title: Central venous catheter replacement strategies: a systematic review of the literature.
abstract: OBJECTIVE
  To evaluate the effect of guidewire exchange and new-site replacement strategies on the frequency of catheter colonization and infection, catheter-related bacteremia, and mechanical complications in critically ill patients.
  
  
  METHODS
  We searched for published and unpublished research by means of MEDLINE and Science Citation Index, manual searching of Index Medicus, citation review of relevant primary and review articles, review of personal files, and contact with primary investigators.
  
  
  METHODS
  From a pool of 151 randomized, controlled trials on central venous catheter management, we identified 12 relevant randomized trials of catheter replacement over a guidewire or at a new site.
  
  
  METHODS
  In duplicate and independently, we abstracted data on the population, intervention, outcome, and methodologic quality.
  
  
  RESULTS
  As compared with new-site replacement, guidewire exchange is associated with a trend toward a higher rate of catheter colonization (relative risk 1.26, 95% confidence interval 0.87 to 1.84), regardless of whether patients had a suspected infection. Guidewire exchange is also associated with trends toward a higher rate of catheter exit-site infection (relative risk 1.52, 95% confidence interval 0.34 to 6.73) and catheter-related bacteremia (relative risk 1.72, 95% confidence interval 0.89 to 3.33). However, guidewire exchange is associated with fewer mechanical complications (relative risk 0.48, 95% confidence interval 0.12 to 1.91) relative to new-site replacement. Exchanging catheters over guidewires or at new sites every 3 days is not beneficial in reducing infections, compared with catheter replacement on an as-needed basis.
  
  
  CONCLUSIONS
  Guidewire exchange of central venous catheters may be associated with a greater risk of catheter-related infection but fewer mechanical complications than new-site replacement. More studies on scheduled vs. as-needed replacement strategies using both techniques are warranted. If guidewire exchange is used, meticulous aseptic technique is necessary.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Cook
authors.forename: A
authors.initials: A
authors.lastname: Randolph
authors.forename: P
authors.initials: P
authors.lastname: Kernerman
authors.forename: C
authors.initials: C
authors.lastname: Cupido
authors.forename: D
authors.initials: D
authors.lastname: King
authors.forename: C
authors.initials: C
authors.lastname: Soukup
authors.forename: C
authors.initials: C
authors.lastname: Brun-Buisson
mesh_terms: D016470:Bacteremia / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D003428:Cross Infection / Q000209:etiology*; D004866:Equipment Contamination; D006801:Humans; D017053:Infection Control; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012307:Risk Factors; D014946:Wound Infection / Q000209:etiology*