背景:一项使用直导管的旧的回顾性研究认为,上行出口部位是最糟糕的频繁ESI。尚未对使用天鹅颈导管的3个出口部位方向进行比较研究,以确定哪个方向最适合我们的终点。易于看到出口现场的背面区域:ESBE,易于消毒出口现场的背面区域:EDBE,减少两个出口部位感染(ESI),有症状的导管脱位和腹膜炎。
方法:我们在定量横截面中评估了出口部位方向与终点的关系,多中心问卷调查。接受非手术导管植入或出口手术的患者被排除在外。
结果:纳入291例患者的出口方向数量(百分比)上升79(26.0),横向108(37.5)和向下105(36.5)。Cochran-Armitage分析显示,随着方向从向上向横向向向下变化,ESI的患病率显着逐步增加(0.15±0.41、0.25±0.54、0.38±0.69发作/患者年,p=0.03)。多变量回归分析显示,高出口位点独立地与ESBE的出现频率较高(OR5.55,95%CI2.23-16.45,p<0.01)和ESI患病率降低(OR0.55,95CI0.27-0.98,p=0.04)。症状性导管脱位的患病率与ESI呈正相关(OR2.84,95%CI1.27-7.82,p=0.01),观察到EDBE与症状性导管脱位(OR0.27,95%CI0.11-0.72)或腹膜炎(OR0.48,95%CI0.23-0.99)的患病率呈负相关.
结论:向上的天鹅颈导管出口可能是ESBE和预防ESI的最佳选择。EDBE可以减少导管脱位和腹膜炎。有症状的导管脱位可以预测ESI。
BACKGROUND: Upward-directed exit-site has been believed to be the worst for frequent ESI by an old retrospective study using straight catheters. No comparison study of 3 exit-site directions using swan-neck catheter has been performed regarding which
direction is the best for our endpoints, Easy-to-see the backside area of exit-site: ESBE, Easy-to-disinfect the backside area of exit-site: EDBE, reduction of both exit-site infection (ESI), symptomatic catheter dislocation and peritonitis.
METHODS: We assessed the relationship of exit-site
direction with our endpoints in a quantitative cross-sectional, multicentered questionnaire survey. Patients who received either non-surgical catheter implantation or exit-site surgery were excluded.
RESULTS: The numbers (percentage) of exit-site directions in included 291 patients were upward 79 (26.0), lateralward 108 (37.5) and downward 105 (36.5). Cochran-Armitage analysis showed a significant step-ladder increase in the prevalence of ESI as the
direction changed from upward to lateralward to downward (0.15 ± 0.41, 0.25 ± 0.54, 0.38 ± 0.69 episodes/patient-year, p = 0.03). Multivariable regression analysis revealed the upward exit-site independently associates with both higher frequency of ESBE (OR 5.55, 95% CI 2.23-16.45, p < 0.01) and reduction of prevalence of ESI (OR 0.55, 95%CI 0.27-0.98, p = 0.04). Positive association between the prevalence of symptomatic catheter dislocation and ESI (OR 2.84, 95% CI 1.27-7.82, p = 0.01), and inverse association between EDBE and either prevalence of symptomatic catheter dislocation (OR 0.27, 95% CI 0.11-0.72) or peritonitis (OR 0.48, 95% CI 0.23-0.99) observed.
CONCLUSIONS: Upward-directed swan-neck catheter exit-site may be the best for both ESBE and prevention of ESI. EDBE may reduce catheter dislocation and peritonitis. Symptomatic catheter dislocation may predict ESI.