Launceston General Hospital, School of Human Life Sciences, University of Tasmania, Australia.
Am J Crit Care. 2012 May;21(3):162-71. doi: 10.4037/ajcc2012675.
Intravascular devices provide essential vascular access for management of critically ill patients but can be associated with bloodstream infections.
To determine colonization rates in segments of concurrently placed peripheral arterial, nontunnelled short-term central venous catheters and peripherally inserted central catheters and the pattern of heaviest colonization when the catheters are removed.
A prospective study was conducted on inpatients with intravascular devices in place for 9 days or more. At removal, each catheter was cut into 3 segments, and each segment was cultured separately. The density of colonization on external and internal surfaces of each segment was compared by estimating odds ratios by repeated-measures ordinal logistic regression.
A total of 48 peripheral arterial, 135 central venous, and 106 peripherally inserted central catheters were obtained from 289 patients. Colonization was greatest at the proximal external segment of all catheters. On the external surface, colonization was lower on the middle (odds ratio, 0.70; P < .001) and distal (odds ratio, 0.56; P < .001) segments than on the proximal segments. On the internal surface, colonization was lower on the proximal (odds ratio, 0.39; P < .001), middle (odds ratio, 0.30; P < .001), and distal (odds ratio, 0.31; P < .001) segments than on the external proximal segments. This trend was similar for all catheter types.
Colonization of intravascular devices was heaviest on proximal segments.
血管内装置为危重症患者的血管管理提供了必要的血管通路，但可能与血流感染有关。
确定同时放置的外周动脉、无隧道短期中心静脉导管和外周置入中心导管各段的定植率，以及导管拔出时定植最严重的模式。
对 289 例血管内装置留置 9 天或以上的住院患者进行前瞻性研究。在取出时，将每个导管切成 3 段，并分别对每个段进行培养。通过重复测量有序逻辑回归估计比值比来比较每个段的内外表面的定植密度。
从 289 例患者中获得了 48 根外周动脉导管、135 根中心静脉导管和 106 根外周置入中心导管。所有导管的近端外段定植最多。在外部表面，中间段（比值比，0.70；P <.001）和远端段（比值比，0.56；P <.001）的定植率低于近端段。在内部表面，近端段（比值比，0.39；P <.001）、中间段（比值比，0.30；P <.001）和远端段（比值比，0.31；P <.001）的定植率低于外近端段。所有导管类型均有类似的趋势。
血管内装置的定植最严重的是近端段。
