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CHANGING CENTRAL LINES: A COMPARISON OF APPROACHES.

Intensive-care units have differing approaches to the replacement of central venous and pulmonary artery catheters, and it is unclear which approach leads to the fewest complications. This randomized trial assigned 160 patients to have their catheters replaced on a regular schedule (every three days) or only as needed. Each group was further randomized to have catheters replaced at the same site (exchanged over a guide wire) or inserted at a new site.

Scheduled catheter replacement was not associated with lower rates of sepsis when compared with as-needed replacement. Sepsis was somewhat less common when catheters were inserted at a new site than at the same site (about 2.5 vs. 4.5 instances per 1000 days of catheter use), but the difference was not statistically significant. Rates of mechanical complications (e.g., pneumothorax or arrhythmias) were significantly higher when catheters were inserted at new sites than at the same sites (5 percent vs. 1 percent).

These findings suggest that it is unnecessary to change central lines every three days; catheters can remain in place until a change is clinically indicated. When there is no obvious infection at the catheter site, replacement over a guide wire may be preferable to insertion at a new site: it decreases the risk of mechanical complications and does not significantly increase the risk of sepsis.

— ALK

Published in Journal Watch General Medicine October 13, 1992

Citation(s):

Cobb DK et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992 Oct 8 327 1062-1068.

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