Karpanen Tarja J, Casey Anna L, Whitehouse Tony, Timsit Jean-Francois, Mimoz Olivier, Palomar Mercedes, Elliott Tom S J
Department of Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
Department of Anaesthetics and Intensive Care, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Edgbaston, B15 2WB, UK.
Ann Intensive Care. 2019 Apr 17;9(1):49. doi: 10.1186/s13613-019-0519-6.
Central venous catheters (CVCs) are commonly secured with sutures which are associated with microbial colonization and infection. We report a comparison of a suture-free system with standard sutures for securing short-term CVC in an international multicentre, prospective, randomized, non-blinded, observational feasibility study. Consented critical care patients who had a CVC inserted as part of their clinical management were randomized to receive either sutures or the suture-free system to secure their CVC. The main outcome measures were CVC migration (daily measurement of catheter movement) and unplanned catheter removals.
The per cent of unplanned CVC removal in the two study groups was 2% (suture group 2 out of 86 patients) and 6% (suture-free group 5 out of 85 patients). Both securement methods were well tolerated in terms of skin irritation. The time and ease of application and removal of either securement systems were not rated significantly different. There was also no significant difference in CVC migration between the two securement systems in exploratory univariate and multivariate analyses. Overall, 42% (36 out of 86) of the CVC secured with sutures and 56% (48 out of 85) of the CVC secured with the suture-free securement system had CVC migration of ≥ 2 mm.
The two securement systems performed similarly in terms of CVC migration and unplanned removal of CVC; however, the feasibility study was not powered to detect statistically significant differences in these two parameters.
ISRCTN, ISRCTN13939744. Registered 9 July 2015, http://www.isrctn.com/ISRCTN13939744 .
中心静脉导管（CVC）通常用缝线固定，这与微生物定植和感染有关。在一项国际多中心、前瞻性、随机、非盲、观察性可行性研究中，我们报告了一种免缝系统与标准缝线在固定短期CVC方面的比较。同意参与的重症监护患者在临床治疗中插入了CVC，他们被随机分配接受缝线或免缝系统来固定CVC。主要观察指标为CVC移位（每日测量导管移动情况）和计划外拔管。
两个研究组的计划外CVC拔除率分别为2%（缝线组86例患者中有2例）和6%（免缝组85例患者中有5例）。两种固定方法在皮肤刺激方面耐受性良好。两种固定系统的应用和移除时间及难易程度评分无显著差异。在探索性单变量和多变量分析中，两种固定系统之间的CVC移位也无显著差异。总体而言，用缝线固定的CVC中有42%（86例中的36例），用免缝固定系统固定的CVC中有56%（85例中的48例）发生了≥2mm的CVC移位。
两种固定系统在CVC移位和计划外拔除CVC方面表现相似；然而，该可行性研究的样本量不足以检测这两个参数的统计学显著差异。
ISRCTN，ISRCTN13939744。于2015年7月9日注册，http://www.isrctn.com/ISRCTN13939744 。
