovanni L</RefAuthor> <RefAuthor>McKiernan J</RefAuthor> <RefAuthor>Panos MZ</RefAuthor> <RefAuthor>Ayres RC</RefAuthor> <RefAuthor>Langman MJ</RefAuthor> <RefTitle>High osmolality feedings do not increase the incidence of thrombophlebitis during peripheral i v nutrition</RefTitle> <RefYear>1996</RefYear> <RefJournal>JPEN J Parenter Enteral Nutr</RefJournal> <RefPage>194-7</RefPage> <RefTotal>Kane KF, Cologiovanni L, McKiernan J, Panos MZ, Ayres RC, Langman MJ, et al. High osmolality feedings do not increase the incidence of thrombophlebitis during peripheral i v nutrition. JPEN J Parenter Enteral Nutr. 1996;20:194-7. DOI: 10.1177/0148607196020003194</RefTotal> <RefLink>http://dx.doi.org/10.1177/0148607196020003194</RefLink> </Reference> <Reference refNo="235"> <RefAuthor>Williams N</RefAuthor> <RefAuthor>Wales S</RefAuthor> <RefAuthor>Irving MH</RefAuthor> <RefTitle>Prolonged peripheral parenteral nutrition with an ultrafine cannula and low-osmolality feed</RefTitle> <RefYear>1996</RefYear> <RefJournal>Br J Surg</RefJournal> <RefPage>114-6</RefPage> <RefTotal>Williams N, Wales S, Irving MH. Prolonged peripheral parenteral nutrition with an ultrafine cannula and low-osmolality feed. Br J Surg. 1996;83:114-6. DOI: 10.1002/bjs.1800830137</RefTotal> <RefLink>http://dx.doi.org/10.1002/bjs.1800830137</RefLink> </Reference> <Reference refNo="236"> <RefAuthor>Everitt NJ</RefAuthor> <RefAuthor>McMahon MJ</RefAuthor> <RefTitle>Influence of fine-bore catheter length on infusion thrombophlebitis in peripheral intravenous nutrition: a randomised controlled trial</RefTitle> <RefYear>1997</RefYear> <RefJournal>Ann R Coll Surg Engl</RefJournal> <RefPage>221-4</RefPage> <RefTotal>Everitt NJ, McMahon MJ. Influence of fine-bore catheter length on infusion thrombophlebitis in peripheral intravenous nutrition: a randomised controlled trial. Ann R Coll Surg Engl. 1997;79(3):221-4.</RefTotal> </Reference> <Reference refNo="237"> <RefAuthor>Madan M</RefAuthor> <RefAuthor>Alexander DJ</RefAuthor> <RefAuthor>McMahon MJ</RefAuthor> <RefTitle>Influence of catheter type on occurrence of thrombophlebitis during peripheral intravenous nutrition</RefTitle> <RefYear>1992</RefYear> <RefJournal>Lancet</RefJournal> <RefPage>101-3</RefPage> <RefTotal>Madan M, Alexander DJ, McMahon MJ. Influence of catheter type on occurrence of thrombophlebitis during peripheral intravenous nutrition. Lancet. 1992;339:101-3. DOI: 10.1016/0140-6736(92)91007-U</RefTotal> <RefLink>http://dx.doi.org/10.1016/0140-6736(92)91007-U</RefLink> </Reference> <Reference refNo="238"> <RefAuthor>Hecker JF</RefAuthor> <RefTitle>Potential for extending survival of peripheral intravenous infusions</RefTitle> <RefYear>1992</RefYear> <RefJournal>BMJ</RefJournal> <RefPage>619-24</RefPage> <RefTotal>Hecker JF. Potential for extending survival of peripheral intravenous infusions. BMJ 1992;304:619-24. DOI: 10.1136/bmj.304.6827.619</RefTotal> <RefLink>http://dx.doi.org/10.1136/bmj.304.6827.619</RefLink> </Reference> <Reference refNo="239"> <RefAuthor>Everitt NJ</RefAuthor> <RefAuthor>McMahon MJ</RefAuthor> <RefTitle>Peripheral intravenous nutrition</RefTitle> <RefYear>1994</RefYear> <RefJournal>Nutrition</RefJournal> <RefPage>49-57</RefPage> <RefTotal>Everitt NJ, McMahon MJ. Peripheral intravenous nutrition. Nutrition. 1994;10(1):49-57.