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Diagnosis of central venous catheter related sepsis--a critical look inside.

The use of central venous catheters for the administration of pharmaceutical agents, including chemotherapy regimens, inotropic support in the intensive care setting, intravenous nutrition, cardiac monitoring, and as a means of maintaining long term venous access, has increased dramatically in the past three decades. Complications associated with central venous catheterisation include those associated with insertion—for example, pneumothorax, haemorrhage, nerve injury, catheter tip misplacement, and cardiac arrhythmias—and those associated primarily with longer term use, including thrombosis and infection. Catheter related infections represent by far the greatest risk associated with the use of central venous catheters, and the rate of catheter related sepsis is variably reported to range from 4% to 14%. 1‐4 The magnitude of this variance reflects true diVerences in the incidence of catheter related sepsis in some patient groups—for example, the rate of catheter related sepsis in burns patients managed in intensive care is approximately 15-fold higher than in those with respiratory disease. 5 Infections associated with central venous catheters therefore represent approximately 30 000 and 400 000 cases in the United Kingdom and the USA, respectively, each year. 6 However, diVerences in the reported incidence of catheter related sepsis also result from a lack of standardisation in diagnostic approach. Catheter related sepsis is associated with significant morbidity and mortality, and with case fatality as high as 10‐20%. 7 Major complica