School of Nursing, University of Rochester, Rochester, NY, USA.
J Pediatr. 2012 Jun;160(6):972-7.e2. doi: 10.1016/j.jpeds.2011.12.004. Epub 2012 Jan 10.
To assess whether introduction of an evidence-based percutaneously inserted central catheter (PICC) care bundle reduced the risk of central line-associated bloodstream infection (CLABSI), thus altering the comparative risk of CLABSI in infants.
This retrospective cohort study included all infants for whom an umbilical venous catheter (UVC) was placed as part of routine care between Jan 1, 2006, and Dec 31, 2009, a period during which standardized PICC insertion and care bundles were introduced. Duration of UVC use was divided in ≤ 7 days and >7 days.
Infants in the ≤ 7 days UVC group had 1.0 CLABSI/1000 catheter days, and infants in the >7 days UVC group had 4.0 CLABSI/1000 catheter days (P < .001). Controlling for birth weight, gestational age, and antibiotic use, the >7 days UVC group had a greater risk of CLABSI (OR, 5.48) than the ≤ 7 days UVC group. CLABSI rate increased more rapidly in UVC than PICC with increasing duration of catheter rose.
Replacement of a UVC with a PICC when central venous access is needed after 7 days of age may reduce CLABSI.
评估引入基于循证的经皮中心静脉导管（PICC）护理包是否降低了中心静脉相关血流感染（CLABSI）的风险，从而改变了婴儿 CLABSI 的相对风险。
这是一项回顾性队列研究，纳入了所有在 2006 年 1 月 1 日至 2009 年 12 月 31 日期间因常规护理而接受脐静脉导管（UVC）置管的婴儿，在此期间引入了标准化的 PICC 置管和护理包。UVC 使用时间分为≤7 天和>7 天。
UVC 使用时间≤7 天的婴儿中，每 1000 个导管日有 1.0 例 CLABSI，而 UVC 使用时间>7 天的婴儿中，每 1000 个导管日有 4.0 例 CLABSI（P<0.001）。控制出生体重、胎龄和抗生素使用情况后，UVC 使用时间>7 天的婴儿发生 CLABSI 的风险高于 UVC 使用时间≤7 天的婴儿（OR，5.48）。随着导管使用时间的增加，UVC 的 CLABSI 发生率比 PICC 更快地增加。
对于需要中心静脉通路的婴儿，如果在 7 天后更换 PICC 而不是 UVC，可能会降低 CLABSI 的发生率。
