응급의료센터와 중환자실에서 시행된 중심정맥카테터 감염률 비교

Abstract

Purpose: The purpose of this study was to compare the rate of bloodstream infections associated with use of central venous catheters (CVCs) by an emergency department (ED) versus an intensive care unit (ICU). Methods: Using the hospital administrative and billing database,we identified patients who received CVCs between January 1, 2006, and December 31, 2009 in the ED and ICU at an academic, urban hospital with an annual census of 55,000. We performed a structured, explicit chart review to determine durations of catheterization and rates of bloodstream infections. Results: We screened 4,088 charts and identified 1,480patients with CVCs that were administered in the ED, (total of 12,888 catheter-days with 47 bloodstream infections),and 982 patients with CVCs that were administered in the ICU (13,326 catheter-days with 52 bloodstream infections). The rate of bloodstream infections associated with CVCs placed in the ED was 3.65 per 1,000 catheter-days (95%confidence interval 2.68 to 4.85), and the rate of bloodstream infections in the ICU was 3.75 per 1,000 catheterdays (95% confidence interval 2.91 to 5.12). The median duration of catheterization was 6.0 days in the ED, and 10.0days in the ICU. Among the infected CVCs, the median duration of catheterization was 12.0 days in the ED, and 14.0 days in the ICU. Of 1480 total CVCs administered in the ED, 897 were placed in the subclavian veins (61%), 554in the internal jugular (37%), and 29 were placed in femoral veins (2%). Of the total 982 CVCs administered in the ICU,779 were placed in the subclavian veins (79%), 158 in the internal jugular veins (16%), and 45 in femoral veins (4.3%). Conclusion: The rate of bloodstream infections in the ED is comparable to those in the ICU. The duration of catheterization was found to be a more important factor than the CVC insertion location.