Department of Medicine, Detroit Medical Center/Wayne State University, Detroit, MI.
Division of Infectious Diseases, Detroit Medical Center/Wayne State University, Detroit, MI.
Am J Infect Control. 2018 Jul;46(7):788-792. doi: 10.1016/j.ajic.2018.01.006. Epub 2018 Mar 7.
With the rising use of midline catheters (MCs), validation of their safety is essential. Our study aimed to evaluate the incidence of bloodstream infections (BSIs) and other complications related to the use of MCs and central venous catheters (CVCs).
A retrospective cohort study was performed at a tertiary care hospital in Detroit, Michigan, from March-September 2016. Adult patients with either MC or CVC were included. Outcomes assessed were catheter-related BSI (CRBSI), mechanical complications, hospital length of stay, readmission within 90 days of discharge (RA), and mortality. Statistical analysis was performed using SAS software.
A total of 411 patients with MC and 282 patients with CVC were analyzed. More CRBSIs were seen in patients with CVC (10/282) than MC (1/411) (3.5% vs 0.2%, respectively; P = .0008). More mechanical complications were seen in patients with MC (2.6%) than CVC (0.3%; P = .03). Patients with CVC had a higher crude mortality (17.3% vs 5.3%; P < .0001), RA (58% vs 35%; P ≤ .0001), line-related RA (2.8% vs 0.2%; P = .0041), and transfer to intensive care unit after line placement (9% vs 5%; P = .01). CVC was a significant exposure for a composite of mortality, CRBSI, mechanical issues, thrombosis, and readmission because of a line-related complication (odds ratio, 3.2; 95% confidence interval, 1.8-5.8).
Our findings show use of MC is safer than CVC, but larger studies are needed to confirm our findings.
随着中线导管（MC）使用的增加，验证其安全性至关重要。我们的研究旨在评估与 MC 和中心静脉导管（CVC）使用相关的血流感染（BSI）和其他并发症的发生率。
这是一项在密歇根州底特律的一家三级护理医院进行的回顾性队列研究，时间为 2016 年 3 月至 9 月。纳入的患者为使用 MC 或 CVC 的成年患者。评估的结果包括导管相关血流感染（CRBSI）、机械并发症、住院时间、出院后 90 天内再入院（RA）和死亡率。统计分析使用 SAS 软件进行。
共分析了 411 例 MC 患者和 282 例 CVC 患者。CVC 患者中 CRBSI 发生率（10/282）高于 MC 患者（1/411）（分别为 3.5%和 0.2%；P = .0008）。MC 患者中机械并发症发生率（2.6%）高于 CVC 患者（0.3%；P = .03）。CVC 患者的粗死亡率（17.3%比 5.3%；P < .0001）、RA（58%比 35%；P ≤ .0001）、与导管相关的 RA（2.8%比 0.2%；P = .0041）和导管放置后转入重症监护病房（9%比 5%；P = .01）更高。CVC 是死亡率、CRBSI、机械问题、血栓形成和因导管相关并发症而再次入院的复合结局的显著暴露因素（比值比，3.2；95%置信区间，1.8-5.8）。
我们的研究结果表明，MC 的使用比 CVC 更安全，但需要更大规模的研究来证实我们的发现。
