Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunctionReportar como inadecuado




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Critical Care

, 20:230

First Online: 30 July 2016Received: 12 April 2016Accepted: 01 July 2016

Abstract

BackgroundIntensive 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.

MethodsUsing 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.

ResultsDC 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.

ConclusionsGWE 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.

Trial registrationThis study is registered with ClinicalTrials.gov, number NCT00563342. Registered 2 April 2009.

KeywordsAcute kidney injury AKI Catheter-related infection Double lumen vascular catheter Guidewire exchange versus new venipuncture Catheter dysfunction Intensive care unit Electronic supplementary materialThe online version of this article doi:10.1186-s13054-016-1402-6 contains supplementary material, which is available to authorized users.

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Autor: Elisabeth Coupez - Jean-François Timsit - Stéphane Ruckly - Carole Schwebel - Didier Gruson - Emmanuel Canet - Kada Klouc

Fuente: https://link.springer.com/







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