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Comparative study between conventional and antiseptic impregnated central venous catheters

Introduction

Central venous catheters (CVCs) are very useful in the management of patients hospitalized in the ICU, but are not devoid of complications. Among the complications related to the permanence of CVCs, infection stands out. This may increase the morbidity, mortality, costs and length of stay in the ICU. The purpose of this study was to compare the duration of standard CVCs with those impregnated with antiseptic: silver sulfadiazine and chlorhexidine.

Methods

A prospective randomized, alternate, nonblind study. Central venous access was taken, alternating the type of CVC used in each patient. Were recorded for each patient the sex, age, APACHE II score, Glasgow coma score, site of the puncture, reason for withdrawal of the catheter and the type of catheter used. The tip of the catheter was cultured (qualitative). The groups were divided: group I (41 patients, 54 punctures) used the standard CVC, and group II (38 patients, 54 punctures) used an impregnated CVC.

Results

See Table 1. We included 62 patients (48.38% female). We studied 108 periods of catheterization, of which 54 were standard CVCs and 54 were impregnated CVCs. The average length of stay was higher in impregnated CVCs (14.11 days) compared with standard CVCs (10.7 days). Excluding death in both groups, the length of stay of the catheter in group I was 10.86 days, compared with 15.43 days in group II. Adding all periods of catheterization for each group, group I had an amount of 578 days and group II had 762 days. The total duration of group II was 31.84% higher than group I. Regarding the reason for withdrawal of the CVC, the suspected infection predominated in 77.8% of the time in standard CVCs and 49.1% of the time in impregnated CVCs. The culture of the catheter's tip was positive on 10 occasions (18.5%) in standard CVCs, against eight occasions (15.1%) in the impregnated group. Most patients had Glasgow coma score <9. The average APACHE II score was 17.97 in patients of group I, compared with an average of 19.63 in group II patients. The predominant site of puncture in this study was the subclavian vein (56.48%), and the catheters remained a long time on this site when compared with others (jugular and femoral vein). But when we considered only group II (impregnated), the catheters located in the jugular vein remained longer. The impregnated catheter cost 40% more than the conventional.

Table 1 Multivariate analysis

Conclusion

The length of stay with the use of impregnated CVCs was higher (15.43 days) than the standard CVC (10.86 days). The rate of colonization was higher in the standard CVC. Patients who require a CVC for long periods have benefited with the use of impregnated CVCs, because they present a long use term, a lower rate of colonization, avoiding complications related to the procedure of successive punctures and related to the permanence of the catheters. In view of the clinical benefits already mentioned, the benefit reached from the use of antiseptic-impregnated catheters compensated the initial expensive cost of 40%.

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Macedo, S., Filho, J.M., Lima, G. et al. Comparative study between conventional and antiseptic impregnated central venous catheters. Crit Care 13, P192 (2009). https://doi.org/10.1186/cc7356

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Keywords

  • Catheter
  • Central Venous Catheter
  • Chlorhexidine
  • Subclavian Vein
  • Glasgow Coma Score