The duration of placement as a predictor of peripheral and pulmonary arterial catheter infections☆

Prospective study of arterial and central venous catheter colonization and of arterial- and central venous catheter–related bacteremia in intensive care units*

“…Some study reports give no details on the culture techniques used (9,10,21). The varied nature of these reports probably accounts for the wide discrepancies in the frequency of infection, with cumulative incidence ranging between 0.4% and 43% and incidence density between 5 and 32 per 1,000 days of catheter use (4,5,9,23). In our study, cumulative incidence was 7.7% and incidence density was 9.3 per 1,000 days of catheter use.…”

Guidelines for the prevention of intravascular catheter-related infections

“…P ! .001 A prospective observational study of 71 pulmonary artery catheters demonstrated higher infection rates in catheters left in place longer than 7 days (2% before 7 days versus 16% after 7 days; ) [147]. However, no studies indicate that cath-P p .056 eter replacement at scheduled time intervals is an effective method to reduce CRBSI [132,135].…”

“…One study of peripheral arterial catheters demonstrated no difference in infection rates between changing catheters at scheduled times and changing arterial catheters on an as-needed basis [132]. One observational study of 71 arterial catheters revealed that 10 local infections and four CRBSIs occurred in patients who had peripheral arterial catheters in place for 14 days compared with one local infection and no CRBSIs in patients whose catheters were in place !4 days ( ) [147]. Because the risk for CRBSI is likely similar to P !…”

Comparison between replacement at 4 days and 7 days of the infection rate for pulmonary artery catheters in an intensive care unit*

“…Previous studies of PA catheters have shown that the risk of infection increases with the duration of catheterization (5,11,17), although some reports have found no such association (3,8,18). Four studies have found that the incidence of infection increases with use of the same PA catheter for Ͼ4 days (19 -22).…”

“…Our hypothesis was that prolonging replacement of the catheter and pressure monitoring systems to 7 days would not increase the risk of colonization and/or infection. By using a previous calculation of sample size for this study, which was based on a previous study (11), and a routine component surveillance of the ICU, we used ␣ ϭ .05, power 80%, and a 1:1 ratio (4-day vs. 7-day), and the expected frequency of catheterassociated complications was 5% in the 4-day group and 18% in the 7-day group. The estimated total sample size was 216 patients.…”