A comparative study between conventional and antimicrobial-filled central venous catheters

Background

Central venous catheters (CVCs) are very useful in the management of patients hospitalized in the ICU. Among the complications related to the permanence of CVCs, infection stands out. This may increase the morbidity and mortality, cost and length of stay in the ICU. A comparative study between antiseptic-impregnated and standard catheters is therefore of great value.

Objective

To compare the duration of standard CVCs with those that are antiseptic-impregnated: silver sulfadiazine and chlorhexidine.

Methods

A prospective study was performed, in a randomized, alternate, and nonblind fashion. The measure of Acute Physiology and Chronic Health Evaluation II score and central venous access were made alternating the type of CVC used in each patient, so the study was randomized. The information recorded on each patient was sex, Glasgow coma score, site of the puncture, reason for withdrawal of the catheter and the type of catheter used. We cultured (qualitatively) the tip of the catheter. The patients were divided into two groups: group I (36 patients, 47 punctures) used the standard CVC, and group II (33 patients, 47 punctures) used the impregnated CVC.

Results

Length of duration: group II = 14.2 days, group I = 10.2 days. Excluding death in both groups, length of stay: group I = 10.4 days, group II = 15.8 days. Adding all periods of catheterization for each group: group I = 483 days, group II = 670 days. The total duration of group II was 38.71% higher than that of group I. Regarding the reason for withdrawal of the CVC, predominant was suspected infection in 74.6% of standard CVCs and in 48.9% of impregnated CVCs. The culture of the catheter tip was positive on 10 occasions (21.2%) in standard CVCs, against six occasions (12.7%) in impregnated CVCs. Most patients had Glasgow coma score <9. Average Acute Physiology and Chronic Health Evaluation II score: 17.8 in group I, 20.2 in group II. The predominant site of puncture was the subclavian vein (56.3%), and the catheters remained much of the time on this site when compared with the other sites used (jugular and femoral). But when we take only group II into consideration, the catheters located in the jugular vein remained longer.

Conclusion

The length of stay with the use of impregnated CVCs was higher (15.8 days) than that for the standard CVCs (10.4 days). The rate of infection was higher in the standard CVCs. Patients who require CVCs for long periods have benefited with the use of impregnated CVCs, because they present long-term use, lower rates of infection, and avoidance of successive punctures and risks of the procedure. In view of the clinical benefits already mentioned, the benefit reached by the use of antiseptic-impregnated catheters compensated the initial extra expensive cost of 40%.