Intensive Care Medicine

, Volume 42, Issue 11, pp 1753–1765 | Cite as

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)

  • 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
Original

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.

Keywords

Catheter-related complications Safety Adverse event ICU Dressing 

Notes

Compliance with ethical standards

Conflicts of interest

This study was financed by a research grant from 3M™ Health Care (Neuss, Germany). The sponsors of the study had no role in study design, data collection, analysis and interpretation, or writing of the report. Sponsors had no role either in the proposal or the election of the Delphi members. Corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. The corresponding author states that there is no further conflict of interest to disclose.

Supplementary material

134_2016_4582_MOESM1_ESM.doc (348 kb)
Supplementary material 1 (DOC 347 kb)
134_2016_4582_MOESM2_ESM.pdf (482 kb)
Supplementary material 2 (PDF 481 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Silvia Calviño Günther
    • 1
  • Carole Schwebel
    • 1
  • Rebecca Hamidfar-Roy
    • 1
  • Agnès Bonadona
    • 1
  • Maxime Lugosi
    • 1
  • Claire Ara-Somohano
    • 1
  • Clémence Minet
    • 1
  • Leïla Potton
    • 1
  • Jean-Charles Cartier
    • 1
  • Aurelien Vésin
    • 2
  • Magalie Chautemps
    • 1
  • Lenka Styfalova
    • 1
  • Stephane Ruckly
    • 2
  • Jean-François Timsit
    • 2
    • 3
    • 4
  1. 1.University Hospital of Grenoble Alpes, Medical Intensive Care UnitAlbert Michallon Teaching HospitalGrenoble Cedex 9France
  2. 2.Albert Bonniot Institute, INSERM U823 “Outcome of Cancer and Critical Illness”GrenobleFrance
  3. 3.Medical and Infectious Diseases Intensive Care UnitAP-HP, Bichat-Claude Bernard Teaching HospitalParisFrance
  4. 4.Inserm Paris-Diderot University-UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and CareParisFrance

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