Safety of central venous catheter change over guidewire for suspected catheter-related sepsis. A prospective randomized trial.
We conducted a study to determine the safety of guidewire exchange of central venous catheters suspected of causing catheter-related sepsis (CRS). Out of a total of 146 patients studied prospectively 41 (28%) suspected of having CRS, were randomly allocated to have their catheters changed over a guidewire (group I) or replaced by a new contralateral venipuncture (group II). One hundred and five patients (group III) requiring only one catheterization served as a control group. Positive semiquantitative cultures (greater than or equal to 15 colonies per plate) of the catheter tip constituted a reliable index of CRS (positive and negative predictive value of 100%). No significant difference in catheter contamination rate and CRS rate was found between group I and II (p = 0.13) and between group I and II versus group III. Nevertheless, there were fewer problems of insertion in the guidewire group (p = 0.03). We conclude that changing a central venous catheter over a guidewire is as safe and has better patient acceptability than inserting a new one, as the proven CRS rate is low (2%) despite a high (27%) suspected rate.
Michel
L A
LA
Surgical Service, Academic Hospital of Mont-Godinne, Yvoir, Belgium.
Bradpiece
H A
HA
Randour
P
P
Pouthier
F
F
D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002986:Clinical Trials as Topic; D015169:Colony Count, Microbial; D006801:Humans; D011446:Prospective Studies; D011897:Random Allocation; D012449:Safety; D018805:Sepsis / Q000209:etiology / Q000382:microbiology / Q000628:therapy*