Head of Infection Control Unit, Bichat-Claude Bernard University Hospital, Assistance publique-hôpitaux de Paris, Paris.
Crit Care Med. 2010 Apr;38(4):1030-5. doi: 10.1097/CCM.0b013e3181d4502e.
Scheduled replacement of central venous catheters and, by extension, arterial catheters, is not recommended because the daily risk of catheter-related infection is considered constant over time after the first catheter days. Arterial catheters are considered at lower risk for catheter-related infection than central venous catheters in the absence of conclusive evidence.
To compare the daily risk and risk factors for colonization and catheter-related infection between arterial catheters and central venous catheters.
We used data from a trial of seven intensive care units evaluating different dressing change intervals and a chlorhexidine-impregnated sponge. We determined the daily hazard rate and identified risk factors for colonization using a marginal Cox model for clustered data.
We included 3532 catheters and 27,541 catheter-days. Colonization rates did not differ between arterial catheters and central venous catheters (7.9% [11.4/1000 catheter-days] and 9.6% [11.1/1000 catheter-days], respectively). Arterial catheter and central venous catheter catheter-related infection rates were 0.68% (1.0/1000 catheter-days) and 0.94% (1.09/1000 catheter-days), respectively. The daily hazard rate for colonization increased steadily over time for arterial catheters (p = .008) but remained stable for central venous catheters. Independent risk factors for arterial catheter colonization were respiratory failure and femoral insertion. Independent risk factors for central venous catheter colonization were trauma or absence of septic shock at intensive care unit admission, femoral or jugular insertion, and absence of antibiotic treatment at central venous catheter insertion.
The risks of colonization and catheter-related infection did not differ between arterial catheters and central venous catheters, indicating that arterial catheter use should receive the same precautions as central venous catheter use. The daily risk was constant over time for central venous catheter after the fifth catheter day but increased significantly over time after the seventh day for arterial catheters. Randomized studies are needed to investigate the impact of scheduled arterial catheter replacement.
不建议常规更换中心静脉导管和动脉导管，因为在首次置管后的最初几天之后，导管相关感染的每日风险被认为是恒定的。在没有确凿证据的情况下，动脉导管被认为比中心静脉导管的感染风险更低。
比较动脉导管和中心静脉导管的定植和导管相关感染的每日风险及相关因素。
我们使用了一项在 7 个重症监护病房中进行的试验数据，该试验评估了不同的敷料更换间隔和氯己定浸渍海绵。我们使用聚集数据的边缘 Cox 模型确定了每日危险率和定植的危险因素。
我们纳入了 3532 根导管和 27541 天导管留置。动脉导管和中心静脉导管的定植率没有差异（分别为 7.9%[11.4/1000 导管天]和 9.6%[11.1/1000 导管天]）。动脉导管和中心静脉导管的导管相关感染率分别为 0.68%（1.0/1000 导管天）和 0.94%（1.09/1000 导管天）。动脉导管的定植每日危险率随时间稳步增加（p=0.008），但中心静脉导管的危险率保持稳定。动脉导管定植的独立危险因素是呼吸衰竭和股动脉置管。中心静脉导管定植的独立危险因素是重症监护病房入院时创伤或无脓毒症休克、股静脉或颈内静脉置管和中心静脉导管插入时无抗生素治疗。
动脉导管和中心静脉导管的定植和导管相关感染风险没有差异，这表明动脉导管的使用应与中心静脉导管的使用一样受到相同的预防措施。在首次置管后的第 5 天之后，中心静脉导管的每日风险是恒定的，但在第 7 天之后，动脉导管的每日风险显著增加。需要进行随机研究来探讨定期更换动脉导管的影响。
