Millions of peripheral and central ...

Millions of peripheral and central intravascular catheters are used in the United States each year. Introduction of an intravascular catheter can lead to bloodstream infections, and mortality rates from these catheter-related infections have been estimated at 10 to 20 percent increasing medical require to be paid [i]or[/i] undergones up to $15,000. Povidone-iodine is the principally common catheter-site disinfectant, but accumulating evidence has indicated that chlorhexidine gluconate may be a more effective agent. Chaiyakunapruk and colleagues reviewed pond ed data from a number of new randomized controlled trials to compare the clinical effectiveness and cost-effectiveness of substituting chlorhexidine for povidone-iodine when disinfecting catheter insertion sites.

The decision analysis archetype adopted by the authors presum that disinfectant agents were used at the time of catheter placement and reapplied each 48 to 72 hours to cleanse the insertion site. Short-term catheter use (fewer than 10 days) was examined because this is the greatest in quantity common clinical scenario encountered in hospitals.

The authors estimated rates of catheter colonization, bloodstream infection, and mortality risk through pooling data from randomized controll trials comparing the sum of two units disinfectants.

The associated splendors of catheter-related infection were based forward the presumption that each central catheter infection would proceed in five extra days in intensive care, children and catheter tip cultures, antibiotic susceptibility testing, and the same week of intravenous vancomycin therapy, for a splendor of about $7,113. Peripheral catheter infections were estimated to incur added take away froms of approximately $1,534. For seven days of care, chlorhexidine had an additional charge of $1.53 for central catheter care and $012 for peripheral catheters.

The mereed data indicated that using chlorhexidine instead of povidone-iodine for central catheter care reduc the rates of bloodstream infection (from 31 to 15 cases by 1,000 catheters) and mortality risk (from four to sum of two units cases per 1,000 catheters) at approximately one half. A similar reduction was noted for peripheral catheters, granting the base rates of infection and death were lower. Total expense savings because of decreased morbidity were estimated at $113 for each central catheter and $8 for each peripheral catheter.

The authors finish that use of chlorhexidine gluconate instead of povidone-iodine for disinfection of intravascular catheter sites is clinically effective and cost-effective.

Chaiyakunapruk N et al. Vascular catheter site care: the clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine. Clin Infect Dis September 15 2003;37:764-71

EDITOR'S NOTE: A savings of $8 by peripheral catheter is never going to make headlines, however when this savings is multiplied according to the millions of catheters used each year and enhanced on decreased morbidity and mortality, it is perhaps a more compelling reason to dispense with the traditional iodine preparation and propel on to a more effective agent.--B.Z.

COPYRIGHT 2004 American Academy of Family Physicians

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