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)

• Published in: Intensive care medicine Vol. 42; no. 11; pp. 1753 - 1765
• Main Authors: Günther, Silvia Calviño, Schwebel, Carole, Hamidfar-Roy, Rebecca, Bonadona, Agnès, Lugosi, Maxime, Ara-Somohano, Claire, Minet, Clémence, Potton, Leïla, Cartier, Jean-Charles, Vésin, Aurelien, Chautemps, Magalie, Styfalova, Lenka, Ruckly, Stephane, Timsit, Jean-François
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2016; Springer; Springer Nature B.V
• Subjects: Adult; Anesthesiology; Bandages; Binomial distribution; Blood clot; Catheter-Related Infections - etiology; Catheterization, Peripheral - adverse effects; Catheters; Catheters, Indwelling - adverse effects; Central Venous Catheters - adverse effects; Clinical trials; Critical Care Medicine; Delphi Technique; Emergency Medicine; Equipment Failure; Female; Health aspects; Hospital patients; Humans; Incidence; Intensive; Intensive care; Intensive Care Units; Intention to Treat Analysis; Length of Stay; Male; Medical equipment; Medicine; Medicine & Public Health; Nosocomial infections; Original; Pain Medicine; Patients; Pediatrics; Phlebitis; Pneumology/Respiratory System; Prospective Studies; Severity of Illness Index; Statistical analysis; Statistics, Nonparametric; Thrombosis; Thrombosis - etiology; Time Factors; France; Adverse event; Dressing; ICU; Safety; Catheter-related complications
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-016-4582-2

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), p  = 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.