Cesaro Simone, Tridello Gloria, Cavaliere Mara, Magagna Laura, Gavin Patrizia, Cusinato Riccardo, Zadra Nicola, Franco Zanon Giovanni, Zanesco Luigi, Carli Modesto
Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, Padova, Italy 35128;
J Clin Oncol. 2009 Apr 20;27(12):2059-65. doi: 10.1200/JCO.2008.19.4860. Epub 2009 Mar 9.
There are limited prospective data on whether the method of flushing affects the complication rate of tunnelled central venous catheters (CVCs).
During a 25-month period, 203 pediatric patients who had newly placed Broviac-Hickman CVCs were randomly assigned to standard flushing with heparin solution or to experimental flushing with normal saline via a positive-pressure cap.
Two hundred twenty-one complications were recorded among 75,249 CVC-days (2.94 per 1,000 CVC-days). A higher incidence of CVC occlusion (83 v 41 episodes; P = .0002) and bacteremia (24 v 9; P = .01) were found in the experimental arm. The cumulative probability of developing at least one CVC complication was higher in the experimental arm than in the standard arm (65.1% [95% CI, 55% to 75%] v 43.8% [95% CI, 34% to 54%], respectively; P = .01). No difference was found in either the cause or the frequency of premature removal of CVCs between the two study arms. After a median follow-up of 360 days (range, 4 to 1,073), CVC survival was similar: 77% (95% CI, 66% to 84%) for the experimental arm and 69% (95% CI, 53% to 80%) for the standard arm (P = .7). The factors associated with the occurrence of CVC complication were a diagnosis of leukemia/lymphoma, double-lumen CVC, and experimental flushing. The only factor significantly associated with premature removal of a CVC was a diagnosis of leukemia/lymphoma (hazard rate, 2.3; 95% CI, 1.1 to 4.7).
An increased complication rate was found with normal saline flushing, but additional investigation is warranted to clarify whether it is related to saline use or to once-a-week flushing.
关于冲洗方法是否会影响隧道式中心静脉导管（CVC）的并发症发生率，前瞻性数据有限。
在25个月期间，203例新置入Broviac - Hickman CVC的儿科患者被随机分配至用肝素溶液进行标准冲洗组或通过正压接头用生理盐水进行试验性冲洗组。
在75249个CVC日中记录到221例并发症（每1000个CVC日2.94例）。试验组中CVC堵塞（83次对41次；P = 0.0002）和菌血症（24例对9例；P = 0.01）的发生率更高。试验组发生至少一种CVC并发症的累积概率高于标准组（分别为65.1%[95%CI，55%至75%]对43.8%[95%CI，34%至54%]；P = 0.01）。两组间CVC提前拔除的原因或频率均未发现差异。中位随访360天（范围4至1073天）后，CVC的留存率相似：试验组为77%（95%CI，66%至84%），标准组为69%（95%CI，53%至80%）（P = 0.7）。与CVC并发症发生相关的因素为白血病/淋巴瘤诊断、双腔CVC和试验性冲洗。与CVC提前拔除显著相关的唯一因素是白血病/淋巴瘤诊断（风险率，2.3；95%CI，1.1至4.7）。
发现生理盐水冲洗会增加并发症发生率，但有必要进行进一步研究以明确这是否与使用生理盐水或每周一次冲洗有关。
