Catheter-related infections (CRI) after guidewire exchange of subclavian catheters compared to CRI after direct placement of the catheter

Objective

To compare CRI rate after guidewire exchange of subclavian catheters for suspected CRI with the rate observed after direct placement.

Study design

Prospective controlled study.

Patients and methods

All subclavian catheters placed consecutively in 202 adult ICU patients, from Oct 1999 to Nov 2000, were included. Maximum barrier precautions were used during insertion. Catheter placement, and catheter site care were made according to the recommendations for the prevention of nosocomial intravascular device-related infections. All catheters were left in place until no longer needed or until there was evidence of phlebitis, malfunction or if CRI was suspected. If a new central catheter was still needed, the catheter was exchanged over a guidewire (GWE catheter), unless there was evidence of phlebitis, inflammation at the catheter insertion point or if the previous catheter changed over a guidewire was colonized, in which case a new anatomical site was used (NSI catheter). After removal of the catheter, the tips were processed according to the Maki semiquantitative method. Catheter colonization, exit-site infection, catheter related blood stream infection (CR-BSI) were defined according to the guidelines for prevention of intravascular device-related infections.

Results

We analysed 423 subclavian catheters (258 NSI and 165 GWE) from a total of 530 inserted (333 NSI and 197GWE). Hundred and seven catheters (74 NSI and 33 GWE), were not included in the study. They were lost to further analysis because either the patient left the ICU with the catheter in place (90), or there were missing data (accidents at the time of removal 10, other 7). Duration of catheterisation was 7.5 ± 4 days for NSI vs 6 ± 4.4 days for GWE catheters (P < 0.05). There were 17 CR-BSI in the NSI catheters (8.8/1000 catheter-days) vs 14 in the GWE (14.1/1000 catheter days) (P > 0.1). Thirty-one NSI catheters were colonized vs 36 GWE (P < 0.05).

Conclusions

Exchange of the subclavian catheters over guidewire was not associated with higher CR-BSI compared to catheters placed directly. A higher rate of colonisation was however observed in the GWE catheters.