CENTRAL VENOUS CATHETER REPLACEMENT STRATEGIES - A SYSTEMATIC REVIEW OF THE LITERATURE

Objective: To evaluate the effect of guidewire exchange and new site r eplacement strategies on the frequency of catheter colonization and in fection, catheter-related bacteremia, and mechanical complications in critically ill patients.Data Sources: We searched for published and un published research by means of MEDLINE and Science Citation Index, man ual searching of Index Medicus, citation review of relevant primary an d review articles, review of personal files, and contact with primary investigators. Study Selection: From a pool of 151 randomized, control led trials on central venous catheter management, we identified 12 rel evant randomized trials of catheter replacement over a guidewire or at a new site. Data Extraction: In duplicate and independently, we abstr acted data on the population, intervention, outcome, and methodologic quality. Data Synthesis: As compared with new-site replacement, guidew ire exchange is associated with a trend toward a higher rate of cathet er colonization (relative risk 1.26, 95% confidence interval 0.87 to 1 .84), regardless of whether patients had a suspected infection, Guidew ire exchange is also associated with trends toward a higher rate of ca theter exit-site infection (relative risk 1.52, 95% confidence interva l 0.34 to 6.73) and catheter-related bacteremia (relative risk 1.72, 9 5% confidence interval 0.89 to 3.33), However, guidewire exchange is a ssociated with fewer mechanical complications (relative risk 0.48, 95% confidence interval 0.12 to 1.91) relative to new-site replacement. E xchanging catheters over guidewires or at new sites every 3 days is no t beneficial in reducing infections, compared with catheter replacemen t on an as-needed basis. Conclusions: Guidewire exchange of central ve nous catheters may be associated with a greater risk of catheter-relat ed infection but fewer mechanical complications than new-site replacem ent, More studies on scheduled vs, as needed replacement strategies us ing both techniques are warranted, if guidewire exchange is used, meti culous aseptic technique is necessary.