title: Central venous catheter replacement in the ICU: new site versus guidewire exchange.
abstract: OBJECTIVE
  Catheter infection (central venous catheter, CVC-I) and catheter-related bacteremia (CRB) are of particular interest with ICU patients; more than 40-60% of them require a CVC. This prospective observational study was performed to determine if a second episode of catheterization and guidewire exchange was related to increased CRB and CVC-I rates in the ICU.
  
  
  METHODS
  Over a period of 3 years, patients requiring a CVC, with catheter care, tip and peripheral blood cultures, were observed.
  
  
  RESULTS
  A total of 898 non-tunneled CVCs were examined. The infection rates for 707 first-positioned CVCs were 4.3/1 000 catheter-day (c.d.) for CVC-I and 1.62 for CRB. Replacement was carried out for 191 CVCs: 7 of 103 CVCs inserted in a new site (4.81/1 000 c.d.) and 2 of 88 guidewire exchanged CVCs (1.75/1 000 c.d.) were infected; 2 replaced CVCs were related to CRB (1.38/1 000 c.d.). A cannulation time of over 7 days was related to a higher infection risk with its progressive reduction after the third week: the absolute risk increase was from 5.3 to 1.01 and the relative risk increased from 2.39 to 0.45 for CVC-I.
  
  
  CONCLUSIONS
  Prolonged indwelling time is a significant risk factor for catheter-related infections; the second episode of cannulation and guidewire exchange did not present significant risk factors for catheter-related infections. A strict stable protocol for catheter insertion, care and proper treatment are necessary to reduce both the catheter-related infection rate and cost.
authors.affiliation: Department of Intensive Care Anaesthesiology and Pain Relief, C. Poma Hospital, Mantua, Italy. gianpaolo.castelli@libero.it
authors.forename: G P
authors.initials: GP
authors.lastname: Castelli
authors.forename: C
authors.initials: C
authors.lastname: Pognani
authors.forename: A
authors.initials: A
authors.lastname: Stuani
authors.forename: M
authors.initials: M
authors.lastname: Cita
authors.forename: R
authors.initials: R
authors.lastname: Paladini
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors