Keogh Samantha, Larsen Emily, Corley Amanda, Takashima Mari, Marsh Nicole, Edwards Melannie, Reynolds Heather, Dhanani Jayesh, Coyer Fiona, Laupland Kevin B, Rickard Claire M
School of Nursing, School of Clinical Sciences and the Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Qld, Australia; Departments of Intensive Care Services, Anaesthesia and Perioperative Medicine, and the Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.
Departments of Intensive Care Services, Anaesthesia and Perioperative Medicine, and the Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia; School of Nursing and Midwifery, School of Medicine and Dentistry, Griffith University, Brisbane, Qld, Australia; Patient-Centred Health Services, Menzies Health Institute Queensland, Brisbane, Qld, Australia.
Infect Dis Health. 2025 Feb;30(1):12-17. doi: 10.1016/j.idh.2024.07.006. Epub 2024 Aug 22.
Access to arterial circulation through arterial catheters (ACs) is crucial for monitoring and decision-making in intensive care units (ICU) but carries the risk of complications including bloodstream infection (BSI).
We conducted a secondary analysis of data from four randomised controlled trials in Australian ICUs, investigating the efficacy of different AC interventions. De-identified data were combined into a single dataset, and per-patient outcomes analysed. The primary outcome was AC-BSI, defined as laboratory confirmed bloodstream infection (LCBI) type 1 or 2, with a concurrent local infection. All-cause AC failure was defined as any unplanned removal. AC infection and failure were reported as rates per 1000 catheter days and hours.
Data from 1117 adult patients were analysed. Mean age was 58.8 years (±16.6); and 41% (n = 462) were male. Median AC dwell time was 110 h (IQR 28.3-168.0). There was one case (<0.1%; 0.18/1000 catheter days [95% CI 0.03-1.29]) of AC-BSI, and 14 cases of LCBI (1%; 13 LCBI-1 and 1 LCBI-2; 2.54/1000 catheter days [95% CI 1.51-4.30]). LCBI were most commonly Enterococcus faecalis; Escherichia coli and Klebsiella pneumoniae. There were four cases of local infection (<1%; 0.73/1000 catheter days [95% CI 0.27-1.94]). Overall AC failure rate was 13% (n = 146) or 26.53/1000 catheter days (95% CI 22.56-31.20).
This study identified a relatively low incidence of complications. This is likely reflective of poor monitoring of ACs in intensive care. Better surveillance and a rigorous prospective evaluation of AC outcomes is required to understand the true risk ACs pose to critically ill patients.
通过动脉导管（AC）进入动脉循环对于重症监护病房（ICU）的监测和决策至关重要，但存在包括血流感染（BSI）在内的并发症风险。
我们对澳大利亚ICU的四项随机对照试验数据进行了二次分析，研究不同AC干预措施的疗效。将去识别化的数据合并到一个单一数据集中，并对每位患者的结局进行分析。主要结局是AC-BSI，定义为实验室确诊的1型或2型血流感染（LCBI），同时伴有局部感染。全因AC失败定义为任何计划外拔除。AC感染和失败以每1000导管日和小时的发生率报告。
分析了1117例成年患者的数据。平均年龄为58.8岁（±16.6）；41%（n = 462）为男性。AC中位留置时间为110小时（IQR 28.3 - 168.0）。有1例AC-BSI（<0.1%；0.18/1000导管日[95% CI 0.03 - 1.29]），14例LCBI（1%；13例LCBI-1和1例LCBI-2；2.54/1000导管日[95% CI 1.51 - 4.30]）。LCBI最常见的是粪肠球菌、大肠杆菌和肺炎克雷伯菌。有4例局部感染（<1%；0.73/1000导管日[95% CI 0.27 - 1.94]）。总体AC失败率为13%（n = 146）或26.53/1000导管日（95% CI 22.56 - 31.20）。
本研究发现并发症发生率相对较低。这可能反映了重症监护中对AC的监测不足。需要更好的监测和对AC结局进行严格的前瞻性评估，以了解AC对危重症患者构成的真正风险。
