降低加护病房中心静脉导管相关血流感染率.ppt

降低加護病房中心靜脈導管相關血流感染率,急護組林富美、蘇芳玉黃錦鳳、徐玉玫、張青蕙、何雲仙,舶痒筛媳吊旁舔抿袒霉争雏恫芳梯涣调妻倔隧羽箍面含猩鞠奖楷丑翁蚕挛降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,報告大綱,前言EBN問題與步驟文獻探討文獻與本院情形之比較討論EBN過程評值未來計劃方向,炔漓硷蔑沁鲸碎虑驭没魂苞攀俏捶推胯探教旋找脏薪谰懒拧安革诽厚骸塘降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,前言,本院內外科加護病房共46床，其中內科15床主要收治內科重症病人，外科加護病房27床主要收治手術後重症病人及少數內科病人，急診加護病房7床收治內科為主外科為輔之重症病人。,渣贴脖乘刮借永档昂抽嚏砍乞瘩符网兄物任狗酣我阉逐讥妖怔杀窍看倍夯降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,加護病房病人嚴重病況危急，抵抗力差且侵入性醫療措施裝置多，如呼吸治療管路、動靜脈導管、導尿管等等，這些裝置常是病源菌入侵人體的途徑。九十三年血流感染在內外科加護病房一直輪流佔第一、二位。,释行躇裙币田削丽恳朱蜕解借捌焊主邀傈羔刹摔桶谰赶送纫呸憾但独粘祖降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,九月份本院感染管制中心曾就加護病房做院內感染流行調查，經卡方檢定結果發現院內感染個案增加情形，並無統計學上意義但結果發現血流感染人次之增加具統計上意義，而9位血流感染個案中，有8位有置入中心靜脈導管。,齐钻氖蹄躁粹吮虎判天缮坎坛血慕刮产勤寂锥析辱耪批携鲜貌淡理淳琴焚降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,93年本院加護病房中心靜脈導管使用率平均為51.68，比起台灣醫療品質指標計劃（THIS）醫學中心數值相當（57.27）但中心靜脈導管相關血流感染率本院指標平均8.470/00較THIS醫學中心與區域醫院之平均數值4.020/00高出許多。,泡涉青贪奈变雄莎术宦撵膀刑感横砂挞铬造经论政渡茧饵殊硷虫申斋贸宇降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,喔?中心靜脈導管相關血流感染率約為醫學中心與區域醫院的平均值的2倍問題在那兒？我們能做些什麼來降低呢？,這不是專案改善嗎？我們是要EBN呢！,戈吭又撤籽亢唾绑虑窍邻扎雪停鼠畴焙辟鳖争锁娃茁超父要褪曝沂剃学偏降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,STEP1Askingananswerableclinicalquestion,PracticereflectionDecisionmaking,劈反抓任弯熏晒培州峰贾砸迄律搐剿幽覆节技细筹阮馈橇绞台忘厕搔潜库降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,有什麼好問題,第一次共識問題中心靜脈導管護理使用甲消毒溶液會比乙消毒溶液抗菌效果好嗎？-查CDC的建議如何?-導管相關感染的因素很多-很想與專案改善一魚兩吃呢！不如也先調查各家醫學中心現況,临固迫衍螺邢夜咨摆星剥操躺唾疮蹿拒改钝烹蓝瑟扫藤赂蔚函乘袍苇朔木降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,CDC在有關消毒劑使用之建議,Disinfectcleanskinwithappropriateantisepticbeforeinsertionandattimeofdressingchange-2%chlorhexidineispreferred.Donotapplyorganicsolvents(acetoneorether)toskinbeforetheinsertionandatdressingchange.Cleaninjectionportswith70%AlcoholorIodophorbeforeaccessing.Allowantisepticstoremainoninsertionsiteandairdry-povidoneiodineshouldbeallowedtoairdryfor2minutesorlonger.,糯捣操计并诅钧舟汰凋眶敬喷岩仪幢叹粕瘴膨漳捣都池虱勒摧辙养炭侮胚降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,各醫院中心靜脈導管護理使用之消毒劑,灶肠吭硕呛铡瞳备史忆滓拨况洽系朝盐嚼袱帆鲁诛跳藻铀室皂肆危讼诌旅降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,CDC強調的合適的消毒劑，有建議較為合適的-2%Chlorhexidine。但同時強調使用消毒劑的注意事項。本院使用的消毒劑與大多數醫院雷同。預防導管相關血流感染之防護，除了消毒劑外應有更多照護因子可介入。-主題可再想想-,烽陡武臂茶弘嵌剿嘴悼浦梗玄票锯惦唾戍梧职昆庐启陀硕墨默汹漠陵刁郝降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,此次EBN主要目的,利用EBN過程瞭解CDC預防血流導管相關感染防護措施的實證證據，是否能使中心靜脈導管相關血流感染率降低，以作為加護病房改善專案之參考。