Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

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Abstract

The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.

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Brian T Tsuji, Jason Pogue, Alexandre P Zavascki … (2019)

The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as salvage therapy for otherwise untreatable gram-negative infections. Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B. We report consensus therapeutic guidelines for agent selection and dosing of the polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP), Infectious Diseases Society of America (IDSA), International Society of Anti-Infective Pharmacology (ISAP), Society for Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement. The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, polymyxin agent selection, dosing, dosage adjustment and monitoring of colistin and polymyxin B, use of polymyxin-based combination therapy, intrathecal therapy, inhalation therapy, toxicity, and prevention of renal failure. The treatment guidelines provide the first ever consensus recommendations for colistin and polymyxin B therapy that are intended to guide optimal clinical use.

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Author and article information

Contributors

Jean-François Timsit: jean-francois.timsit@aphp.fr

Julien Baleine: jf-baleine@chu-montpellier.fr

Louis Bernard: louis.bernard@univ-tours.fr

Silvia Calvino-Gunther: SCalvino-gunther@chu-grenoble.fr

Michael Darmon: michael.darmon@aphp.fr

Jean Dellamonica: jean.dellamonica@univ-cotedazur.fr

Eric Desruennes: ericdesruennes@yahoo.fr

Marc Leone: marc.leone@ap-hm.fr

Alain Lepape: alain.lepape@chu-lyon.fr

Olivier Leroy: oleroy@ch-tourcoing.fr

Jean-Christophe Lucet: jean-christophe.lucet@aphp.fr

Zied Merchaoui: zied.merchaoui@aphp.fr

Olivier Mimoz: olivier.mimoz@chu-poitiers.fr

Benoit Misset: benoit.misset@chuliege.be

Jean-Jacques Parienti: parienti-jj@chu-caen.fr

Jean-Pierre Quenot: jean-pierre.quenot@chu-dijon.fr

Antoine Roch: antoine.roch@ap-hm.fr

Matthieu Schmidt: matthieu.schmidt@aphp.fr

Michel Slama: slama.michel@chu-amiens.fr

Bertrand Souweine: bsouweine@chu-clermontferrand.fr

Jean-Ralph Zahar: jeanralph.zahar@aphp.fr

Walter Zingg: Walter.Zingg@hcuge.ch

Laetitia Bodet-Contentin: laetitia.bodet@univ-tours.fr

Virginie Maxime: virginie.maxime@aphp.fr

Journal

Journal ID (nlm-ta): Ann Intensive Care

Journal ID (iso-abbrev): Ann Intensive Care

Title: Annals of Intensive Care

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2110-5820

Publication date (Electronic): 7 September 2020

Publication date PMC-release: 7 September 2020

Publication date Collection: 2020

Volume: 10

Electronic Location Identifier: 118

Affiliations

[1 ]APHP/Hopital Bichat-Medical and Infectious Diseases ICU (MI2), 46 rue Henri Huchard, 75018 Paris, France

[2 ]GRID grid.469994.f, ISNI 0000 0004 1788 6194, UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Université de Paris, , Sorbonne Paris Cité, ; 75018 Paris, France

[3 ]GRID grid.413745.0, ISNI 0000 0001 0507 738X, Department of Neonatal Medicine and Pediatric Intensive Care, , Arnaud de Villeneuve University Hospital, ; 371 Avenue Doyen G Giraud, 34295 Montpellier Cedex 5, France

[4 ]GRID grid.411167.4, ISNI 0000 0004 1765 1600, Infectious Diseases Unit, , University Hospital Tours, ; Nîmes 2 Boulevard, 37000 Tours, France

[5 ]GRID grid.410529.b, ISNI 0000 0001 0792 4829, CHU Grenoble Alpes, , Réanimation Médicale Pôle Urgences Médecine Aiguë, ; 38000 Grenoble, France

[6 ]GRID grid.413328.f, ISNI 0000 0001 2300 6614, Medical ICU, , Saint-Louis University Hospital, AP-HP, ; Paris, France

[7 ]GRID grid.460782.f, ISNI 0000 0004 4910 6551, Centre Hospitalier Universitaire de Nice, Médecine Intensive Réanimation, Archet 1, UR2CA Unité de Recherche Clinique Côte d’Azur, , Université Cote d’Azur, ; Nice, France

[8 ]GRID grid.414184.c, ISNI 0000 0004 0593 6676, Clinique d’anesthésie pédiatrique, Hôpital Jeanne-de-Flandre, ; avenue Eugène-Avinée, CHU Lille, 59000 Lille, France

[9 ]GRID grid.452351.4, ISNI 0000 0001 0131 6312, Unité accès vasculaire, , Centre Oscar Lambret, ; 3 rue Frédéric Combemale, 59000 Lille, France

[10 ]GRID grid.414244.3, ISNI 0000 0004 1773 6284, Anesthésie Réanimation, , Hôpital Nord, ; 13015 Marseille, France

