This is the podcast, ICU rounds.

My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director of the Burns Center at the Vanderbilt University School of Medicine in Nashville, Tennessee.

Welcome back to the podcast.

The topic of discussion today is going to be the complication that we have with Central Lines once they're in patience.

Now, you remember on the last podcast we did a rather lengthy discussion about all the things that give me heartburn trying to teach residents how to put in central lines.

And the reality is, as many of the residents, particularly our senior residents, are much better at putting central lines than I am.

But we need to be mindful.

Once we have a catheter in that's been inserted safely and we know everything has been done well and checked well.

We have to remember that we're putting plastic where plastic was not intended to be.

And there are complications associated with that.

And I think the most obvious of that is infection.

But we need to be mindful of there are other complications aside from infection that can be as serious, if not even more serious.

Now, certainly infection is the most likely complication.

Depending on what you're reading and the type of patients and the site of insertion,

the incidence of infection with an indwelling catheter is estimated to be about 5.3 infections per thousand catheter days.

And that has an attributive mortality rate of 18%, which seems rather high, and depending on what particular paper you're looking at, they report

associated mortality rate or attributed mortality rates between 0 and 35%. Now, most infections arise

at a skin insertion site or the catheter hub, depending on the

indwelling time, and then it's perpetuated by a biofilm, which is basically a bacterial

derived community embedded in a matrix of extracellular polymeric substances that they produce.

Basically, it's a big goopless gel produced by the bacteria.

...