Is anyone using Cook's Power PICC? Does anyone have any knowledge about this product? Feedback, please?
I am beginning to think that no one is using this type of PICC! Has anyone seen or at least tried this PICC??????
Karen McKeon Williford RN, CRNI
I recently read an article in the Journal of Clinical Oncology , Aug 2004. Long -Term Silicone Catheters Impregnated With Minocycline and Rifampin Decrease Rates of Catheter-Related Bloodstream infection in Cancer Patients: A Prospective Randomized Clinical Trial.At MD Anderson Cancer Center, the study is compelling enough that I asked, why am I not using these catherters? Is there anyone out there that is using them? There were no companies or products identified by brand in this study.
In reference to Candida albicans you may want to do a little more research. The spectrum is highly effective against this bug. Also studies on Spectrum range from 93 to 2006. And not all are done by Raad and Darouiche. Also, you may want to look into articles done by Maki on CRBSI's. Do a bit of research on your own and then make the decison for yourself Kevin.
Also silicon catheters are no more unstable than polyurethan. If that were the case, much like other technology, silicone would have long been passed to the wayside in virtually every medical setting.
You're right Casey. They are not all by Raad and Darouiche. I found a few that weren't.
Wright, et al, Clinical Intensive Care, 2001 - "antibiotic central lines were not associated with any benefit in this critically ill patient population. They were associated with increased candida colonization and the development of rifampin resistance to Staphylococcus epidermidis". Partially funded Cook Canada.
Leon, et al, Intensive Care Medicine, 2004 - "Antimicrobial catheters were associated with a significan decrease of coagulase negative staphylococci colonization ... and a significant increase in Candida colonization." Partially funded Cook Europe.
Henna, HA, Raad, Isaam I, Chest, 2003 - "within the limitations of small numbers, there was no significant decrease in the frequency of Pseudomonas aeruginosa or Candida infections for the two time periods."
Walz, et al, Critical Care Medicine, 2001 - "Of the four CRBSI that developed in the MR group, 3 were fungal. There were no fungal CRBSI in the uncoated catheter group. Conclusions: Use of antibiotic impregnated catheters may predispose to fungemia."
Not looking to do more research, looking for input on the impregnated catheters. I do appreciate the help and further research from Jeff though, thanks for being objective and helpful Jeff, exactly what this site was set up for.
I would ask your infection control department to estimate the lethality and prevalence of these organisms. By one account, Candida (all species) is the 4th most common cause of CRBSI, accounting for about 8% of infections. Doesn't seem like a big deal when you consider the frequency of staph infections, but the mortality rates are a different story. In one study, at the same institutions attibutable mortality for the Candida infections went from 38% (1983-86) to 49% (1997-2001). I'm not an epidemiologist, but flipping a coin is not good odds. The % of CRBSI deaths attributable to Candida species must be significantly higher than 8%.
Giving TPN through a catheter encourages the growth of biofilms, particularly for Candida parapsilosis, and these biofilms are highly antifungal resistant.
The odd thing about Candida is that authors in three studies experienced an increase of attributable CRBSI's using Spectrum compared with a non-coated catheter. The other pathogen seem alongside Candida in these studies is pseudomonas, another tough customer. I'll take my chances with BioPatch, since we know Chlorhexidine is a truly broad spectrum preventative.
Interesting comments from all. Everyone needs to remember to look at the parameters of these studies. To date, there has not been a prospective randomized study that proves handwashing has any statisical effect on BSI. To date, there has been only one prospective randomized trial that has shown maximum sterile barrier has any statistical effect on CRBSI. Yet, these are both considered "musts", which I do not disagree with, but there is no evidence to support these practices.
Fact, to date, there 27 prospective randomiized clinical studies that all prove that the combination of Minocycline and Rifampin (Spectrum) statically lowers the CRBSI rates. These are prospective and randomized. 27! All showing positive outcomes. The actual clinical evidence that everyone always is asking for is there.
Handwashing was proven effective in the spread of disease decades ago, I would never try disproving that! Just ask Florence Nightingale. As far as Maximum precautions ANYthing to help is better than standing still.
We were given some COOK abx impregnated caths to try, and I am willing to do anything for my Patients!