Use of continuous infusion technique with pre-filled elastic pumps for prevention of centrally inserted central catheter occlusion in critically ill patients: A feasibility study.

BACKGROUND

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.

OBJECTIVE

To determine the feasibility and direct outcomes of continuous infusion technique in preventing CICC occlusion among critically ill patients.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.