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Scheduled Replacement of Central Venous Catheters Is Not Necessary

Published online by Cambridge University Press:  02 January 2015

Jean-François Timsit
Jean-François Timsit*
Affiliation:
Hôpital Saint Joseph, Paris, France
*
Hôpital Saint Joseph, Réanimation polyvalente, 185 rue Raymond Losserand, 75014 Paris, France
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Abstract

Although half of intensivists routinely replace their central venous catheters (CVCs), this practice is not supported by data from randomized control studies or by pathophysiology of CVC infection. The daily risk of CVC infection is considered to be a constant; the risk of catheter infection is directly related to the duration of catheter insertion. Consequently, the routine change of the catheter is able to decrease the number of infections per catheter but not to modify the number of infections per day of catheter insertion. This assertion is supported by evidence-based medicine: scheduled replacement every 3 or 7 days has not been shown to alter the infectious risks of CVCs in randomized studies or a meta-analysis.

Moreover, routine replacement at a new site exposes the patient to an increased risk of mechanical complications. The overall rate of mechanical complications per catheter inserted is approximately 3%. Guidewire exchange of the catheters may reduce the risk of mechanical complications, but unfortunately is associated with a higher rate of catheter colonization and catheter-related bacteremia. Routine replacement of CVCs is not necessary.

