Effect of Frequent Guidewire Changes on Triple-Lumen Catheter Sepsis

Frequent guidewire changes of single-lumen (SLC) and triple-lumen (TLC) catheters have been proposed to decrease catheter sepsis. We placed TLC in 126 patients needing total parenteral nutrition (TPN) and multiple venous access, prospectively randomizing them to two groups: group I received a guidew...

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Published in:	JPEN. Journal of parenteral and enteral nutrition Vol. 12; no. 5; pp. 462 - 464
Main Authors:	Powell, Carla, Kudsk, Kenneth A., Kulich, Patricia A., Mandelbaum, Jon A., Fabri, Peter J.
Format:	Journal Article
Language:	English
Published:	Thousand Oaks, CA Sage Publications 01-09-1988 SAGE Publications ASPEN
Subjects:	Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Catheters, Indwelling - adverse effects Clinical Trials as Topic Emergency and intensive care: techniques, logistics Female Humans Intensive care medicine Male Medical sciences Middle Aged Parenteral Nutrition, Total - adverse effects Parenteral Nutrition, Total - instrumentation Parenteral Nutrition, Total - methods Perfusions. Catheterizations. Hyperbaric oxygenotherapy Prospective Studies Random Allocation Sepsis - etiology Time Factors Human Infection Catheterization Catheter Bacteria Complication Vein Contamination Resuscitation Parenteral administration Feeding
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Summary:	Frequent guidewire changes of single-lumen (SLC) and triple-lumen (TLC) catheters have been proposed to decrease catheter sepsis. We placed TLC in 126 patients needing total parenteral nutrition (TPN) and multiple venous access, prospectively randomizing them to two groups: group I received a guidewire change every 3 days, and group II received guidewire changes for mechanical or septic complications only. Tips were cultured at each line change and tips and blood for each septic episode. Catheter sepsis was defined by the criteria of the Association for Practitioners in Infection Control (APIC). There were 67 positive cultures in 52 patients, but most produced very few colonies or grew the same organisms in other infection sites. Forty-seven% of all cultures grew Staphylococci, and 23% grew Candida. APIC-defined catheter sepsis was detected in 12.7% of group I and 15.9% of group II. Although we observed no statistically significant difference in the two techniques, if we assume that a 20% difference in the incidence of catheter-induced sepsis would be important to detect, the probability of failing to detect such a difference is 0.24 with an 0.05 level of significance (two-sided). Prophylactic guidewire changes did not alter the incidence of catheter sepsis in patients with TLC who required TPN. The high rate of sepsis and Candida infection may be due to the critical illness of the immunocompromised population studied. (Journal of Parenteral and Enteral Nutrition 12:462-464, 1988)
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	0148-6071 1941-2444
DOI:	10.1177/0148607188012005462