[11 ]GRID grid.413852.9, ISNI 0000 0001 2163 3825, Service d’Anesthésie et de Réanimation, , Hospices Civils de Lyon, Groupement Hospitalier Sud, ; Lyon, France

[12 ]GRID grid.462394.e, ISNI 0000 0004 0450 6033, UMR CNRS 5308, Inserm U1111, Laboratoire des Pathogènes Émergents, , Centre International de Recherche en Infectiologie, ; Lyon, France

[13 ]Medical ICU, Chatilliez Hospital, Tourcoing, France

[14 ]GRID grid.440907.e, ISNI 0000 0004 1784 3645, U934/UMR3215, Institut Curie, , PSL Research University, ; 75005 Paris, France

[15 ]GRID grid.411119.d, ISNI 0000 0000 8588 831X, AP-HP, Infection Control Unit, , Bichat-Claude Bernard University Hospital, ; 46 rue Henri Huchard, 75877 Paris Cedex, France

[16 ]GRID grid.10988.38, ISNI 0000 0001 2173 743X, INSERM IAME, U1137, Team DesCID, , University of Paris, ; Paris, France

[17 ]Pediatric Intensive Care, Paris South University Hospitals AP-HP, Le Kremlin Bicêtre, France

[18 ]GRID grid.411162.1, ISNI 0000 0000 9336 4276, Services des Urgences Adultes and SAMU 86, , Centre Hospitalier Universitaire de Poitiers, ; 86021 Poitiers, France

[19 ]GRID grid.11166.31, ISNI 0000 0001 2160 6368, Université de Poitiers, ; Poitiers, France

[20 ]Inserm U1070, Poitiers, France

[21 ]GRID grid.4861.b, ISNI 0000 0001 0805 7253, Department of Intensive Care, , Sart-Tilman University Hospital, and University of Liège, ; Liège, Belgium

[22 ]GRID grid.411149.8, ISNI 0000 0004 0472 0160, Department of Biostatistics and Clinical Research and Department of Infectious Diseases, , Caen University Hospital, ; 14000 Caen, France

[23 ]GRID grid.412043.0, ISNI 0000 0001 2186 4076, EA2656 Groupe de Recherche sur l’Adaptation Microbienne (GRAM 2.0) UNICAEN, , CHU Caen Medical School Université Caen Normandie, ; Caen, France

[24 ]GRID grid.31151.37, Department of Intensive Care, , François Mitterrand University Hospital, ; Dijon, France

[25 ]GRID grid.5613.1, ISNI 0000 0001 2298 9313, Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, , University of Burgundy, ; Dijon, France

[26 ]GRID grid.5613.1, ISNI 0000 0001 2298 9313, INSERM CIC 1432, Clinical Epidemiology, , University of Burgundy, ; Dijon, France

[27 ]GRID grid.414244.3, ISNI 0000 0004 1773 6284, Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Service des Urgences, ; 13015 Marseille, France

[28 ]GRID grid.5399.6, ISNI 0000 0001 2176 4817, Centre d’Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, , Aix-Marseille Université, ; 13005 Marseille, France

[29 ]GRID grid.411147.6, ISNI 0000 0004 0472 0283, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, , Medical Intensive Care Unit, ; 75651 Paris, France

[30 ]GRID grid.462844.8, ISNI 0000 0001 2308 1657, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, , Sorbonne Universités, ; 75651 Paris Cedex 13, France

[31 ]Medical Intensive Care Unit, CHU Sud Amiens, Amiens, France

[32 ]GRID grid.411163.0, ISNI 0000 0004 0639 4151, Medical ICU, , Gabriel-Montpied University Hospital, ; Clermont-Ferrand, France

[33 ]GRID grid.469994.f, ISNI 0000 0004 1788 6194, IAME, UMR 1137, Université Paris 13, , Sorbonne Paris Cité, ; Paris, France

[34 ]GRID grid.50550.35, ISNI 0000 0001 2175 4109, Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, , Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, ; 125 Rue de Stalingrad, 93000 Bobigny, France

[35 ]GRID grid.150338.c, ISNI 0000 0001 0721 9812, Infection Control Programme and WHO Collaborating Centre on Patient Safety, , University of Geneva Hospitals and Faculty of Medicine, ; Geneva, Switzerland

[36 ]GRID grid.411167.4, ISNI 0000 0004 1765 1600, Medical Intensive Care Unit, INSERM CIC 1415, CRICS-TriGGERSep Network, , CHRU de Tours and Université de Tours, ; Tours, France

[37 ]Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230 Garches, France

Article

Publisher ID: 713

DOI: 10.1186/s13613-020-00713-4

PMC ID: 7477021

PubMed ID: 32894389

SO-VID: 6cb95bc6-fc51-408d-9803-6dcb14859ce6

License:

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