What is the management for a colonized Kendall (central venous catheter)?

From the Guidelines

Colonization of a central venous catheter (CVC) does not necessarily require removal of the catheter.

Management of Colonized CVC

• The management of a colonized CVC depends on the presence of symptoms, the type of microorganism, and the clinical context 1.
• If the patient is asymptomatic and the microorganism is a common skin commensal, such as coagulase-negative staphylococcus, the CVC can often be salvaged with antibiotic therapy 1.
• However, if the patient has symptoms of infection, such as fever or chills, or if the microorganism is a more virulent pathogen, such as Staphylococcus aureus or Candida, removal of the CVC is usually recommended 1.
• Antibiotic lock therapy may be used in conjunction with systemic antibiotic therapy to attempt to salvage the CVC, but this approach is not always successful and should be used with caution 1.
• The use of antimicrobial-impregnated dressings or catheters may help reduce the risk of colonization and infection, but the evidence for these interventions is not yet conclusive 1.
• Regular dressing changes, proper catheter care, and adherence to infection control protocols are essential to prevent colonization and infection of CVCs 1.
• In patients with home parenteral nutrition (HPN), the management of colonized CVCs is similar to that in other patients, but the risk of cumulative complications and loss of vascular access is higher, and efforts should be made to ensure the longevity of lines 1.

From the Research

Management of Colonized Central Venous Catheters

The management of colonized central venous catheters, such as a Kendall catheter, involves several strategies to prevent infection and colonization. The following points summarize the key findings from the studies:

• Catheter replacement strategies: A study 2 found that replacing a colonized catheter over a guidewire can lead to rapid colonization of the new catheter, while removing the colonized catheter and inserting a new one after a 48-hour interval can prevent recolonization.
• Antiseptic solutions: A prospective randomized trial 3 compared the effectiveness of three antiseptic solutions (10% aqueous povidone iodine, 2% aqueous chlorhexidine gluconate, and 0.5% alcoholic chlorhexidine gluconate) in preventing catheter colonization. The results showed that the aqueous and alcoholic chlorhexidine gluconate solutions were superior to the aqueous povidone iodine solution in preventing colonization.
• Catheter care: A study 4 found that daily applications of povidone-iodine did not reduce colonization of central venous catheters compared to dry dressing changes.
• Colonization dynamics: A longitudinal study 5 found that colonization of hemodialysis catheters is dominated by multidrug-resistant, icaA-positive coagulase-negative staphylococci (CoNS) clones, and that mixed CoNS colonization can occur but is delayed.
• Prevention of bacterial colonization: A study 6 found that both cyanoacrylate glue and chlorhexidine-releasing sponge dressings were effective in controlling bacterial colonization of the exit site of peripherally inserted central catheters (PICCs).

Key Considerations

When managing a colonized central venous catheter, the following considerations are important:

• The type of antiseptic solution used for catheter care
• The catheter replacement strategy
• The timing of catheter replacement
• The use of dressings or securement devices to prevent bacterial colonization
• The monitoring of catheter colonization and infection

Strategies for Prevention

To prevent colonization and infection of central venous catheters, the following strategies can be employed:

• Use of antiseptic solutions for catheter care
• Implementation of catheter replacement strategies
• Use of dressings or securement devices to prevent bacterial colonization
• Monitoring of catheter colonization and infection
• Adherence to proper catheter care and handling techniques