Hagley M T, Martin B, Gast P, Traeger S M
Division of Critical Care, Akron City Hospital, OH 44304.
Crit Care Med. 1992 Oct;20(10):1426-30. doi: 10.1097/00003246-199210000-00011.
To compare the frequency of infectious and mechanical complications of central venous and pulmonary artery catheters placed by initial venipuncture vs. over a guidewire at existing sites.
Exchange of central venous catheters and pulmonary artery catheters over a guidewire as opposed to fresh venipuncture reduces mechanical complications without increasing risk of infection.
Chart audit.
Medical, surgical, and coronary ICU patients requiring invasive monitoring or central venous access.
Patients requiring prolonged catheterization underwent periodic exchange of catheters over a guidewire. Rates of catheter-related infections and mechanical complications were determined for central venous catheters placed by initial venipuncture and those catheters placed by guidewire exchange.
Over a 12-month period, 939 catheters were inserted in 454 patients. Of these 939 catheters, 534 were placed by guidewire exchange. Use of a guidewire was associated with a decreased frequency of pneumothorax and hemothorax compared with initial venipuncture (0/405 [0%] vs. 7/534 [1.3%], respectively; p < .05) but not with increased risk of infection (9/405 [2.2%] vs. 14/534 [2.6%], respectively; NS). Guidewire-facilitated replacement of multiple consecutive catheters at the same site did not increase the risk of catheter-related infection. Catheters placed via internal jugular veins were more likely to become infected than catheters placed via subclavian veins (17/477 [3.6%] vs. 3/430 [0.7%], respectively; p < .01).
When prolonged central venous or pulmonary artery catheterization is necessary, periodic catheter replacement over a guidewire is associated with fewer mechanical complications than initial venipuncture. Periodic catheter replacement over a guidewire is also associated with no increase in risk of infection.
比较通过初次静脉穿刺与在现有部位经导丝放置中心静脉导管和肺动脉导管时感染性及机械性并发症的发生率。
与重新进行静脉穿刺相比，经导丝更换中心静脉导管和肺动脉导管可减少机械性并发症，且不会增加感染风险。
图表审查。
需要进行有创监测或中心静脉通路的内科、外科及冠心病重症监护病房患者。
需要长期置管的患者定期经导丝更换导管。确定初次静脉穿刺置入的中心静脉导管以及经导丝更换置入的导管的导管相关感染率和机械性并发症发生率。
在12个月期间，454例患者共置入939根导管。其中939根导管中，534根是经导丝更换置入的。与初次静脉穿刺相比，使用导丝与气胸和血胸发生率降低相关（分别为0/405 [0%] 对7/534 [1.3%]；p < 0.05），但与感染风险增加无关（分别为9/405 [2.2%] 对14/534 [2.6%]；无显著差异）。在同一部位经导丝连续多次更换导管不会增加导管相关感染风险。经颈内静脉置入的导管比经锁骨下静脉置入的导管更易发生感染（分别为17/477 [3.6%] 对3/430 [0.7%]；p < 0.01）。
当需要长期进行中心静脉或肺动脉置管时，与初次静脉穿刺相比，定期经导丝更换导管的机械性并发症更少。定期经导丝更换导管也不会增加感染风险。
