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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2007 Maggio;73(5):267-73
Central venous catheter replacement in the ICU: new site versus guidewire exchange
Castelli G. P., Pognani C., Stuani A., Cita M., Paladini R.
Department of Intensive Care Anaesthesiology and Pain Relief, “C. Poma” Hospital, Mantua, Italy
Aim. Catheter infection (central venous catheter, CVC-I) and catheter-related bacteremia (CRB) are of particular interest with ICU patients; more than 40-60% of them require a CVC. This prospective observational study was performed to determine if a second episode of catheterization and guidewire exchange was related to increased CRB and CVC-I rates in the ICU.
Methods. Over a period of 3 years, patients requiring a CVC, with catheter care, tip and peripheral blood cultures, were observed.
Results. A total of 898 non-tunneled CVCs were examined. The infection rates for 707 first-positioned CVCs were 4.3/1 000 catheter-day (c.d.) for CVC-I and 1.62 for CRB. Replacement was carried out for 191 CVCs: 7 of 103 CVCs inserted in a new site (4.81/1 000 c.d.) and 2 of 88 guidewire exchanged CVCs (1.75/1 000 c.d.) were infected; 2 replaced CVCs were related to CRB (1.38/1 000 c.d.). A cannulation time of over 7 days was related to a higher infection risk with its progressive reduction after the third week: the absolute risk increase was from 5.3 to 1.01 and the relative risk increased from 2.39 to 0.45 for CVC-I.
Conclusion. Prolonged indwelling time is a significant risk factor for catheter-related infections; the second episode of cannulation and guidewire exchange did not present significant risk factors for catheter-related infections. A strict stable protocol for catheter insertion, care and proper treatment are necessary to reduce both the catheter-related infection rate and cost.