title: Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunction?
abstract: Intensive care unit (ICU) patients require dialysis catheters (DCs) for renal replacement therapy (RRT). They carry a high risk of developing end-stage renal disease, and therefore their vascular access must be preserved. Guidewire exchange (GWE) is often used to avoid venipuncture insertion (VPI) at a new site. However, the impact of GWE on infection and dysfunction of DCs in the ICU is unknown. Our aim was to compare the effect of GWE and VPI on DC colonization and dysfunction in ICU patients.
  
  
  
  Using data from the ELVIS randomized controlled trial (RCT) (1496 ICU adults requiring DC for RRT or plasma exchange) we performed a matched-cohort analysis. Cases were DCs inserted by GWE (n = 178). They were matched with DCs inserted by VPI. Matching criteria were participating centre, simplified acute physiology score (SAPS) II +/-10, insertion site (jugular or femoral), side for jugular site, and length of ICU stay before DC placement. We used a marginal Cox model to estimate the effect of DC insertion (GWE vs. VPI) on DC colonization and dysfunction.
  
  
  
  DC colonization rate was not different between GWE-DCs and VPI-DCs (10 (5.6 %) for both groups) but DC dysfunction was more frequent with GWE-DCs (67 (37.6 %) vs. 28 (15.7 %); hazard ratio (HR), 3.67 (2.07-6.49); p < 0.01). Results were similar if analysis was restricted to DCs changed for dysfunction.
  
  
  
  GWE for DCs in ICU patients, compared with VPI did not contribute to DC colonization or infection but was associated with more than twofold increase in DC dysfunction.
  
  
  
  This study is registered with ClinicalTrials.gov, number NCT00563342 . Registered 2 April 2009.
authors.affiliation: Medical Intensive Care Unit, University Hospital of Clermont-Ferrand, 58 rue Montalembert, 63000, Clermont-Ferrand, France. ecoupez@chu-clermontferrand.fr.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Coupez
authors.affiliation: IAME UMR 1137 Inserm Université Paris Diderot, Paris, F-75018, France.|Medical and Infectious Diseases ICU -Paris Diderot University / Bichat Hospital, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.affiliation: IAME UMR 1137 Inserm Université Paris Diderot, Paris, F-75018, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.affiliation: U823 "Outcome of Cancers and Critical Illness," Albert Bonniot Institute, La Tronche, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.affiliation: Medical Intensive Care Unit, Pellegrin Teaching Hospital, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
authors.affiliation: Medical Intensive Care Unit, Saint Louis Teaching Hospital, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.affiliation: Medical Intensive Care Unit, Lapeyronie Teaching Hospital, University Hospital of Montpellier, Montpellier, France.
authors.forename: Kada
authors.initials: K
authors.lastname: Klouche
authors.affiliation: Medical Intensive Care Unit, Edouard Herriot Teaching Hospital, University of Lyon, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.affiliation: Medical Intensive Care Unit, University Hospital of Lyon, Lyon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Bohe
authors.affiliation: Critical Care Medicine Unit, Saint-Joseph Hospital, Paris, France.
authors.forename: Maïté
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.affiliation: Nephrology and Critical Care Unit, Nord Teaching Hospital, University of Saint Etienne, Saint Etienne, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariat
authors.affiliation: Medical Intensive Care Unit, Avicenne Teaching Hospital, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Cayot
authors.affiliation: Nephrology and Critical Care Medicine, Rangueil Teaching Hospital, University of Toulouse, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Cointault
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine Pierre Benite Teaching Hospital, University Hospital of Lyon, Lyon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Lepape
authors.affiliation: Medical Intensive Care Unit, Nord Teaching Hospital, University of Saint Etienne, Saint Etienne, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: Medical Intensive Care Unit, Pellegrin Teaching Hospital, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boyer
authors.affiliation: Medical Intensive Care Unit, Saint Louis Teaching Hospital, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Medical Intensive Care Unit, Bichat-Claude Bernard Teaching Hospital, Paris, France.
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.affiliation: Medical Intensive Care Unit, University Hospital of Clermont-Ferrand, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lautrette
authors.affiliation: Medical Intensive Care Unit, University Hospital of Clermont-Ferrand, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
mesh_terms: D000368:Aged; D055499:Catheter-Related Infections / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000379:methods / Q000451:nursing; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D015331:Cohort Studies; D004311:Double-Blind Method; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D010919:Placebos; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods
chemical_list: D010919:Placebos
keywords: Acute kidney injury (AKI); Catheter dysfunction; Catheter-related infection; Double lumen vascular catheter; Guidewire exchange versus new venipuncture; Intensive care unit