Nadelfreie Konnektionsventile und Blutstrominfektionen - Kommentar aus klinischer Sicht

Zusammenfassung

Nadelfreie Konnektionsventile (NFCs) für Infusionssysteme bzw. für die Blutentnahme aus dem zentralvenösen Katheter oder für die Bolusapplikation von Medikamenten können für die Patienten und das Personal von Vorteil sein. In der Literatur gibt es jedoch eine Reihe von Berichten zu einer erhöhten Rate Katheter-assoziierter Infektionen nach Neueinführung von NFCs. Wenn in vitro Studien die Sicherheit des NFC belegen (Desinfizierbarkeit der Membran, keine internen Kontaminations- Reservoire im Gebrauch) und ihre Neueinführung von einer kontinuierlichen Surveillance Katheter-assoziierter Infektionen begleitet wird, können bestimmte NFC im klinischen Alltag wahrscheinlich die Sicherheit und die Praktikabilität der intravenösen Therapie über zentralvenöse Katheter für Patient und Behandlungsteam erhöhen.

Abstract

Needle-less connection valves (NFCs) for infusion systems, blood drawing- or i. v. injection ports may offer significant benefits to the patient and the attending health care workers. On the other hand, a number of recent reports described a relationship between an increased incidence density of catheter-associated infections and the introduction of certain NFCs in clinical practice. Thus, the safety of the device in terms of an effective and feasible disinfection protocol for the outer membrane and absence of unintended bacterial deposits inside the device should have been confirmed with appropriate in vitro investigations. In addition, the introduction into clinical practice should be supervised by continuously performed surveillance for catheter-associated infections. Taking these prerequisites into account, NFCs may increase the safety and feasibility of intravenous therapy using central venous catheters in high-risk patients.

Konnektionsventile - iv. Katheter-Bakteriämie

valve connectors - iv. catheter bloodstream infection

Literatur

• 1 Adams D, Karpanen T, Worthington T, Lambert P, Elliott T S. Infection risk associated with a closed luer access device.  J Hosp Infect. 2006;  62 353-7
• 2 Arduino M J, Bland L A, Danzig L E, McAllister S K, Aguero S M. Microbiologic evaluation of needleless and needle-access devices.  Am J Infect Control. 1997;  25 377-80
• 3 Bouza E, Munoz P, Lopez-Rodriguez J. et al . A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study.  J Hosp Infect. 2003;  54 279-87
• 4 Brown M. The impact of safety product use on catheter-related infections.  J Infus Nurs. 2004;  27 245-50
• 5 Casey A L, Lambert P A and Elliott TS. Is there evidence for recommending needleless closed catheter access systems in guidelines?.  J Hosp Infect. 2006;  64 405-6
• 6 Casey A L, Worthington T, Lambert P A. et al . A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector.  J Hosp Infect. 2003;  54 288-93
• 7 Cesaro S, Cavaliere M, Spiller M. et al . A simplified method of antibiotic lock therapy for Broviac-Hickman catheters using a CLC 2000 connector device.  Support Care Cancer. 2007;  15 95-9
• 8 Cookson S T, Ihrig M, O’Mara E M. et al . Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device.  Infect Control Hosp Epidemiol. 1998;  19 23-7
• 9 Danzig L E, Short L J, Collins K. et al . Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy.  Jama. 1995;  273 1862-4
• 10 Do A N, Ray B J, Banerjee S N. 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
• 11 Donlan R M, Murga R, Bell M. et al . Protocol for detection of biofilms on needleless connectors attached to central venous catheters.  J Clin Microbiol. 2001;  39 750-3
• 12 Field K, McFarlane C, Cheng A C. et al . Incidence of catheter-related bloodstream infection among patients with a needleless, mechanical valve-based intravenous connector in an Australian hematology-oncology unit.  Infect Control Hosp Epidemiol. 2007;  28 610-3
• 13 Kellerman S, Shay D K, Howard J. et al . Bloodstream infections in home infusion patients: the influence of race and needleless intravascular access devices.  J Pediatr. 1996;  129 711-7
• 14 Kommission für Krankenhaushygiene und Infektionsprävention . Prävention Gefäßkatheter-assoziierter Infektionen - Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention am Robert Koch-Institut.  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2002;  25 907-924
• 15 Lee O K, Johnston L. A systematic review for effective management of central venous catheters and catheter sites in acute care paediatric patients.  Worldviews Evid Based Nurs. 2005;  2 4-15
• 16 Maragakis L L, Bradley K L, Song X. et al . Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port.  Infect Control Hosp Epidemiol. 2006;  27 67-70
• 17 McDonald L C, Banerjee S N, Jarvis W R. Line-associated bloodstream infections in pediatric intensive-care-unit patients associated with a needleless device and intermittent intravenous therapy.  Infect Control Hosp Epidemiol. 1998;  19 772-7
• 18 Menyhay S Z, Maki D G. Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap.  Infect Control Hosp Epidemiol. 2006;  27 23-7
• 19 Niel-Weise B S, Daha T J, van den Broek P J. Is there evidence for recommending needleless closed catheter access systems in guidelines? A systematic review of randomized controlled trials.  J Hosp Infect. 2006;  62 406-13
• 20 Rupp M E, Sholtz L A, Jourdan D R. et al . Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve.  Clin Infect Dis. 2007;  44 1408-14
• 21 Russo P L, Harrington G A, Spelman D W. Needleless intravenous systems: A review.  Am J Infect Control. 1999;  27 431-4
• 22 Seymour V M, Dhallu T S, Moss H A, Tebbs S E, Elliot T S. A prospective clinical study to investigate the microbial contamination ofa needleless connector.  J Hosp Infect. 2000;  45 165-8
• 23 Simon A, Bode U, Fleischhack G, Kramer M. Surveillance of nosocomial infections in pediatric cancer patients.  Am J Infect Control. 2005;  33 611
• 24 Trautmann M, Moosbauer S, Schmitz F J, Lepper P M. Experimental study on the safety of a new connecting device.  Am J Infect Control. 2004;  32 296-300
• 25 Widmer A, Bolliger D. Infection risk associated with a closed luer access device.  J Hosp Infect. 2006;  63 479; author reply 479-80
• 26 Yebenes J C, Martnez R, Serra-Prat M. et al . Resistance to the migration of microorganisms of a needle-free disinfectable connector.  Am J Infect Control. 2003;  31 462-4
• 27 Yebenes J C, Vidaur L, Serra-Prat M. et al . Prevention of catheter-related bloodstream infection in critically ill patients using a disinfectable, needle-free connector: a randomized controlled trial.  Am J Infect Control. 2004;  32 291-5