Abstract ID: A49

Abstract Title: BACTERIAL COLONIZATION RATES IN PERIPHERAL NERVE CATHETERS

Authors: Mekasha D¹, Perov S², Orlewicz M³
Wayne State University Detroit MI USA¹, Wayne State University Detroit MI USA², Wayne State University Detroit MI USA³
Poster Type: Poster

ABSTRACT BODY

Introduction:
In the treatment of patients with chronic or acute pain, peripheral nerve catheters (PNC) which continuously deposit local anesthetic to the affected area is an alternative to conventional PCA or oral medication. A possible adverse side effect in using PNC is bacterial colonization through insertion technique with skin flora, which in turn may lead to infection and complication of the nerve block (1). The aim of this study was to determine if PNCs are associated with bacterial colonization and whether duration of catheter use increases the occurrence of colonization and possibly infection.

Methods:
Study participants (n = 20) were patients with reflex sympathetic dystrophy, brachial plexus injury, radius and ulna fractures. Exclusion criteria were age <18 yr or >80 yr, diabetes mellitus, HIV, malignancy or an immunocompromised status. Institutional approval and informed consent was obtained from each patient. Participants were divided into two groups: those who were treated with PNCs for a duration of 0 to 7 days and those treated with PNC for greater than 7 days (up to 15 days). All participants used the same model of PNCs and pump delivery system (Contiplex, Braun, Bethlehem, PA; pump; Microjet/Sorensen Medical, USA) delivering a local anesthetic mixture (Bupivicaine 0.125 %). Procedures for skin preparation, stimulating needle, catheter insertion and securement (Tegaderm, 3M, St.Paul, MN) were uniform. Following treatment for both groups PNCs were removed under sterile conditions, and 3cm of the distal portion was cut and cultured. Upon culturing of the catheter tips fifteen colony-forming units were considered to represent positive colonization of the catheter (2). For statisitical analyses a Chi-squared test was used to compare bacterial colonization rates between the two groups. P-values of < 0.05 were considered statistically significant.

Results:
Preliminary results from the first 20 patients enrolled in study showed that the group of patients using catheters for a duration < 7 days had no bacterial colonization present in catheter tips used. This bacterial colonization was significantly lower than that of the group of patients using catheters > 7 days which showed 50% bacterial colonization of catheters used (see table).

Discussion:
Initial results thus far indicate catheters used for less than seven days will develop less colonization rates in patients and in turn less infection. It is anticipated that a further 30 participants will be able to be enrolled to further investigate this trend. Choosing to decontaminate the skin with alcohol, before catheter insertion may decrease skin flora cross contamination of catheter tip and increase the time till bacterial colonization (3). Further studies involving methods to improve skin flora conditions may decrease bacterial colonization rates.
References:
1. Adam F,Jaziril S, Chauvin M. Psoas abscess complicating femoral Block Catheter. Anesthesiology 2003:99:2301-1.
2. Cuvillon P, Ripart J, Lalourcey L, et al. The continuous femoral nerve block catheter for postoperative analgesia; Bacterial colonization, infectious rate and adverse effect. Anesth Analg, 2001; 93; 1045-9
3. please see attachment.

ATTACHED FILES

A49_Table 1.doc

Reg Anesth Pain Med 2005; 30(3):A49