A CONTROLLED TRIAL OF SCHEDULED REPLACEMENT OF CENTRAL VENOUS AND PULMONARY-ARTERY CATHETERS
A CONTROLLED TRIAL OF SCHEDULED REPLACEMENT OF CENTRAL VENOUS AND PULMONARY-ARTERY CATHETERS
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DOI：
10.1056/nejm199210083271505
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发表时间：
1992-10-08
影响因子：
158.5
通讯作者：
FARR, BM
中科院分区：
文献类型：
--
作者：
COBB, DK;HIGH, KP;FARR, BM
背景感染的发生率随着中心血管导管的长期使用而增加，但目前尚不清楚是否每三天更换一次导管，就像一些人建议的那样，会降低感染率。目前还不清楚是通过导丝更换导管还是将其插入新的部位更安全。我们在重症监护室的成人患者中进行了一项对照试验，这些患者需要中心静脉或肺动脉导管超过三天。患者被随机分配接受四种导管更换方法中的一种：每三天更换一次，插入新部位（第1组）或通过导丝更换（第2组），或在临床有指征时更换，插入新部位（第3组）或通过导丝更换（第4组）。结果。在160名患者中，5%的患者患有导管相关的血流感染，16%的患者患有导管定植，9%的患者患有严重的机械并发症。血流感染的发生率（每1000天导管使用）在第1组中为3例，在第2组中为6例，在第3组中为2例，在第4组中为3例;机械并发症的发生率分别为14例、4例、8例和3例。随机分配到导丝辅助交换组的患者在导管插入术的前三天更有可能发生血流感染（6% vs. 0，P = 0.06）。在新部位插入与更多的机械并发症相关（5%对1%，P = 0.005）。每三天更换一次中心血管导管并不能预防感染。使用导丝更换导管会增加血流感染的风险，但在新部位插入导管的更换会增加机械并发症的风险。
Background. The incidence of infection increases with the prolonged use of central vascular catheters, but it is unclear whether changing catheters every three days, as some recommend, will reduce the rate of infection. It is also unclear whether it is safer to change a catheter over a guide wire or insert it at a new site.Methods. We conducted a controlled trial in adult patients in intensive care units who required central venous or pulmonary-artery catheters for more than three days. Patients were assigned randomly to undergo one of four methods of catheter exchange: replacement every three days either by insertion at a new site (group 1) or by exchange over a guide wire (group 2), or replacement when clinically indicated either by insertion at a new site (group 3) or by exchange over a guide wire (group 4).Results. Of the 160 patients, 5 percent had catheter-related bloodstream infections, 16 percent had catheters that became colonized, and 9 percent had major mechanical complications. The incidence rates (per 1000 days of catheter use) of bloodstream infection were 3 in group 1, 6 in group 2, 2 in group 3, and 3 in group 4; the incidence rates of mechanical complications were 14, 4, 8, and 3, respectively. Patients randomly assigned to guide-wire-assisted exchange were more likely to have bloodstream infection after the first three days of catheterization (6 percent vs. 0, P = 0.06). Insertions at new sites were associated with more mechanical complications (5 percent vs. 1 percent, P = 0.005).Conclusions. Routine replacement of central vascular catheters every three days does not prevent infection. Exchanging catheters with the use of a guide wire increases the risk of bloodstream infection, but replacement involving insertion of catheters at new sites increases the risk of mechanical complications.