Michel L A, Bradpiece H A, Randour P, Pouthier F
Surgical Service, Academic Hospital of Mont-Godinne, Yvoir, Belgium.
Int Surg. 1988 Jul-Sep;73(3):180-6.
We conducted a study to determine the safety of guidewire exchange of central venous catheters suspected of causing catheter-related sepsis (CRS). Out of a total of 146 patients studied prospectively 41 (28%) suspected of having CRS, were randomly allocated to have their catheters changed over a guidewire (group I) or replaced by a new contralateral venipuncture (group II). One hundred and five patients (group III) requiring only one catheterization served as a control group. Positive semiquantitative cultures (greater than or equal to 15 colonies per plate) of the catheter tip constituted a reliable index of CRS (positive and negative predictive value of 100%). No significant difference in catheter contamination rate and CRS rate was found between group I and II (p = 0.13) and between group I and II versus group III. Nevertheless, there were fewer problems of insertion in the guidewire group (p = 0.03). We conclude that changing a central venous catheter over a guidewire is as safe and has better patient acceptability than inserting a new one, as the proven CRS rate is low (2%) despite a high (27%) suspected rate.
我们开展了一项研究，以确定对疑似导致导管相关脓毒症（CRS）的中心静脉导管进行导丝更换的安全性。在总共146例前瞻性研究的患者中，41例（28%）疑似患有CRS，被随机分配为通过导丝更换导管（I组）或通过对侧新的静脉穿刺进行更换（II组）。105例仅需一次置管的患者（III组）作为对照组。导管尖端半定量培养阳性（每平板大于或等于15个菌落）是CRS的可靠指标（阳性和阴性预测值均为100%）。I组和II组之间以及I组和II组与III组之间在导管污染率和CRS率方面均未发现显著差异（p = 0.13）。然而，导丝组的置管问题较少（p = 0.03）。我们得出结论，尽管疑似率较高（27%），但经导丝更换中心静脉导管与插入新导管一样安全，且患者接受度更高，因为已证实的CRS率较低（2%）。
