Nolan Matthew E, Yadav Hemang, Cawcutt Kelly A, Cartin-Ceba Rodrigo
Division of Pulmonary and Critical Care, Mayo Clinic, 200 First St SW, Rochester, MN, 55905.
Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905.
J Crit Care. 2016 Feb;31(1):238-42. doi: 10.1016/j.jcrc.2015.09.024. Epub 2015 Oct 5.
There are limited contemporary data describing the rates of catheter-related deep vein thrombosis (CRDVT) and central line-associated bloodstream infection for peripherally inserted central venous catheters (PICCs) and centrally inserted central venous catheters (CICCs) in the medical intensive care unit (ICU).
We performed a retrospective cohort study of 200 PICCs (dual/triple lumen) and 200 CICCs (triple/quadruple lumen) placed in medical ICU adults at Mayo Rochester between 2012 and 2013. Central lines were followed from insertion time until hospital dismissal (primary analysis) or ICU discharge (secondary analysis). Symptomatic CRDVT was determined by Doppler ultrasound. Central line-associated bloodstream infection was defined according to federal reporting criteria.
During 1730 PICC days and 637 CICC days, the incidence of CRDVT when followed until hospital dismissal was 4% and 1% (4.6 and 3.1 per 1000 catheter-days), respectively, P = .055. When censored at the time of ICU dismissal, the rates were 2% and 1% (5.3 and 3.7 per 1000 catheter-days), P = .685. Only 1 central line-associated bloodstream infection occurred in a PICC following ICU dismissal, P > .999.
Thrombotic and infectious complications were uncommon following PICC and CICC insertion, with no significant difference in complication rates observed. Half of PICC DVTs occurred on the general floor, and like all central catheters placed in the ICU, PICCs should be aggressively discontinued when no longer absolutely needed.
目前关于医学重症监护病房（ICU）中经外周静脉穿刺中心静脉置管（PICC）和经中心静脉穿刺中心静脉置管（CICC）的导管相关深静脉血栓形成（CRDVT）发生率及中心静脉导管相关血流感染的当代数据有限。
我们对2012年至2013年期间在梅奥罗切斯特医学ICU为成年患者置入的200根PICC（双腔/三腔）和200根CICC（三腔/四腔）进行了一项回顾性队列研究。从置管时间开始对中心静脉导管进行随访，直至患者出院（主要分析）或ICU转出（次要分析）。通过多普勒超声确定有症状的CRDVT。根据联邦报告标准定义中心静脉导管相关血流感染。
在1730个PICC置管日和637个CICC置管日期间，随访至患者出院时CRDVT的发生率分别为4%和1%（每1000导管日4.6例和3.1例），P = 0.055。在ICU转出时进行截尾分析，发生率分别为2%和1%（每1000导管日5.3例和3.7例），P = 0.685。在ICU转出后，PICC仅发生1例中心静脉导管相关血流感染，P > 0.999。
PICC和CICC置管后血栓形成和感染并发症并不常见，观察到的并发症发生率无显著差异。一半的PICC相关深静脉血栓形成发生在普通病房，与所有放置在ICU的中心静脉导管一样，当不再绝对需要时，应积极拔除PICC。
