Programmed Central Line Change on the Eighth Day Is Better than Being Guided by Signs of Infection for Changing it in Critically-ill Patients

Abstract

Objectives. Comparing the efficacy of a protocol for scheduled central line change 8 days after insertion to local/systemic driven change protocol regarding the prevention of central venous or arterial catheter colonisation and infection.

Design. Prospective, randomised clinical trial.

Patients. All patients admitted to the ICU requiring central venous catheter insertion from August 1st 2008 to October 31st 2009. Patients were randomly assigned to one of two groups according to timing of central line exchange. In one group, venous catheter was removed by day 8, and in the other group, it was removed guided by local or systemic signs of infection.

Measurements and Main Results. Catheter distal tips were quantitatively cultured in all patients. Significant catheter colonisation rate (i.e. > or = 103 colony-forming units [cfu]/mL by quantitative culture) and catheter-related sepsis (as defined by sepsis abating following catheter removal per 1,000 catheter-days) were significantly lower in the 8th day removal group (12 vs. 31 [0.4 relative risk; 0.1 to 0.9 95 % confidence interval; p < 0.1] and 6 vs. 16 [0.4 relative risk; 0.1 to 0.97 95 % confidence interval; p=0.05], respectively). Central venous catheter colonisation and central venous catheter-related sepsis rate per 1,000 catheter-days were also significantly lower in the 8th day removal group (8 vs. 31 [0.3 relative risk; 0.1 to 0.9 95 % confidence interval; p = 0.03] and 5 vs. 19 [0.3 relative risk; 0.1 to 0.9 95 % confidence interval; p = 0.02], respectively).

Conclusions. The 8th day catheter removal strategy was more effective than catheter removal strategy guided by signs of infection in terms of colonisation and catheter-related sepsis.