</RefTotal> </Reference> <Reference refNo="240"> <RefAuthor>Kuwahara T</RefAuthor> <RefAuthor>Asanami S</RefAuthor> <RefAuthor>Tamura T</RefAuthor> <RefAuthor>Kubo S</RefAuthor> <RefTitle>Experimental infusion phlebitis: importance of titratable acidity on phlebitic potential of infusion solution</RefTitle> <RefYear>1996</RefYear> <RefJournal>Clin Nutr</RefJournal> <RefPage>129-32</RefPage> <RefTotal>Kuwahara T, Asanami S, Tamura T, Kubo S. Experimental infusion phlebitis: importance of titratable acidity on phlebitic potential of infusion solution. Clin Nutr. 1996;15:129-32. DOI: 10.1016/S0261-5614(96)80037-9</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0261-5614(96)80037-9</RefLink> </Reference> <Reference refNo="241"> <RefAuthor>Hessov I</RefAuthor> <RefAuthor>Bojsen-Mooller M</RefAuthor> <RefTitle>Experimental infusion thrombophlebitis. Importance of the pH of glucose solutions</RefTitle> <RefYear>1976</RefYear> <RefJournal>Eur J Intensive Care Med</RefJournal> <RefPage>97-101</RefPage> <RefTotal>Hessov I, Bojsen-Mooller M. Experimental infusion thrombophlebitis. Importance of the pH of glucose solutions. Eur J Intensive Care Med. 1976;2:97-101. DOI: 10.1007/BF01886123</RefTotal> <RefLink>http://dx.doi.org/10.1007/BF01886123</RefLink> </Reference> <Reference refNo="242"> <RefAuthor>Lai KK</RefAuthor> <RefTitle>Safety of prolonging peripheral cannula and i v tubing use from 72 hours to 96 hours</RefTitle> <RefYear>1998</RefYear> <RefJournal>Am J Infect Control</RefJournal> <RefPage>66-70</RefPage> <RefTotal>Lai KK. Safety of prolonging peripheral cannula and i v tubing use from 72 hours to 96 hours. Am J Infect Control. 1998;26:66-70. DOI: 10.1016/S0196-6553(98)70063-X</RefTotal> <RefLink>http://dx.doi.org/10.1016/S0196-6553(98)70063-X</RefLink> </Reference> <Reference refNo="243"> <RefAuthor>Bregenzer T</RefAuthor> <RefAuthor>Conen D</RefAuthor> <RefAuthor>Sakmann P</RefAuthor> <RefAuthor>Widmer AF</RefAuthor> <RefTitle>Is routine replacement of peripheral intravenous catheters necessary?</RefTitle> <RefYear>1998</RefYear> <RefJournal>Arch Intern Med</RefJournal> <RefPage>151-6</RefPage> <RefTotal>Bregenzer T, Conen D, Sakmann P, Widmer AF. Is routine replacement of peripheral intravenous catheters necessary? Arch Intern Med. 1998;158:151-6. DOI: 10.1001/archinte.158.2.151</RefTotal> <RefLink>http://dx.doi.org/10.1001/archinte.158.2.151</RefLink> </Reference> <Reference refNo="244"> <RefAuthor>Cornely OA</RefAuthor> <RefAuthor>Bethe U</RefAuthor> <RefAuthor>Pauls R</RefAuthor> <RefAuthor>Waldschmidt D</RefAuthor> <RefTitle>Peripheral Teflon catheters: factors determining incidence of phlebitis and duration of cannulation</RefTitle> <RefYear>2002</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>249-53</RefPage> <RefTotal>Cornely OA, Bethe U, Pauls R, Waldschmidt D. Peripheral Teflon catheters: factors determining incidence of phlebitis and duration of cannulation. Infect Control Hosp Epidemiol. 2002;23:249-53. DOI: 10.1086/502044</RefTotal> <RefLink>http://dx.doi.org/10.1086/502044</RefLink> </Reference> <Reference refNo="245"> <RefAuthor>Shimandle RB</RefAuthor> <RefAuthor>Johnson D</RefAuthor> <RefAuthor>Baker M</RefAuthor> <RefAuthor>Stotland N</RefAuthor> <RefAuthor>Karrison T</RefAuthor> <RefAuthor>Arnow PM</RefAuthor> <RefTitle>Safety of peripheral intravenous catheters in children</RefTitle> <RefYear>1999</RefYear> <RefJournal>Infect Control Hosp Epidemiol</RefJournal> <RefPage>736-40</RefPage> <RefTotal>Shimandle RB, Johnson D, Baker M, Stotland N, Karrison T, Arnow PM. Safety of peripheral intravenous catheters in children. Infect Control Hosp Epidemiol. 