Ultrasound guidance practices used for the placement of vascular accesses in intensive care units: an observational multicentre study.
Arterial catheter
Dialysis catheter
Improvement of practices
Infectious risk
Intensive care unit
Long-lasting peripheral venous catheters
Peripheral inserted central catheter
Short-term central venous catheter
Ultrasound guidance
Journal
European journal of medical research
ISSN: 2047-783X
Titre abrégé: Eur J Med Res
Pays: England
ID NLM: 9517857
Informations de publication
Date de publication:
16 Nov 2023
16 Nov 2023
Historique:
received:
25
04
2023
accepted:
08
11
2023
medline:
27
11
2023
pubmed:
17
11
2023
entrez:
17
11
2023
Statut:
epublish
Résumé
Central catheters expose ICU patients at risk of catheter-related bloodstream infections. A mechanism by which these infections occur is the contamination of the catheter during its insertion if aseptic techniques are not strictly applied. Recent studies suggest that the use of ultrasound guidance (USG) may increase the risk of catheter contamination during insertion. We assessed current practices regarding the use of USG during catheter insertion, with a focus on identifying breaches of the surgical asepsis required for this invasive procedure. In 26 intensive care units, we evaluated the use of USG during catheter insertion, using a questionnaire addressed to intensivists and direct observation of their practices. We analyzed 111 questionnaires and 36 observations of intensivists placing catheters. The questionnaires revealed that 88% of intensivists used USG for catheter insertion. Among those using USG, 56% had received specific training, 17% benefited from specific recommendations, 76% marked the insertion site before skin antisepsis, and during catheter insertion, 96% used sterile gel and 100% used a sterile sheath and sterile gloves. We identified potential deviations from strict aseptic technique, including contact between the sheath and the needle (19.4%), handling of the US system during catheter insertion (2.8%), and use of sterile devices, where they were not yet necessary (during the marking site or skin antisepsis), resulting in their contamination at the time of catheter insertion. Interventions aimed at ensuring compliance with measures to prevent CRBs should be organized to prevent an increase in infections associated with US-guided catheter insertion.
Sections du résumé
BACKGROUND
BACKGROUND
Central catheters expose ICU patients at risk of catheter-related bloodstream infections. A mechanism by which these infections occur is the contamination of the catheter during its insertion if aseptic techniques are not strictly applied. Recent studies suggest that the use of ultrasound guidance (USG) may increase the risk of catheter contamination during insertion. We assessed current practices regarding the use of USG during catheter insertion, with a focus on identifying breaches of the surgical asepsis required for this invasive procedure.
METHODS
METHODS
In 26 intensive care units, we evaluated the use of USG during catheter insertion, using a questionnaire addressed to intensivists and direct observation of their practices.
RESULTS
RESULTS
We analyzed 111 questionnaires and 36 observations of intensivists placing catheters. The questionnaires revealed that 88% of intensivists used USG for catheter insertion. Among those using USG, 56% had received specific training, 17% benefited from specific recommendations, 76% marked the insertion site before skin antisepsis, and during catheter insertion, 96% used sterile gel and 100% used a sterile sheath and sterile gloves. We identified potential deviations from strict aseptic technique, including contact between the sheath and the needle (19.4%), handling of the US system during catheter insertion (2.8%), and use of sterile devices, where they were not yet necessary (during the marking site or skin antisepsis), resulting in their contamination at the time of catheter insertion.
CONCLUSIONS
CONCLUSIONS
Interventions aimed at ensuring compliance with measures to prevent CRBs should be organized to prevent an increase in infections associated with US-guided catheter insertion.
Identifiants
pubmed: 37974277
doi: 10.1186/s40001-023-01518-4
pii: 10.1186/s40001-023-01518-4
pmc: PMC10652560
doi:
Types de publication
Multicenter Study
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
528Investigateurs
Alexandra Allaire
(A)
Elise Balestrat Sovic
(EB)
Frédéric Barbut
(F)
Patrick Barthelemy
(P)
Pierre Berger
(P)
Marie-Camille Betti
(MC)
Mathilde Blanié
(M)
Isabelle Cattaneo
(I)
Agnès Cecille
(A)
Hiba Chakaroun
(H)
Anne-Clémence Cholley
(AC)
Marion David
(M)
Aude Davy
(A)
Joël Delhomme
(J)
Catherine Duval
(C)
Stéphanie Edouard
(S)
Laure Gabriele
(L)
Séverine Gallais
(S)
Colette Gerbier
(C)
Gilles Manquat
(G)
Valérie Goldstein
(V)
Florence Gourdon
(F)
Sylvie Joron
(S)
Anne-Marie Kayoulou-Bour
(AM)
Gratienne Laethem
(G)
Florence Lemann
(F)
Martine Lemenager
(M)
Marie-Laure Lier
(ML)
Malcie Mesnil
(M)
Nadine Mertel
(N)
Virginie Morange
(V)
Benoit Mottet
(B)
Stella Niot
(S)
Souad Ouzani
(S)
Christophe Perdrix
(C)
Amélie Renaud
(A)
Clémence Richaud
(C)
Catherine Rougier
(C)
Maryline Tarsac
(M)
Myriam Venelle
(M)
Isabelle Vidal
(I)
Informations de copyright
© 2023. The Author(s).
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