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Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Jean-François Timsit 1, 2 Julien Baleine 3 Louis Bernard 4 Silvia Calvino-Gunther 5 Michael Darmon 6 Jean Dellamonica 7 Eric Desruennes 8, 9 Marc Leone 10 Alain Lepape 11, 12 Olivier Leroy 13 Jean-Christophe Lucet 14, 2 Zied Merchaoui 15 Olivier Mimoz 16, 17 Benoit Misset 18 Jean-Jacques Parienti 19, 20 Jean-Pierre Quenot 21, 22, 23 Antoine Roch 24, 10 Matthieu Schmidt 25 Michel Slama 26 Bertrand Souweine 27 Jean-Ralph Zahar 2 Walter Zingg 28 Laetitia Bodet-Contentin 29 Virginie Maxime 30
Abstract : The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections' prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2- adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.
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Submitted on : Monday, January 11, 2021 - 11:34:50 AM
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Jean-François Timsit, Julien Baleine, Louis Bernard, Silvia Calvino-Gunther, Michael Darmon, et al.. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Annals of Intensive Care, SpringerOpen, 2020, 10 (1), pp.118. ⟨10.1186/s13613-020-00713-4⟩. ⟨hal-03105706⟩

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