Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance.
Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance.
复制标题
导管相关脓毒症：对三种长期导管维护方法的前瞻性随机研究。
DOI：
--
复制
发表时间：
1990
影响因子：
8.8
通讯作者：
Frank E. Cerra
中科院分区：
文献类型：
--
作者：
S. Eyer;C. Brummitt;K. Crossley;R. Siegel;Frank E. Cerra
我们研究了不同的血管导管管理方法在长期使用期间的感染风险。连续需要三腔导管、肺动脉导管或动脉导管超过7天的外科ICU患者被前瞻性地随机分成三组：a)在新的部位每更换7天的导管进行经皮(PERC)穿刺术，b)每周更换一次新的部位(NWC)，或c)在同一部位每7天更换一次导管进行导丝交换(GWX)。在所有组中，对于血培养阳性、皮肤部位感染或无可能来源的脓毒症，必须强制更换导管。在临床指征和每次更换导尿管时进行培养。导管相关性脓毒症(CRS)定义为血培养阳性和导管培养阳性的细菌相同。共有112名患者符合评估标准。在年龄、最初诊断、损伤或疾病的严重程度、学习天数、违反规程的次数、导尿途径、留置导尿管的数量/患者日、导管败血症发生率或菌血症发生率方面，两组间没有差异。NWC组显示每根导管的天数增加，每例患者的导管/皮下段培养减少，导管尖端定植的发生率降低。这些结果发生在GWX组、PERC组和NWC组的CRS发作数分别为0.17、0.22和0.16的情况下。我们得出的结论是，这三种长期管理导管的方法在感染风险方面没有差异。应采用并发症和费用最小的方法。(摘要截断250字)
We studied the infectious risk of different methods of managing vascular catheters during long-term use. Consecutive surgical ICU patients requiring triple lumen catheters, pulmonary artery catheters, or arterial catheters for greater than 7 days were prospectively randomized to one of three management groups: a) percutaneous (PERC) puncture with every 7-day catheter change at a new site, b) no weekly change (NWC) with a new site when changed, or c) guidewire exchange (GWX) with every 7-day catheter change at the same site. In all groups, a catheter change was mandatory for a positive blood culture, skin site infection, or sepsis without a likely source. Cultures were obtained when clinically indicated and at the time of every catheter change. Catheter-related sepsis (CRS) was defined as a positive blood culture and catheter culture with the same organism. A total of 112 patients met evaluation criteria. There were no intergroup differences in age, primary diagnosis, severity of injury or illness, number of study days, number of protocol violations, route of catheterization, number of catheters present/patient day, catheter sepsis rate, or bacteremia rate. The NWC group demonstrated an increased number of days/catheter, fewer catheter/subcutaneous tract segment cultures/patient, and a reduced incidence of catheter tip colonization. These results occurred in a setting where the number of CRS episodes/patient was 0.17 for GWX, 0.22 for PERC, and 0.16 for NWC. We conclude that there is no difference in infectious risk between these three methods of long-term catheter management. The method with the least complications and expense should be used.(ABSTRACT TRUNCATED AT 250 WORDS)