Endemic rate of fluid contamination and related septicemia in arterial pressure monitoring

Abstract

Contamination of the fluid within intra-arterial infusions used for hemodynamic monitoring has produced epidemic bacteremias, but little data exist on endemic rates of contamination and related septicemia. We prospectively studied 102 intra-arterial infusions used in 56 high-risk patients who required prolonged monitoring. During the study, administration sets were changed every 48 hours, but transducer chamber-domes and continuous flow devices were used until the intra-arterial infusion was discontinued. Cultures were obtained from the transducer-transducer chamber-dome interface and of fluid in the transducer chamber-dome of the 102 intra-arterial infusions; 12 (11.8 percent) showed contamination of transducer chamber-dome fluid, in 8 cases (7.8 percent) associated with concordant bacteremia. In each bacteremia, transducer chamber-dome fluid contained 1 to greater than 10(5) (median, 10(4)) cfu/ml. Four bacteremias are considered definitely related and four, possibly related, to the intra-arterial infusion. In all 12 contaminated intra-arterial infusions and with all eight bacteremias, the transducer chamber-dome had been used for more than two days (P = 0.006). No concordant contamination of transducer-transducer chamber-dome interfaces was identified. (1) Intra-arterial infusions for pressure monitoring cause sporadic septicemias endemically. (2) With prolonged monitoring, transducer chamber-domes and continuous flow devices should be replaced at periodic intervals, ideally with the administration set, every 48 hours; since implementing this policy, only three contaminated intra-arterial infusions and no related septicemias have been detected in 53 intra-arterial infusions monitored over our months (P = 0.02).