Routine replacement of central venous catheters: telephone survey of intensive care units in mainland Britain

The incidence of sepsis with duration of central venous catheterisation remains controversial. Although some authors routinely replace central venous catheters,¹,² this practice is not supported by data from randomised, controlled studies.³,⁴ We surveyed intensive care units in mainland Britain to determine whether central venous catheters are replaced routinely.

Subjects, methods, and results

We conducted a telephone survey in the first two months of 1997 of all general intensive care units in mainland Britain mentioned in the Directory of Emergency and Special Care Units 1996. We spoke to the consultant when available or the senior sister on duty and asked about their current practice of replacing central venous catheters. Of the 169 units contacted, 165 agreed to participate, two were busy, and two refused to respond. We asked three questions: Does your intensive care unit practise routine scheduled replacement of central venous catheters? If so, for how long are catheters left in place before replacement? What is your current practice based on (research, audit, microbiology advice, no reason given)? Any additional comments were noted.

Eighty six of the respondents (52%) routinely replaced central venous catheters, leaving them in place for a mean of 6.5 days (SD 1.6, range 2-14 days); replacement was also scheduled by 22 of the 37 teaching hospitals (60%) and 64 of the 128 non-teaching hospitals (50%). The figure shows the distribution of the units’ practice according to the number of days before central venous catheters were replaced. Of the 86 units routinely replacing catheters, 23 based their practice on published research, three on local clinical audit, and nine on advice from their microbiology department, while 51 could not give a reason. Two units had been advised by their microbiology departments not to practise routine replacement; seven units said that their practice depended on the consultant on duty; two units had abandoned the practice in the past two years; one unit’s practice was arbitrary; one unit’s practice was pragmatic; and four units were in the process of implementing a policy.

Comment

Our survey shows that the routine replacement of central venous catheters in intensive care units in mainlaind Britain is variable. Examples of indications for replacement of central venous catheters included blocked lumens, inflamed entry sites, and suspected sepsis related to the catheter. Recent recommendations from the United States suggest that non-tunnelled central venous catheters should not be routinely replaced as a means of preventing catheter related infections.⁵ This guideline is strongly recommended for all hospitals and is supported by well designed studies.⁵

Fifty eight of the 86 units that routinely replaced central venous catheters removed them at 7 days. This practice was arbitrary, pragmatic, or influenced by conclusions from uncontrolled data.¹,² The incidence of sepsis related to the catheter is not increased when central venous catheters are replaced after more than three days.³,⁴ Scheduled replacement has recognised complications and is demanding of staff and resources. Despite the additional risks, the lack of evidence of benefit, and the extra costs entailed, routine scheduled replacement is still widely practised in many intensive care units in mainland Britain.

Figure.

Scheduled replacement of central venous catheters by 165 of the 169 intensive care units in mainland Britain listed in Directory of Emergency and Special Care Units 1996

Editorial byO’Leary and Bihari