Reingardiene Dagmara
Clinic of Intensive Care, Kaunas University of Medicine Hospital, Eiveniu 2, 3007 Kaunas, Lithuania.
Medicina (Kaunas). 2004;40(1):84-91.
Peripheral, especially central venous catheters, are used with increasing frequency in the intensive care unit and in general medical wards to administer intravenous fluids and blood products, drugs, parenteral nutrition, and to monitor hemodynamic status. Catheter infection is associated with increased morbidity, mortality, and duration of hospital stay. Risk factors in the development of catheter colonization and bloodstream infections include patient factors (increased risk associated with malignancy, neutropenia, and shock) and treatment-related factors (increased risk associated with total parenteral nutrition, intensive care unit admission for any reason, and endotracheal intubation). In this review article terms and definitions of catheter-related infections, pathophysiology and epidemiology of "catheter sepsis", factors determining risk of infection, catheter types and materials, insertion procedure, choice of insertion site, indwelling time, dressing and care of the insertion site, various preventive strategies and future developments, special situations and procedures, and treatment are discussed. Reducing catheter infections rates requires a multiple-strategy approach. Therefore, intensive care units and other locations where catheters are used should implement strict guidelines and protocols for catheter insertion, care, and maintenance.
外周静脉导管，尤其是中心静脉导管，在重症监护病房和普通内科病房中使用的频率越来越高，用于输注静脉液体、血液制品、药物、肠外营养以及监测血流动力学状态。导管感染与发病率、死亡率的增加以及住院时间的延长有关。导管定植和血流感染发生发展的危险因素包括患者因素（与恶性肿瘤、中性粒细胞减少症和休克相关的风险增加）以及治疗相关因素（与全肠外营养、因任何原因入住重症监护病房以及气管插管相关的风险增加）。在这篇综述文章中，讨论了导管相关感染的术语和定义、“导管败血症”的病理生理学和流行病学、决定感染风险的因素、导管类型和材料、插入操作、插入部位的选择、留置时间、插入部位的敷料和护理、各种预防策略和未来发展、特殊情况和操作以及治疗方法。降低导管感染率需要采取多策略方法。因此，重症监护病房和其他使用导管的场所应实施严格的导管插入、护理和维护指南及规程。
