Jia Wei, Wu Kaiping, Song Kaifei, Yun Wenjuan, Wang Jin, Yi Yaping, Xu Lingyun
Department of Breast Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
Changzhou Medical Center, Nanjing Medical University, Changzhou, China.
Medicine (Baltimore). 2024 Dec 13;103(50):e40930. doi: 10.1097/MD.0000000000040930.
Flushing catheter seems to be a crucial procedure for preventing centrally inserted central catheter (CICC) occlusion, which can flush the liquid and blood attached to the lumen into the bloodstream. The continuous infusion technique is characterized by continuous perfusion of flushing fluid and maintaining positive pressure in the lumen, which has been demonstrated to effectively prevent peripheral indwelling needle occlusion. However, the use of continuous infusion technique in CICC care among critically ill patients has been rarely described.
To determine the feasibility and direct outcomes of continuous infusion technique in preventing CICC occlusion among critically ill patients.
Participants from the intensive care unit who had a new centrally inserted central catheter placed within 24 hours were randomly assigned to 2 groups at a ratio of 1:1. They received pulsed infusion or continuous catheter infusion using pre-filled elastic pumps. During the trial period, on days 3 and 7 and whenever there were signs of catheter occlusion, whether the catheter occlusion was evaluated by the Catheter Injection and Aspiration Classification. Moreover, nurses meticulously observed the incidence of catheter-related complications, altered vital signs, and dysfunctions of elastic pump.
The catheter occlusion rates were 17.4% and 43.5% in participants who received continuous infusion (n = 23) and those who received pulsed infusion (n = 23), respectively. There was no significant difference in catheter occlusion rate between the 2 groups (χ² = 3.696, P = .06). The Kaplan-Meier curve results showed that the cumulative probability of central catheter occlusion events (within 7 days) in the continuous infusion group decreased (χ²=4.322, Log rank P = .04). Moreover, multivariate Cox regression indicated that the continuous infusion can reduce the risk of occlusion within 7 days by 91.8% (hazard ratio = 0.082, 95% confidence interval [0.014-0.487], P = .006). During the trial, no cases of detrimental altered vital signs and catheter-related complications in addition to occlusion were documented.
In this study, continuous infusion technique with pre-filled elastic pumps was successfully used in critically ill patients for prevention of CICC occlusion, without major undesired effects. A larger cohort and a randomized clinical trial are warranted in order to establish its absolute efficacy in CICC care.
冲管似乎是预防中心静脉导管（CICC）堵塞的关键操作，它能将附着在管腔内的液体和血液冲入血液循环。持续输注技术的特点是持续灌注冲洗液并在管腔内维持正压，这已被证明能有效预防外周留置针堵塞。然而，在重症患者的CICC护理中使用持续输注技术的情况鲜有报道。
确定持续输注技术在预防重症患者CICC堵塞方面的可行性和直接效果。
将重症监护病房中在24小时内新置入中心静脉导管的参与者按1:1的比例随机分为两组。他们使用预充式弹力泵接受脉冲式输注或持续导管输注。在试验期间，于第3天和第7天以及出现导管堵塞迹象时，通过导管注入和抽吸分类评估导管堵塞情况。此外，护士仔细观察导管相关并发症的发生率、生命体征变化以及弹力泵功能障碍情况。
接受持续输注的参与者（n = 23）和接受脉冲式输注的参与者（n = 23）的导管堵塞率分别为17.4%和43.5%。两组之间的导管堵塞率无显著差异（χ² = 3.696，P = 0.06）。Kaplan-Meier曲线结果显示，持续输注组中心静脉导管堵塞事件（7天内）的累积概率降低（χ² = 4.322，对数秩检验P = 0.04）。此外，多因素Cox回归表明，持续输注可使7天内的堵塞风险降低91.8%（风险比 = 0.082，95%置信区间[0.014 - 0.487]，P = 0.006）。在试验期间，除堵塞外，未记录到有害的生命体征变化和导管相关并发症病例。
在本研究中，预充式弹力泵持续输注技术成功用于重症患者预防CICC堵塞，且无重大不良影响。为确定其在CICC护理中的绝对疗效，有必要进行更大规模的队列研究和随机临床试验。
