To the Editor.—Modern critical care medicine depends extensively on invasive monitoring techniques to provide timely information about the rapidly fluctuating physiologic environment of the seriously ill or injured patient. The Swan-Ganz pulmonary artery catheter, in particular, provides data that are difficult to gather by other means. Unfortunately, catheter malfunction due to clotting, balloon rupture, environmental misadventure, etc, frequently confronts the critical care staff.
Early in the course of a major illness, vascular access is often relatively easily obtained. As a patient becomes a long-term resident of the critical care unit, entry into the venous circulation becomes more difficult. Some patients, notably those who are elderly and obese, pose a challenge to venous catheterization from the time of admission.
At our institution, the infection rate for indwelling monitors, especially central venous catheters and intracranial pressure monitors, is relatively low, but rises exponentially after 72 hours. Most catheter-induced infections can be