THE HANDS-OFF CATHETER AND THE PREVENTION OF SYSTEMIC INFECTIONS ASSOCIATED WITH PULMONARY-ARTERY CATHETER - A PROSPECTIVE-STUDY

The Arrow ''Hands-Off'' thermodilution catheter (AHO) is completely sh ielded during balloon testing, preparation, and insertion. To assess t he value of the AHO in the prevention of systemic infections associate d with pulmonary artery catheterization (SIAPAC), we conducted a rando mized prospective study over an 18-mo period. The patients were random ly assigned to two groups, of which one received the thermodilution ca theter routinely used in our department and the other, the AHO cathete r. The diagnosis of SIAPAC was based on recovery of the same organism from the thermodilution catheter (TC) and blood samples, absence of an y other infectious focus, and improvement or resolution of clinical ev idence of infection after removal of the TC. A total of 166 TCs were r andomized in 150 patients. The two groups (mean +/- SD) were comparabl e in terms of age, SAPS on admission (15.6 +/- 5.2 versus 15.2 +/- 6.2 ), SAPS on the day of catheter insertion (17.6 +/- 4.8 versus 17.3 +/- 5.8), duration of catheter insertion (22.8 +/- 11.3 versus 25.3 +/- 1 9.5 min), insertion site, hemodynamic status, duration of use of the T C (3.6 +/- 1.3 versus 3.5 +/- 1.5 d), and outcome. A total of eight ca ses of SIAPAC were diagnosed in the standard TC group, versus none in the AHO group (p < 0.002). No cases of SIAPAC occurred in those patien ts who had their TC for less than four days. This study demonstrates t he value of the AHO for preventing systemic infections associated with prolonged pulmonary artery catheterization.