Abstract
BackgroundThe impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), catheter-related bloodstream infections (CR-BSI) or colonization, using univariate and multivariate marginal Cox model for clustered data. The skin colonization at catheter removal was evaluated to explain our results.ResultsWe used individual data from two multicenter randomized-controlled trials (RCTs) that included a total of 3029 patients, 10 ICUs and 3950 ACs. US guidance was used for 386 (9.8%) catheter placements. In the univariate Cox model analysis, AC insertion with US versus without US exhibited similar risks for MCRI (HR 0.86, CI 95% 0.27–2.72, p = 0.79), CR-BSI (HR 0.87, CI 95% 0.20–3.72, p = 0.85) and catheter colonization (HR 1.31, CI 95% 0.92–1.86, p = 0.13). After adjustment on confounders, risks associated with US guidance remained similar versus non-US for MCRI (HR 0.71, CI 95% 0.23–2.24, p = 0.56), CR-BSI (HR 0.71, CI 95% 0.17–3.00, p = 0.63) and catheter colonization (HR 0.92, CI 95% 0.63–1.34, p = 0.67). No differences between US and non-US for MCRI, CR-BSI and colonization were observed according to the insertion site, radial or femoral. At catheter removal, the skin colonization was similar between US and non-US groups (p = 0.69).ConclusionsUsing the largest dataset ever collected from large multi-centric RCTs conducted with relatively consistent insertion and maintenance catheter protocols, we showed that the risk of infectious complications for ACs inserted under US guidance is not superior compared to those inserted without US guidance.Trial registration These studies were registered within ClinicalTrials.gov (numbers NCT01629550 and NCT 01189682).
Highlights
The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs)
Our primary aim was to investigate the association between ultrasound guidance (US) for AC insertion and the intravascular catheter-related infection or colonization, using data gathered for two large Randomized-controlled trial (RCT) with an extensive prospective data collection at catheter insertion and catheter removal [6, 7]
All study centers complied with the French recommendations for catheter insertion and care, which are similar to CDC recommendations [8]: (1) maximal sterile barrier precautions; (2) the site of insertion was left to the discretion of the physician caring for the patient; (3) alcoholic povidone iodine solution or chlorhexidine gluconate was used for skin antisepsis at catheter insertion and during dressing changes; (4) semipermeable chlorhexidine-impregnated or standard dressing was used at all insertion sites and was changed 24 h after catheter insertion and every 3 or 7 days according to standard practice in each Intensive Care Unit (ICU)
Summary
The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). Arterial catheterization using anatomical ‘landmarks’ is associated with an increase in the number of attempts and time needed for successful cannulation [3,4,5]. The ultrasound guidance effect on infectious risk remains controversial. No large randomized-controlled trials (RCTs) analyzed the infectious risk between both AC insertion strategies, anatomical landmarks’ technique and ultrasound guidance. Our primary aim was to investigate the association between ultrasound guidance (US) for AC insertion and the intravascular catheter-related infection or colonization, using data gathered for two large RCTs with an extensive prospective data collection at catheter insertion and catheter removal [6, 7]
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