INFECTIOUS RATES OF CENTRAL VENOUS-PRESSURE CATHETERS - COMPARISON BETWEEN NEWLY PLACED CATHETERS AND THOSE THAT HAVE BEEN CHANGED

Objective: To analyze the rate of infection of de novo, guidewire exch anged, and new site replacement catheters in a cohort of patients in w hom catheters were changed on the basis of the clinical discretion of the attending physicians. Design: We conducted an observational cohort study in catheterized patients in the intensive-care unit (ICU). Mate rial and Methods: ICU patients admitted between Jan, 1, 1991, and Dec, 31, 1992, were eligible for enrollment in the study, Catheter care, r eplacement, and duration were prospectively documented, Catheter-relat ed infection was prospectively evaluated, Rates of catheter-related in fection were determined for de novo, guidewire exchanged, and new site replacement catheters and analyzed relative to the duration of placem ent of individual catheters and the total duration of central venous c atheterization for a specific patient. Results: Fifty catheter-related infections developed in 2,470 patients, When the rate of catheter-ass ociated infection was determined for each type of catheterization, de novo catheters had a lower observed rate of infection than either repl acement type (P less than or equal to 0.0001). After controlling for t he effect of time, we found that the rate of catheter-related infectio ns associated with a de novo catheter was less than the rate in guidew ire exchanged catheters (P = 0.035), Rates of infection were similar b etween guidewire exchanged catheters and catheters replaced to a new s ite. Conclusion: In a population of ICU patients in whom catheter chan ge was governed by clinical-judgment, no differences were noted betwee n the observed rates of infection of new site replacement catheters an d guidewire exchange catheters.