title: Complications of intravascular catheters in ICU: definitions, incidence and severity. A randomized controlled trial comparing usual transparent dressings versus new-generation dressings (the ADVANCED study).
abstract: OBJECTIVE
  To describe all post-insertion complications involving most used intravascular access, and to determine whether the use of a new-generation transparent dressing (3M™ IV Advanced) might reduce their number and impact on ICU patient outcomes.
  
  
  METHODS
  Patients older than 18, with an expected length of stay ≥48 h and requiring at least one central venous catheter (CVC), arterial catheter (AC), haemodialysis catheter (HDC), pulmonary arterial catheters (PAC) or peripheral venous catheter (PVC) were randomized into two groups: a new-generation transparent dressing, or the hospital's classical transparent dressing, and were followed daily for any infectious and non-infectious complications. Complications were graduated for severity by an independent international multicentre multidisciplinary panel of practitioners using a Delphi process.
  
  
  RESULTS
  We included 628 patients, 2214 catheters (873 PVCs, 630 CVCs, 512 ACs and 199 HDCs and PACs) and 4836 dressings. Overall incidence rate was of 60.9/1000 catheter-days. The most common complication was dysfunction (34.6/1000 catheter-days), mainly for PVCs (16/1000 catheter-days) and ACs (12.9/1000 catheter-days). Infectious complications incidence rate in CVCs and ACs was of 14.5/1000, mostly due to colonization (14.2/1000 catheter-days). Thrombosis incidence was of 3.8/1000 catheter-days with severe and very severe complications in 16 cases (1.8/1000 catheter-days) and one thrombosis-related death. 3M™ IV Advanced dressing did not decrease the rate of catheters with at least a minor complication [57.37/1000 vs. 57.52/1000 catheter-days, HR 1.03, CI (0.84-1.27), p = 0.81]. Incidence rates for each single complication remained equivalent: infectious [HR 0.93 (0.62-1.40), p = 0.72], deep thrombosis [HR 0.90 (0.39-2.06), p = 0.80], extravasation and phlebitis [HR 1.40 (0.69-2.82), p = 0.35], accidental removal [1.07 (0.56-2.04), p = 0.84] and dysfunction [HR 1.04 (0.80-1.35), p = 0.79].
  
  
  CONCLUSIONS
  The ADVANCED study showed the overall risk of complications to intravascular catheters in ICU patients being dysfunction, infection and thrombosis. The 3M™ IV Advanced dressing did not decrease complication rates as compared to standard dressings.
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France. SCalvino-gunther@chu-grenoble.fr.
authors.forename: Silvia Calviño
authors.identifier: http://orcid.org/0000-0003-3586-7205
authors.initials: SC
authors.lastname: Günther
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hamidfar-Roy
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Bonadona
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Lugosi
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Ara-Somohano
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Minet
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Leïla
authors.initials: L
authors.lastname: Potton
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Cartier
authors.affiliation: Albert Bonniot Institute, INSERM U823 "Outcome of Cancer and Critical Illness", 38076, Grenoble, France.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Vésin
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Magalie
authors.initials: M
authors.lastname: Chautemps
authors.affiliation: University Hospital of Grenoble Alpes, Medical Intensive Care Unit, Albert Michallon Teaching Hospital, CS10217, 38043, Grenoble Cedex 9, France.
authors.forename: Lenka
authors.initials: L
authors.lastname: Styfalova
authors.affiliation: Albert Bonniot Institute, INSERM U823 "Outcome of Cancer and Critical Illness", 38076, Grenoble, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Ruckly
authors.affiliation: Albert Bonniot Institute, INSERM U823 "Outcome of Cancer and Critical Illness", 38076, Grenoble, France.|Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard Teaching Hospital, 75018, Paris, France.|Inserm Paris-Diderot University-UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care, Sorbonne Paris Cité, 75018, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000328:Adult; D001458:Bandages; D055499:Catheter-Related Infections / Q000209:etiology*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D003697:Delphi Technique; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D057194:Intention to Treat Analysis; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013927:Thrombosis / Q000209:etiology*; D013997:Time Factors
keywords: Adverse event; Catheter-related complications; Dressing; ICU; Safety