Type
Reviews
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 6 , June 2000 , pp. 371 - 374
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;5:887–892.CrossRefGoogle Scholar
2. Ullman, RF, Gurevich, I, Schoch, PE, Cunha, BA. Colonization and bacteremia related to duration of triple-lumen intravascular catheter placement. Am J Infect Control 1990;18:201–207.CrossRefGoogle ScholarPubMed
3. Pearson, ML. Guideline for the prevention of intravascular device-related infections. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:438–473.Google ScholarPubMed
4. Saint, S, Matthay, MA. Risk reduction in the intensive care unit. Am J Med 1998;105:515–523.CrossRefGoogle ScholarPubMed
5. Cyna, AM, Hovenden, JL, Lehmann, A, Rajaseker, K, Kalia, P. Routine replacement of central venous catheters: telephone survey of intensive care units in mainland Britain. BMJ 1998;316:1944–1945.CrossRefGoogle ScholarPubMed
6. Stenzel, JP, Green, TP, Fuhrman, BP, Carlson, PE, Marchessault, RP. Percutaneous central venous catheterization in a pediatric intensive care unit a survival analysis of complications. Crit Care Med 1989;17:984–988.CrossRefGoogle Scholar
7. Souweine, B, Traore, O, Aublet-Cuvelier, B, Badrikian, L, Bret, L, Sirot, J, et al. Dialysis and central venous catheter infections in critically ill patients: results of a prospective study. Crit Care Med 1999;27:2394–2398.CrossRefGoogle ScholarPubMed
8. Cobb, DK, High, KP, Sawyer, RG, Sable, CA, Adams, RB, Lindley, DA, et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992;327:1062–1068.CrossRefGoogle ScholarPubMed
9. Sherertz, RJ, Carruth, W, Hu, Q, Solomon, DD. Factors modifying the risk of S aureus infection associated with silicone catheters in a rabbit model. Presented at the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy. October 21-24,1990; Atlanta, GA. Abstract 91.Google Scholar
10. Badley, AD, Steckelberg, JM, Wollan, PC, Thompson, RL. Infectious rates of central venous pressure catheters: comparison between newly placed catheters and those that have been changed. Mayo Clin Proc 1996;71:838–846.CrossRefGoogle ScholarPubMed
11. Timsit, JF, Bruneel, F, Cheval, C, Mamzer, MF, Garrouste-Orgeas, M, Wolff, M, et al. Use of tunneled femoral catheters to prevent catheter-related infection. A randomized controlled trial. Ann Intern Med 1999;130:729–735.CrossRefGoogle ScholarPubMed
12. Eerola, R, Kaukinen, L, Kaukinen, S. Analysis of 13800 subclavian vein catheterizations. Acta Anaesthesiol Scand 1985;29:193–197.CrossRefGoogle Scholar
13. Kaye, CG, Smith, DR. Complications of central venous cannulation. BMJ 1988;297:572–573.CrossRefGoogle ScholarPubMed
14. Ryan, JA, Abel, RM, Abbot, WM, Cyrus, C, Hopkins, CC, Chesney, TC, et al. Catheter complications in total parenteral nutrition. N Engl J Med 1974;290:757–761.CrossRefGoogle ScholarPubMed
15. Haire, WD, Lieberman, RP. Defining the risks of subclavian-vein catheterization. N Engl J Med 1994;26:1769–1770.CrossRefGoogle Scholar
16. Oates, A, Hajela, V, Channer, KS. Complications and failures of subclavian vein catheterization. N Engl J Med 1995;23:1580.Google Scholar
17. Beilin, Y, Bronheim, D, Mandelbaum, C. Hemothorax and subclavian artery laceration during “J” wire change of a right internal jugular vein catheter. Anesthesiology 1998;88:1399–1400.CrossRefGoogle ScholarPubMed
18. Krauss, D, Schmidt, GA. Cardiac tamponade and contralateral hemothorax after subclavian vein catheterization. Chest 1991;99:517–518.CrossRefGoogle ScholarPubMed
19. Groudine, S. Endotracheal tube cuff perforation as a complication of subclavian vein catheterization. Chest 1993;104:1313.CrossRefGoogle ScholarPubMed
20. Mercer-Jones, MA, Wenstone, R, Hershman, MJ. Fatal subclavian artery haemorrhage. A complication of subclavian vein catheterisation. Anaesthesia 1995;50:639–640.CrossRefGoogle ScholarPubMed
21. Powell, H, Beechey, AP. Internal jugular catheterisation. Case report of a potentially fatal hazard. Anaesthesia 1990;45:458–459.CrossRefGoogle ScholarPubMed
22. Peters, JL, Armstrong, R, Bradford, R, Gelister, JK. Air embolism: a serious hazard of central venous catheter systems. Nitens Care Med 1984;10:261–262.Google ScholarPubMed
23. Mansfield, PF, Hohn, DC, Fornage, BD, Gregurich, MA, Ota, DM. Complications and failures of subclavian-vein catheterization. N Engl J Med 1994;331:1735–1738.CrossRefGoogle ScholarPubMed
24. Eyer, S, Brumitt, C, Crossley, K, Siegel, R, Cerra, F. Catheter related sepsis: a prospective randomized study of three methods of catheter maintenance. Crit Care Med 1990;18:1073–1079.CrossRefGoogle ScholarPubMed
25. Arnow, PM, Quimosing, EM, Brech, M. Consequences of intravascular catheter sepsis. Clin Infect Dis 1993;16:778–784.CrossRefGoogle ScholarPubMed
26. Berthelot, P, Zeni, F, Pain, P, Berthier, S, Aubert, G, Venet, C, et al. Infections sur cathéters en réanimation: influence de l'échange systématique tous les 4 jours des voies veineuses centrales. Presse Med 1997;26:1089–1094.Google Scholar
27. Armstrong, CW, Mayhall, CG, Miller, KB, Newsome, HH Jr, Sugerman, HJ, Dalton, HP, et al. Prospective study of catheter replacement and other risk factors for infection of hyperalimentation catheter. J Infect Dis 1986;154:806–816.CrossRefGoogle Scholar
28. Rex, JH, Bennett, JE, Sugar, AM, Pappas, PG, Serody, J, Edwards, JE, et al. Intravascular catheter exchange and duration of candidemia. NIAID Mycoses Study Group and the Candidemia Study Group. Clin Infect Dis 1995;21:994–996.CrossRefGoogle ScholarPubMed
29. Nguyen, MH, Peacock, JE Jr, Tanner, DC, Morris, AJ, Nguyen, ML, Snydman, DR, et al. Therapeutic approaches in patients with candidemia. Evaluation in a multicenter, prospective, observational study. Arch Intern Med 1995;155:2429–2435.CrossRefGoogle Scholar
30. Malanovsi, GJ, Samore, MH, Pefanis, A, Karchner, AW. Staphylococcus aureus catheter-associated bacteremia: minimal effective therapy and unusual infectious complications associated with arterial sheath catheters. Arch Intern Med 1995;155:1161–1166.Google Scholar
31. Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative method for identifying intravenous catheter related infection. N Engl J Med 1977;296:1305–1309.CrossRefGoogle ScholarPubMed
32. Brun-Buisson, D, Abrouk, F, Legrand, P, Huet, Y, Larabi, S, Rapin, M, et al. Diagnosis of central venous catheter-related sepsis: critical level of quantitative tip cultures. Arch Intern Med 1987;147:873–877.CrossRefGoogle ScholarPubMed