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Erschienen in: Intensive Care Medicine 11/2016

12.10.2016 | Original

Complications of intravascular catheters in ICU: definitions, incidence and severity. A randomized controlled trial comparing usual transparent dressings versus new-generation dressings (the ADVANCED study)

verfasst von: Silvia Calviño Günther, Carole Schwebel, Rebecca Hamidfar-Roy, Agnès Bonadona, Maxime Lugosi, Claire Ara-Somohano, Clémence Minet, Leïla Potton, Jean-Charles Cartier, Aurelien Vésin, Magalie Chautemps, Lenka Styfalova, Stephane Ruckly, Jean-François Timsit

Erschienen in: Intensive Care Medicine | Ausgabe 11/2016

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Abstract

Purpose

To describe all post-insertion complications involving most used intravascular access, and to determine whether the use of a new-generation transparent dressing (3M™ IV Advanced) might reduce their number and impact on ICU patient outcomes.

Methods

Patients older than 18, with an expected length of stay ≥48 h and requiring at least one central venous catheter (CVC), arterial catheter (AC), haemodialysis catheter (HDC), pulmonary arterial catheters (PAC) or peripheral venous catheter (PVC) were randomized into two groups: a new-generation transparent dressing, or the hospital’s classical transparent dressing, and were followed daily for any infectious and non-infectious complications. Complications were graduated for severity by an independent international multicentre multidisciplinary panel of practitioners using a Delphi process.

Results

We included 628 patients, 2214 catheters (873 PVCs, 630 CVCs, 512 ACs and 199 HDCs and PACs) and 4836 dressings. Overall incidence rate was of 60.9/1000 catheter-days. The most common complication was dysfunction (34.6/1000 catheter-days), mainly for PVCs (16/1000 catheter-days) and ACs (12.9/1000 catheter-days). Infectious complications incidence rate in CVCs and ACs was of 14.5/1000, mostly due to colonization (14.2/1000 catheter-days). Thrombosis incidence was of 3.8/1000 catheter-days with severe and very severe complications in 16 cases (1.8/1000 catheter-days) and one thrombosis-related death. 3M™ IV Advanced dressing did not decrease the rate of catheters with at least a minor complication [57.37/1000 vs. 57.52/1000 catheter-days, HR 1.03, CI (0.84–1.27), p = 0.81]. Incidence rates for each single complication remained equivalent: infectious [HR 0.93 (0.62–1.40), p = 0.72], deep thrombosis [HR 0.90 (0.39–2.06), = 0.80], extravasation and phlebitis [HR 1.40 (0.69–2.82), p = 0.35], accidental removal [1.07 (0.56–2.04), p = 0.84] and dysfunction [HR 1.04 (0.80–1.35), p = 0.79].

Conclusion

The ADVANCED study showed the overall risk of complications to intravascular catheters in ICU patients being dysfunction, infection and thrombosis. The 3M™ IV Advanced dressing did not decrease complication rates as compared to standard dressings.
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Metadaten
Titel
Complications of intravascular catheters in ICU: definitions, incidence and severity. A randomized controlled trial comparing usual transparent dressings versus new-generation dressings (the ADVANCED study)
verfasst von
Silvia Calviño Günther
Carole Schwebel
Rebecca Hamidfar-Roy
Agnès Bonadona
Maxime Lugosi
Claire Ara-Somohano
Clémence Minet
Leïla Potton
Jean-Charles Cartier
Aurelien Vésin
Magalie Chautemps
Lenka Styfalova
Stephane Ruckly
Jean-François Timsit
Publikationsdatum
12.10.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 11/2016
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4582-2

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