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Indwelling Central Venous Catheters and Sepsis

Indwelling central lines offer the potential of great benefit of providing a mechanism for parenteral nutrition in patients with significant gut dysmotility or IV fluids in patients with vascular dysautonomia.  However, the risk of sepsis and other complications including clotting cannot be overstated, and clinicians and patients/parents must carefully weigh the risks and benefits in making a decision.

The use of an indwelling line is associated with varying degrees of risk depending on how and how often it is being used.  Ports placed for occasional phlebotomy access are associated with a lower risk, assuming that an aseptic technique is used to access the line.  As the frequency of access increases though, so does the risk of infection, such that continuous use is associated with a higher risk.  The use of parenteral nutrition creates a higher risk than crystalline fluids provided for hydration only.  Unfortunately, those patients who have the greatest requirement for IV nutrition generally have poorly functioning guts with a higher chance of bacterial translocation. 

The use of antibiotic or ethanol locks or flushes theoretically reduces the chance of external infection but there exist little supportive data.

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