Ullman Amanda J, Cooke Marie L, Gillies Donna, Marsh Nicole M, Daud Azlina, McGrail Matthew R, O'Riordan Elizabeth, Rickard Claire M
NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, 170 Kessels Road, Brisbane, Queensland, Australia, 4111.
Cochrane Database Syst Rev. 2013 Sep 15;2013(9):CD003588. doi: 10.1002/14651858.CD003588.pub3.
The tubing (administration set) attached to both venous and arterial catheters may contribute to bacteraemia and other infections. The rate of infection may be increased or decreased by routine replacement of administration sets. This review was originally published in 2005 and was updated in 2012.
The objective of this review was to identify any relationship between the frequency with which administration sets are replaced and rates of microbial colonization, infection and death.
We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (1950 to June 2012), CINAHL (1982 to June 2012), EMBASE (1980 to June 2012), reference lists of identified trials and bibliographies of published reviews. The original search was performed in February 2004. We also contacted researchers in the field. We applied no language restriction.
We included all randomized or controlled clinical trials on the frequency of venous or arterial catheter administration set replacement in hospitalized participants.
Two review authors assessed all potentially relevant studies. We resolved disagreements between the two review authors by discussion with a third review author. We collected data for seven outcomes: catheter-related infection; infusate-related infection; infusate microbial colonization; catheter microbial colonization; all-cause bloodstream infection; mortality; and cost. We pooled results from studies that compared different frequencies of administration set replacement, for instance, we pooled studies that compared replacement ≥ every 96 hours versus every 72 hours with studies that compared replacement ≥ every 48 hours versus every 24 hours.
We identified 26 studies for this updated review, 10 of which we excluded; six did not fulfil the inclusion criteria and four did not report usable data. We extracted data from the remaining 18 references (16 studies) with 5001 participants: study designs included neonate and adult populations, arterial and venous administration sets, parenteral nutrition, lipid emulsions and crystalloid infusions. Most studies were at moderate to high risk of bias or did not adequately describe the methods that they used to minimize bias. All included trials were unable to blind personnel because of the nature of the intervention.No evidence was found for differences in catheter-related or infusate-related bacteraemia or fungaemia with more frequent administration set replacement overall or at any time interval comparison (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.67 to 1.69; RR 0.67, 95% CI 0.27 to 1.70). Infrequent administration set replacement reduced the rate of bloodstream infection (RR 0.73, 95% CI 0.54 to 0.98). No evidence revealed differences in catheter colonization or infusate colonization with more frequent administration set replacement (RR 1.08, 95% CI 0.94 to 1.24; RR 1.15, 95% CI 0.70 to 1.86, respectively). Borderline evidence suggested that infrequent administration set replacement increased the mortality rate only within the neonatal population (RR 1.84, 95% CI 1.00 to 3.36). No evidence revealed interactions between the (lack of) effects of frequency of administration set replacement and the subgroups analysed: parenteral nutrition and/or fat emulsions versus infusates not involving parenteral nutrition or fat emulsions; adult versus neonatal participants; and arterial versus venous catheters.
AUTHORS' CONCLUSIONS: Some evidence indicates that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the risk of infection. Other evidence suggests that mortality increased within the neonatal population with infrequent administration set replacement. However, much the evidence obtained was derived from studies of low to moderate quality.
连接静脉和动脉导管的输液管（给药装置）可能导致菌血症和其他感染。常规更换给药装置可能会增加或降低感染率。本综述最初发表于2005年，并于2012年更新。
本综述的目的是确定给药装置更换频率与微生物定植、感染和死亡率之间的关系。
我们检索了考克兰对照试验中心注册库（CENTRAL）（《考克兰图书馆》2012年第6期）、医学期刊数据库（MEDLINE，1950年至2012年6月）、护理学与健康领域数据库（CINAHL，1982年至2012年6月）、荷兰医学文摘数据库（EMBASE，1980年至2012年6月）、已识别试验的参考文献列表以及已发表综述的书目。最初的检索于2004年2月进行。我们还联系了该领域的研究人员。我们未设语言限制。
我们纳入了所有关于住院患者静脉或动脉导管给药装置更换频率的随机或对照临床试验。
两名综述作者评估了所有可能相关的研究。我们通过与第三位综述作者讨论解决了两位综述作者之间的分歧。我们收集了七个结局的数据：导管相关感染；输注液相关感染；输注液微生物定植；导管微生物定植；全因血流感染；死亡率；以及成本。我们汇总了比较不同给药装置更换频率的研究结果，例如，我们将比较每96小时及以上更换一次与每72小时更换一次的研究，与比较每48小时及以上更换一次与每24小时更换一次的研究进行了汇总。
我们为此次更新综述识别出26项研究，其中10项被排除；6项不符合纳入标准，4项未报告可用数据。我们从其余18篇参考文献（16项研究）中提取了数据，涉及5001名参与者：研究设计包括新生儿和成人人群、动脉和静脉给药装置、肠外营养、脂质乳剂和晶体输液。大多数研究存在中度至高偏倚风险，或者未充分描述其用于最小化偏倚的方法。由于干预措施的性质，所有纳入试验均无法使人员设盲。未发现总体上更频繁更换给药装置或在任何时间间隔比较中，导管相关或输注液相关菌血症或真菌血症存在差异（风险比（RR）1.06，95%置信区间（CI）0.67至1.69；RR 0.67，95%CI 0.27至1.70）。不频繁更换给药装置降低了血流感染率（RR 0.73，95%CI 0.54至0.98）。未发现更频繁更换给药装置在导管定植或输注液定植方面存在差异（RR分别为1.08，95%CI 0.94至1.24；RR 1.15，95%CI 0.70至1.86）。有边缘证据表明，仅在新生儿人群中，不频繁更换给药装置会增加死亡率（RR 1.84，95%CI 1.00至3.36）。未发现给药装置更换频率（缺乏）效应与所分析的亚组之间存在相互作用：肠外营养和/或脂肪乳剂与不涉及肠外营养或脂肪乳剂的输注液；成人与新生儿参与者；以及动脉与静脉导管。
一些证据表明，不含有脂质、血液或血液制品的给药装置可以留置长达96小时，而不会增加感染风险。其他证据表明，在新生儿人群中，不频繁更换给药装置会增加死亡率。然而，所获得的许多证据来自质量低至中等的研究。
