Publications by authors named "John R Gowardman"
Background: Central venous access devices (CVADs) allow intravenous therapy, haemodynamic monitoring and blood sampling but many fail before therapy completion.
Objective: To quantify CVAD failure and complications; and identify risk factors.
Designs, Settings, And Participants: Secondary analysis of multicentre randomised controlled trial including patients aged ≥16 years with a non-tunnelled CVAD (NTCVAD), peripherally-inserted central catheter (PICC) or tunnelled CVAD (TCVAD).
Background: The optimal duration of infusion set use to prevent life-threatening catheter-related bloodstream infection (CRBSI) is unclear. We aimed to compare the effectiveness and costs of 7-day (intervention) versus 4-day (control) infusion set replacement to prevent CRBSI in patients with central venous access devices (tunnelled cuffed, non-tunnelled, peripherally inserted, and totally implanted) and peripheral arterial catheters.
Methods: We did a randomised, controlled, assessor-masked trial at ten Australian hospitals.
Article Synopsis
- Vascular access devices (VADs) are essential for medical procedures, but their associated administration sets (AS) are often replaced every 3-4 days, which may unnecessarily increase costs and workload despite evidence supporting longer use.
- A randomized controlled trial is being conducted to compare the safety and effectiveness of AS replacement every 4 days versus every 7 days on the incidence of bloodstream infections (BSIs) in patients with various types of catheters over a period of 4 years.
- The study aims to determine not only the primary outcome of VAD-related BSIs but also secondary factors like cost and device colonization rates, with strict ethical guidelines in place for dissemination of results.
Purpose: To assess the utility of two in situ techniques, differential time to positivity (DTP) and semiquantitative superficial cultures (SQSC) for diagnosing catheter-related bloodstream infection (CR-BSI) in critically ill adults.
Methods: This was a prospective cohort study in patients with suspected CR-BSI arising from a short-term arterial catheter (AC) or a central venous catheter (CVC). On suspicion of CR-BSI, devices were removed.
Background: The millions of peripheral intravenous catheters used each year are recommended for 72-96 h replacement in adults. This routine replacement increases health-care costs and staff workload and requires patients to undergo repeated invasive procedures. The effectiveness of the practice is not well established.
View Article and Find Full Text PDFBackground: Intravascular catheter related infection (CRI) is one of the most serious nosocomial infections. Diagnostic criteria include a positive culture from the catheter tip along with blood, yet in many patients with signs of infection, current culture techniques fail to identify pathogens on catheter segments. We hypothesised that a molecular examination of the bacterial community on short term arterial catheters (ACs) would improve our understanding of the variety of organisms that are present in this niche environment and would help develop new methods for the diagnosis of CRI.
View Article and Find Full Text PDFObjective: To compare colonization and catheter-related bloodstream infection (CR-BSI) rates among three insertion sites (subclavian, internal jugular, femoral) used for central venous catheter (CVC) placement.
Design: Twenty-four-month prospective study, with relative effects analyzed by Cox proportional hazards regression.
Setting: Eight-bed intensive care unit.
Objective: Peripheral arterial catheters are perceived as having low infective potential compared with other catheters and may be overlooked as a cause of catheter-related bloodstream infection. We aimed to measure colonization and rates of catheter-related bloodstream infection in arterial catheters, to investigate risk factors for arterial catheter colonization, and to compare arterial catheter infection rates with those in concurrently sited and managed central venous catheters.
Design: Prospective 24-month cohort study.
Background: A reported association between extubation failure (EF) and increased hospital length of stay and mortality led us to assess outcome of EF in an Australian intensive care unit.
Design And Setting: Non-interventional cohort study in the intensive care/high dependency unit of a tertiary referral hospital, 2000-2003.
Methods: EF was defined as reintubation within 72 hours of extubation.
A 43-year-old woman taking warfarin for past venous thrombosis presented with 4 days of flu-like symptoms and deterioration in level of consciousness. Computed tomography suggested subarachnoid haemorrhage, and magnetic resonance imaging showed widespread cerebral infarcts. However, these seemed out of proportion to the amount of haemorrhage, and lumbar puncture revealed meningitis caused by Streptococcus pneumoniae.
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