Safety of a guidewire technique for replacement of pulmonary artery catheters.
The purpose of this study was to determine if a guidewire change from a pulmonary artery catheter (PAC) to a central venous catheter (CVC) poses a significant infection risk. A total of 128 consecutive cardiac surgical patients with PACs inserted in the operating room were entered into this study. Postoperatively, patients were randomly allocated to receive a double-lumen CVC, either at the initial introducer insertion site over a guidewire, or at a new site with de novo catheterization. The tips of all introducers, PACs, and CVCs were cut off, cultured, and semi-quantitatively analyzed. The results show that insertion of CVCs over a guidewire within 48 hours after initial venapuncture is no more likely to be associated with catheter colonization than is de novo percutaneous insertion at a different site. From 48 hours up to 72 hours following initial insertion of the PAC, an incidence of catheter-related infection of 35.3% was observed in the guidewire group, as opposed to 12.5% in the de novo group. It is recommended that the use of a guidewire technique for catheter replacement (PAC to CVC) is a safe alternative to de novo insertion of a CVC within 48 hours after initial insertion of the PAC. In order to minimize the potential risk of catheter-related infection and bacteremia in cardiac surgical patients, de novo catheterization beyond 48 hours after initial venapuncture is suggested.
Bach
A
A
Department of Anesthesiology, University of Heidelberg, Germany.
Böhrer
H
H
Geiss
H K
HK
D016470:Bacteremia / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004866:Equipment Contamination; D006801:Humans; D011651:Pulmonary Artery; D011677:Punctures; D012449:Safety; D013203:Staphylococcal Infections; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D013997:Time Factors