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.
Source Information
University of Virginia Health Sciences Center, Charlottesville 22908.
This article has been cited by other articles:
Farr, B. M.
(2004). Catheters, Microbes, Time, and Gold Standards. ANN INTERN MED
140: 62-64
[Full Text]
McGee, D. C., Gould, M. K.
(2003). Preventing Complications of Central Venous Catheterization. NEJM
348: 1123-1133
[Full Text]
Wong, G K C, Poon, W S, Wai, S, Yu, L M, Lyon, D, Lam, J M K
(2002). Failure of regular external ventricular drain exchange to reduce cerebrospinal fluid infection: result of a randomised controlled trial. J. Neurol. Neurosurg. Psychiatry
73: 759-761
[Abstract][Full Text]
O'Grady, N. P., Alexander, M., Dellinger, E. P., Gerberding, J. L., Heard, S. O., Maki, D. G., Masur, H., McCormick, R. D., Mermel, L. A., Pearson, M. L., Raad, I. I., Randolph, A., Weinstein, R. A.
(2002). Guidelines for the Prevention of Intravascular Catheter-Related Infections. Pediatrics
110: e51-51
[Abstract][Full Text]
Saint, S., Savel, R. H., Matthay, M. A.
(2002). Enhancing the Safety of Critically Ill Patients by Reducing Urinary and Central Venous Catheter-related Infections. Am. J. Respir. Crit. Care Med.
165: 1475-1479
[Full Text]
Raad, I. I., Hanna, H. A.
(2002). Intravascular Catheter-Related Infections: New Horizons and Recent Advances. Arch Intern Med
162: 871-878
[Abstract][Full Text]
Heard, S. O., Wagle, M., Vijayakumar, E., McLean, S., Brueggemann, A., Napolitano, L. M., Edwards, L. P., O'Connell, F. M., Puyana, J. C., Doern, G. V.
(2001). Influence of Triple-Lumen Central Venous Catheters Coated With Chlorhexidine and Silver Sulfadiazine on the Incidence of Catheter-Related Bacteremia. Arch Intern Med
158: 81-87
[Abstract][Full Text]
Veenstra, D. L., Saint, S., Sullivan, S. D.
(1999). Cost-Effectiveness of Antiseptic-Impregnated Central Venous Catheters for the Prevention of Catheter-Related Bloodstream Infection. JAMA
282: 554-560
[Abstract][Full Text]
Veenstra, D. L., Saint, S., Saha, S., Lumley, T., Sullivan, S. D.
(1999). Efficacy of Antiseptic-Impregnated Central Venous Catheters in Preventing Catheter-Related Bloodstream Infection: A Meta-analysis. JAMA
281: 261-267
[Abstract][Full Text]
Kampf, G., Dietze, B., Große-Siestrup, C., Wendt, C., Martiny, H.
(1998). Microbicidal Activity of a New Silver-Containing Polymer, SPI-ARGENT II. Antimicrob. Agents Chemother.
42: 2440-2442
[Abstract][Full Text]
Cyna, A M, Hovenden, J L, Lehmann, A, Rajaseker, K, Kalia, P
(1998). Routine replacement of central venous catheters: telephone survey of intensive care units in mainland Britain. BMJ
316: 1944-1945
[Full Text]
ARTIGAS, A., BERNARD, G. R., CARLET, J., DREYFUSS, D., GATTINONI, L., HUDSON, L., LAMY, M., MARINI, J. J., MATTHAY, M. A., PINSKY, M. R., SPRAGG, R., SUTER, P. M., the Consensus Committee,
(1998). The American-European Consensus Conference on ARDS, Part 2 . Ventilatory, Pharmacologic, Supportive Therapy, Study Design Strategies, and Issues Related to Recovery and Remodeling. Am. J. Respir. Crit. Care Med.
157: 1332-1347
[Abstract][Full Text]
Bregenzer, T., Conen, D., Sakmann, P., Widmer, A. F.
(1998). Is Routine Replacement of Peripheral Intravenous Catheters Necessary?. Arch Intern Med
158: 151-156
[Abstract][Full Text]
Blot, F, Schmidt, E, Nitenberg, G, Tancrede, C, Leclercq, B, Laplanche, A, Andremont, A
(1998). Earlier positivity of central-venous- versus peripheral-blood cultures is highly predictive of catheter-related sepsis [In Process Citation]. J. Clin. Microbiol.
36: 105-109
[Abstract][Full Text]
Feldman, T., Fabri, P. J., Rizzo, J. D., Strom, B. L., Berlin, J., Cobb, D. K., High, K. P., Farr, B. M.
(1993). Replacement of Central Vascular Catheters. NEJM
328: 445-446
[Full Text]
(1992). CHANGING CENTRAL LINES: A COMPARISON OF APPROACHES. JWatch General
1992: 1-1
[Full Text]
Previous
