Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-07-30

AUTHORS

Elisabeth Coupez, Jean-François Timsit, Stéphane Ruckly, Carole Schwebel, Didier Gruson, Emmanuel Canet, Kada Klouche, Laurent Argaud, Julien Bohe, Maïté Garrouste-Orgeas, Christophe Mariat, François Vincent, Sophie Cayot, Olivier Cointault, Alain Lepape, Michael Darmon, Alexandre Boyer, Elie Azoulay, Lila Bouadma, Alexandre Lautrette, Bertrand Souweine

ABSTRACT

BACKGROUND: Intensive care unit (ICU) patients require dialysis catheters (DCs) for renal replacement therapy (RRT). They carry a high risk of developing end-stage renal disease, and therefore their vascular access must be preserved. Guidewire exchange (GWE) is often used to avoid venipuncture insertion (VPI) at a new site. However, the impact of GWE on infection and dysfunction of DCs in the ICU is unknown. Our aim was to compare the effect of GWE and VPI on DC colonization and dysfunction in ICU patients. METHODS: Using data from the ELVIS randomized controlled trial (RCT) (1496 ICU adults requiring DC for RRT or plasma exchange) we performed a matched-cohort analysis. Cases were DCs inserted by GWE (n = 178). They were matched with DCs inserted by VPI. Matching criteria were participating centre, simplified acute physiology score (SAPS) II +/-10, insertion site (jugular or femoral), side for jugular site, and length of ICU stay before DC placement. We used a marginal Cox model to estimate the effect of DC insertion (GWE vs. VPI) on DC colonization and dysfunction. RESULTS: DC colonization rate was not different between GWE-DCs and VPI-DCs (10 (5.6 %) for both groups) but DC dysfunction was more frequent with GWE-DCs (67 (37.6 %) vs. 28 (15.7 %); hazard ratio (HR), 3.67 (2.07-6.49); p < 0.01). Results were similar if analysis was restricted to DCs changed for dysfunction. CONCLUSIONS: GWE for DCs in ICU patients, compared with VPI did not contribute to DC colonization or infection but was associated with more than twofold increase in DC dysfunction. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, number NCT00563342 . Registered 2 April 2009. More... »

PAGES

230

Journal

TITLE

Critical Care

ISSUE

1

VOLUME

20

Author Affiliations

  • Medical Intensive Care Unit, University Hospital of Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France
  • Medical and Infectious Diseases ICU -Paris Diderot University / Bichat Hospital, Paris, France
  • IAME UMR 1137 Inserm Université Paris Diderot, Paris, F-75018 France
  • U823 “Outcome of Cancers and Critical Illness,” Albert Bonniot Institute, La Tronche, France
  • Medical Intensive Care Unit, Pellegrin Teaching Hospital, University Hospital of Bordeaux, Bordeaux, France
  • Medical Intensive Care Unit, Saint Louis Teaching Hospital, Paris, France
  • Medical Intensive Care Unit, Lapeyronie Teaching Hospital, University Hospital of Montpellier, Montpellier, France
  • Medical Intensive Care Unit, Edouard Herriot Teaching Hospital, University of Lyon, Lyon, France
  • Medical Intensive Care Unit, University Hospital of Lyon, Lyon, France
  • Critical Care Medicine Unit, Saint-Joseph Hospital, Paris, France
  • Nephrology and Critical Care Unit, Nord Teaching Hospital, University of Saint Etienne, Saint Etienne, France
  • Medical Intensive Care Unit, Avicenne Teaching Hospital, Paris, France
  • Department of Anaesthesiology and Critical Care Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
  • Nephrology and Critical Care Medicine, Rangueil Teaching Hospital, University of Toulouse, Toulouse, France
  • Department of Anaesthesiology and Critical Care Medicine Pierre Benite Teaching Hospital, University Hospital of Lyon, Lyon, France
  • Medical Intensive Care Unit, Nord Teaching Hospital, University of Saint Etienne, Saint Etienne, France
  • Medical Intensive Care Unit, Bichat-Claude Bernard Teaching Hospital, Paris, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s13054-016-1402-6

    DOI

    http://dx.doi.org/10.1186/s13054-016-1402-6

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1047109127

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/27473868


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