Catheter Infection Clinical Trial
Official title:
Local Inflammation Does Not Correlate With Bacterial Colonization and Contamination of Perineural Catheters
The aim of this study was to investigate the influence of alcoholic skin disin-fection before PNC (perineural catheter)-removal on the detection of bacteria on the subcutaneous part of the PNC or on the tip. Furthermore, the correlation of bacterial colonization with PNC-associated local inflammation or infection was evaluated.
Two hundred orthopedic patients planned to receive a PNC are prospectively randomized to
group PNC-removal with alcoholic skin disinfection or group PNC-removal without skin
disinfection.
After standardized PNC-placement under sterile conditions, patients receive a perioperative
antibiotic prophylaxis and clinical signs of local inflammation or infection are
periodically recorded: The PNC were observed twice daily for clinical signs of local
inflammation and local infection. Patients were also evaluated for clinical signs of
systemic infection. The adhesive dressing was changed only if it became dislodged or if
blood or secretions made visualization of the puncture site impossible. For the dressing
change, the anaesthesiologist wore a facemask, a cap and sterile gloves.
Postoperatively, 6 hours after the initial bolus, a local anaesthetic infusion line was
connected to the micro filter of the PNC. All patients received patient-controlled
perineural analgesia (basal rate 5 ml/h, bolus 4 ml, lock-out time 20 min) with ropivacaine
0.3% for 24 hours, and then reduced to ropivacaine 0.2%.
PNC were removed under sterile conditions after 72h or earlier in the case of signs of
infection: Removal of the PNC was performed on the surgical ward by an anaesthesiologist
according to a standardized procedure: Wearing a facemask and a cap, the adhesive skin
dressing was removed. In the "WITH-group", the skin was now disinfected with an aerosolized
alcoholic solution (propanol-biphenol). Procedure continued after three minutes, when the
skin was dry with the anaesthesiologist wearing sterile gloves and using sterile tweezers.
The distal part of the PNC (directed to the tip of the PNC) was withdrawn for 1 cm at the
insertion site and then cut distally from the tweezers with a sterile pair of scissors. The
distal part of the PNC was then totally withdrawn with the sterile tweezers, and with the
sterile pair of scissors cut in two parts: the tip (defined as the most distal 2 cm) and the
subcutaneous part, which were placed in separate dry sterile containers.
Finally, the remaining proximal part of the PNC was thrown away.
The sterile containers containing the PNC were stored at 4°C and were sent to the laboratory
the same day for microbiological analysis of the PNC: The PNC were rolled onto sheep blood
agar plates (Becton Dickinson BD, Basel, Switzerland) similar to the semiquantitative
culture method for intravenous catheters [10] and thereafter immediately transferred to a
liquid enrichment medium (thioglycolate medium, BD Basel Switzerland). Sheep blood agar was
incubated for 2 days and thioglycolate for 5 days. In case of growth in the enrichment media
only, an aliquot of the liquid was subcultured on solid media. Reports were considered to be
positive if any growth was present. Identification of the isolated bacteria and
susceptibility testing were performed according to standard methods.
All patients were observed for clinical signs of local infection at the PNC insertion site
and for clinical signs of systemic infection one week after PNC-removal. For the correlation
of the detection of bacteria on the PNC with clinical signs of in-flammation, the
sensitivity, specificity, positive and negative predictive values were calculated on the
basis of the following three categories: 1) any growth of bacteria including enrichment, 2)
more or equal 5 colonies and 3) more or equal 15 colonies with the semiquantative culture
technique, respectively.
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