Cohen Regev
Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel.
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Infect Prev Pract. 2024 Nov 7;6(4):100420. doi: 10.1016/j.infpip.2024.100420. eCollection 2024 Dec.
Central venous catheters (CVCs) are essential in modern healthcare but are associated with significant risks, particularly catheter-related bloodstream infections (CRBSIs). Current guidelines do not recommend routine replacement of CVCs based on time alone. However, recent evidence challenges this recommendation. A comprehensive literature review was conducted, focusing on studies exploring the risk-factors of short-term, non-hemodialysis CVCs, that were published in the last two decades while including seminal older works for context. The guidelines regarding scheduled CVC-replacement are not based on sufficiently convincing data. Current literature establishes the significance of CVC-duration as a major risk-factor for CRBSI occurrence, especially after 9-14 days of catheter-dwelling. The daily CRBSI risk is probably not constant, and the cumulative risk may reach high rates after 9-14 days, especially for femoral and jugular insertions compared to the subclavian site, suggesting potential benefits of scheduled CVC replacement, especially for non-subclavian catheters.
中心静脉导管（CVC）在现代医疗保健中至关重要，但也伴随着重大风险，尤其是导管相关血流感染（CRBSI）。目前的指南不建议仅基于时间进行CVC的常规更换。然而，最近的证据对这一建议提出了挑战。我们进行了一项全面的文献综述，重点关注过去二十年发表的探索短期、非血液透析CVC风险因素的研究，同时纳入了早期的经典著作以作背景参考。关于定期更换CVC的指南并非基于充分令人信服的数据。当前文献证实，CVC留置时间是CRBSI发生的主要风险因素，尤其是在导管留置9 - 14天后。每日CRBSI风险可能并非恒定不变，9 - 14天后累积风险可能达到较高水平，特别是与锁骨下置管相比，股静脉和颈内静脉置管的情况，这表明定期更换CVC可能有益，尤其是对于非锁骨下导管。