1999;20:736-40. DOI: 10.1086/501574</RefTotal> <RefLink>http://dx.doi.org/10.1086/501574</RefLink> </Reference> <Reference refNo="246"> <RefAuthor>Garland JS</RefAuthor> <RefAuthor>Dunne WM Jr</RefAuthor> <RefAuthor>Havens P</RefAuthor> <RefAuthor>Hintermeyer M</RefAuthor> <RefAuthor>Bozzette MA</RefAuthor> <RefAuthor>Wincek J</RefAuthor> <RefAuthor>Bromberger T</RefAuthor> <RefAuthor>Seavers M</RefAuthor> <RefTitle>Peripheral intravenous catheter complications in critically ill children: a prospective study</RefTitle> <RefYear>1992</RefYear> <RefJournal>Pediatrics</RefJournal> <RefPage>1145-50</RefPage> <RefTotal>Garland JS, Dunne WM Jr, Havens P, Hintermeyer M, Bozzette MA, Wincek J, Bromberger T, Seavers M. Peripheral intravenous catheter complications in critically ill children: a prospective study. Pediatrics. 1992;89(6 Pt 2):1145-50.</RefTotal> </Reference> <Reference refNo="247"> <RefAuthor>Garland JS</RefAuthor> <RefAuthor>Nelson DB</RefAuthor> <RefAuthor>Cheah TE</RefAuthor> <RefAuthor>Hennes HH</RefAuthor> <RefAuthor>Johnson TM</RefAuthor> <RefTitle>Infectious complications during peripheral intravenous therapy with Teflon catheters: a prospective study</RefTitle> <RefYear>1987</RefYear> <RefJournal>Pediatr Infect Dis J</RefJournal> <RefPage>918-21</RefPage> <RefTotal>Garland JS, Nelson DB, Cheah TE, Hennes HH, Johnson TM. Infectious complications during peripheral intravenous therapy with Teflon catheters: a prospective study. Pediatr Infect Dis J. 1987;6:918-21. DOI: 10.1097/00006454-198710000-00012</RefTotal> <RefLink>http://dx.doi.org/10.1097/00006454-198710000-00012</RefLink> </Reference> <Reference refNo="248"> <RefAuthor>Nelson DB</RefAuthor> <RefAuthor>Garland JS</RefAuthor> <RefTitle>The natural history of Teflon catheter-associated phlebitis in children</RefTitle> <RefYear>1987</RefYear> <RefJournal>Am J Dis Child</RefJournal> <RefPage>1090-2</RefPage> <RefTotal>Nelson DB, Garland JS. The natural history of Teflon catheter-associated phlebitis in children. Am J Dis Child. 1987;141:1090-2.</RefTotal> </Reference> <Reference refNo="249"> <RefAuthor>Maki DG</RefAuthor> <RefAuthor>Mermel LA</RefAuthor> <RefTitle>Infections due to infusion therapy</RefTitle> <RefYear>1998</RefYear> <RefBookTitle>Hospital infections</RefBookTitle> <RefPage>689-724</RefPage> <RefTotal>Maki DG, Mermel LA. Infections due to infusion therapy. In: Bennett JV, Brachman PS, editors. Hospital infections. Philadelphia: Lippencott-Raven; 1998. p. 689-724.</RefTotal> </Reference> </References> <Media> <Tables> <NoOfTables>0</NoOfTables> </Tables> <Figures> <Figure format="png" height="1273" width="853"> <MediaNo>1</MediaNo> <MediaID>1</MediaID> <Caption> <Pgraph> <Mark1>Figure 1: Procedure in case of suspected central venous catheter related systemic infection</Mark1> </Pgraph> </Caption> </Figure> <NoOfPictures>1</NoOfPictures> </Figures> <InlineFigures> <NoOfPictures>0</NoOfPictures> </InlineFigures> <Attachments> <NoOfAttachments>0</NoOfAttachments> </Attachments> </Media> </OrigData> </GmsArticle>