A 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 permanence of CVCs, infection stands out. This may increase the morbidity, mortality, costs 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 impregnated with chlorhexidine–silver sulfadiazine.

Design

A prospective, randomized, alternate, nonblind study.

Methods

Central venous access was taken, alternating the type of CVC used in each patient. The following were recorded for each patient: sex, age, APACHE II 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 patients were divided: Group I (41 patients, 54 punctures) used the standard CVC, and Group II (38 patients, 54 punctures) used the impregnated CVC.

Results

Sixty-two patients (48.38% female) were included. 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 has an amount of 578 days, and 762 days for Group II. The total duration of the Group II was 31.84% higher than Group I. Regarding the reason for withdrawal of the CVC, 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 the standard group, against eight occasions (15.1%) in the impregnated group. The predominant site of puncture in this study was the subclavian vein (56.48%), and the catheters remained much of the time at this site when compared with other sites (jugular and femoral vein). But when we considered only Group II (impregnated), the catheters located in the jugular vein remained longer. The impregnated catheters cost 40% more than conventional ones. (See Table 1.)

Table 1 (abstract P11)

Conclusion

The length of stay with the use of impregnated CVCs was higher (15.43 days) than the standard CVCs (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 long-term use and lower rates 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 gained by the use of antiseptic-impregnated catheters compensated for the initial expensive cost of 40%.