Cambio de catéter central programado al octavo día es superior al cambio guiado por signos de infección en pacientes críticamente enfermos

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 1^st 2008 to October 31^st 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 = 10 ³ 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 8^th day catheter removal strategy was more effective than catheter removal strategy guided by signs of infection in terms of colonisation and catheter-related sepsis.