Bach A, Böhrer H, Geiss H K
Department of Anesthesiology, University of Heidelberg, Germany.
J Cardiothorac Vasc Anesth. 1992 Dec;6(6):711-4. doi: 10.1016/1053-0770(92)90057-e.
The purpose of this study was to determine if a guidewire change from a pulmonary artery catheter (PAC) to a central venous catheter (CVC) poses a significant infection risk. A total of 128 consecutive cardiac surgical patients with PACs inserted in the operating room were entered into this study. Postoperatively, patients were randomly allocated to receive a double-lumen CVC, either at the initial introducer insertion site over a guidewire, or at a new site with de novo catheterization. The tips of all introducers, PACs, and CVCs were cut off, cultured, and semi-quantitatively analyzed. The results show that insertion of CVCs over a guidewire within 48 hours after initial venapuncture is no more likely to be associated with catheter colonization than is de novo percutaneous insertion at a different site. From 48 hours up to 72 hours following initial insertion of the PAC, an incidence of catheter-related infection of 35.3% was observed in the guidewire group, as opposed to 12.5% in the de novo group. It is recommended that the use of a guidewire technique for catheter replacement (PAC to CVC) is a safe alternative to de novo insertion of a CVC within 48 hours after initial insertion of the PAC. In order to minimize the potential risk of catheter-related infection and bacteremia in cardiac surgical patients, de novo catheterization beyond 48 hours after initial venapuncture is suggested.
本研究的目的是确定从肺动脉导管（PAC）更换为中心静脉导管（CVC）时导丝的更换是否会带来显著的感染风险。共有128例在手术室插入PAC的连续心脏手术患者纳入本研究。术后，患者被随机分配接受双腔CVC，要么通过导丝在初始穿刺部位插入，要么在新部位重新进行导管插入。所有穿刺针、PAC和CVC的尖端均被剪下，进行培养和半定量分析。结果显示，在初次静脉穿刺后48小时内通过导丝插入CVC与在不同部位重新经皮插入相比，导管定植的可能性并无差异。在PAC初次插入后48小时至72小时期间，导丝组导管相关感染的发生率为35.3%，而重新插入组为12.5%。建议在PAC初次插入后48小时内，使用导丝技术更换导管（从PAC更换为CVC）是重新插入CVC的安全替代方法。为了将心脏手术患者导管相关感染和菌血症的潜在风险降至最低，建议在初次静脉穿刺48小时后进行重新导管插入。
