Deutsch Gary B, Sathyanarayana Sandeep Anantha, Singh Narendra, Nicastro Jeffrey
Department of General Surgery, North Shore-Long Island Jewish Health System, New Hyde Park, New York.
Department of General Surgery, North Shore-Long Island Jewish Health System, New Hyde Park, New York.
J Surg Res. 2014 Sep;191(1):1-5. doi: 10.1016/j.jss.2013.03.047. Epub 2013 Apr 6.
The early removal of central intravenous (IV) catheters, as a means of reducing the incidence of central line-associated blood stream infections (CLABSI), remains a major health care initiative. However, attaining IV access in the surgical intensive care unit (SICU) can be quite difficult. We report the success of a novel, resident-driven program for the placement of ultrasound-guided midline catheters in critically ill patients.
A prospective pilot study of 31 subjects admitted to the SICU from June to December 2011 was performed. Intermediate-length (20 cm) midline catheters were placed by trained housestaff, under ultrasound guidance, into the basilic or cephalic veins. Procedural details including time to cannulation, complications, and costs were recorded.
Successful placement was achieved in 96.8% (n = 30), with a mean follow-up of 9.8 ± 5.6 (range 2-21) days. An average of 1.3 ± 0.7 (range 1-4) attempts with a median of 13.0 ± 14.5 (range 0.5-68) minutes was required for successful venous cannulation. The most common site was the basilic vein (n = 23). Only minor complications were encountered; three catheters leaked at the insertion site and one patient developed phlebitis. No CLABSI occurred. The total procedure cost was $87 per catheter for the SICU team compared with $1500 per catheter when performed by an interventional radiologist. During the study period, a total of 283 central line days were avoided with an estimated cost savings of $13,614.
Ultrasound-guided midline catheters placed by the housestaff are a cost-effective alternative for patients in the SICU with difficult IV access. Successful placement can help facilitate early central line removal and thus may reduce CLABSI rates.
尽早拔除中心静脉导管作为降低中心静脉导管相关血流感染（CLABSI）发生率的一种手段，仍然是一项重要的医疗保健举措。然而，在外科重症监护病房（SICU）建立静脉通路可能相当困难。我们报告了一项由住院医师主导的新项目在危重症患者中成功放置超声引导中线导管的情况。
对2011年6月至12月入住SICU的31名受试者进行了一项前瞻性试点研究。由经过培训的住院医师在超声引导下将中等长度（20厘米）的中线导管置入贵要静脉或头静脉。记录包括置管时间、并发症和费用在内的操作细节。
96.8%（n = 30）的患者成功置管，平均随访时间为9.8±5.6（范围2 - 21）天。成功静脉置管平均需要1.3±0.7（范围1 - 4）次尝试，中位数为13.0±14.5（范围0.5 - 68）分钟。最常见的置管部位是贵要静脉（n = 23）。仅出现了轻微并发症；3根导管在插入部位渗漏，1名患者发生了静脉炎。未发生CLABSI。SICU团队置管的总费用为每根导管87美元，而由介入放射科医生操作时每根导管费用为1500美元。在研究期间，总共避免了283个中心静脉导管日，估计节省费用13614美元。
住院医师放置的超声引导中线导管对于SICU中静脉通路建立困难的患者是一种经济有效的替代方法。成功置管有助于促进早期拔除中心静脉导管，从而可能降低CLABSI发生率。