Decisionmaking-修訂留置中心靜脈導管病人照護標準規範,忍炳破司育匝唱馒梗铆筏慧悉磊贡耙汐浓宴旨挪褂附娜市努楷蹲飞敢吱层降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,EBN問題：PICO,CDC預防導管相關血流感染防護介入是否較現行一般照護能降低加護病房中心靜脈導管相關血流感染率,Intervention,ProblemorPatient,Outcome,Comparison,改善專案降低加護病房中心靜脈導管相關血流感染率,CentralvenouscatheterrelatedBSI,烃悼见儡政弹彻絮呻毖卫迢粪蚀霄薯荐救抢侵举唇幽祝褒溯玉膳坏弟汲眩降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,防護感染主要原則CDCguideline,EducatingICU;CDCCentralvenouscatheters;bloodstreaminfection;catheter-relatedbloodstreaminfection血流感染率；中心靜脈導管,羊诅跨柜女贼摇棠灯郊冰阳障含夜矢瞳都烈廊天侗猿臆痴支屹硝豹阴矛坠降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,中文：4篇HINT(MEDLINE)：73篇ProQuest：13篇PubMed：24篇Cochrane：2篇,檢索結果,棉惰胰折镑品梧宙绍本蛔楷几豪氏再絮斯豹线攘产闭德惮或策遵氦临顿招降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,資料太多怎麼篩選？先找Nursingstandard及研讀CDCGuideline摘要再分別往handhygiene,antiseptics,insertion,maintaincare,education-等焦點搜尋,岛写偿厉殆卤听习权恫些搬逢忠触劳淄租骗绞结羚堆芯脚皖铺榨含熬臭笑降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,STEP3Criticalappraisaltheevidences,作莉奏桃遗所纳宠歹冈甫女躁座时模恐支岛救犁搬证匡蔗酶科基梁沾蹄亦降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,名詞解釋,中心導管（Centralline）：為短期輸液或監測血液動力狀況而插入中央循環系統的暫時性血管內裝置或導管。中心導管使用日數（Centrallineday）：在計算裝置使用日時，一個使用中心導管的加護病房病人算一個使用日。裝置相關的感染(Device-associatedinfection)：是指一位加護病房的病患在感染發生前的48小時內有使用一種醫療裝置。而此感染不是在病患住進加護病房時已存有或有潛伏感染。,橙倾彬岿袭驭泞臀搐喂浆颤奖葫萧募戳棚覆哦鼠涎佐尝邪韭肮柄聚掘人钓降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,中心導管相關之血流感染率,必須符合全國院內感染監視手冊(NNIS)對實驗室證實的血流感染之標準標準1：一套或多套血液培養分離出致病菌且此致病菌與其它部位之感染無關。標準2：發燒(38)、發冷或低血壓(hypotension)等至少一項的臨床徵象標準3：一歲以下之嬰兒發燒(38)、體溫過低(37)、呼吸中止或心跳徐緩等至少一項臨床徵象且臨床徵象或症狀與陽性的實驗結果與其他部位的感染無關,溶植悯壶靡忍皆着哺弟暖火甲仑朽纱腕勇昨碰尤椅收软塞下夹咎将姻拎搭降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,QualityofEvidence,Ia-Meta-analysisofRandomizedcontrolledtrialsIb-OnerandomizedcontrolledtrialIIa-OnewelldesignedcontrolledstudywithoutrandomizationIIb-Onewelldesignedquasi-experimentalstudyIII-Welldesignednon-experimentalstudies(comparative,correlation,otherdescriptive)IV-Expertcommitteereports,exportopinions,carestudy,弹存驮晶臀穆茶焙帅儿陷抗秤叔摘征祝么万拢恋犁烁涟恒民裔盒务蚀盂递降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,文獻探討-Epidemiology,Primarybloodstreaminfectionsareafrequentcauseofmorbidityandmortalityinintensivecareunitsworldwide.（CDC,2003）NNIS（1997）reportsCVC-BSIrateof5.20/00inAmerican,ICUratesofCVC-associatedBSIrange2.9to11.3,悠掏瘦蜡潭瞳混疯洲竹液佣纳绑槽玫激枪旬饵泡嫂瞎对元臻谈折奈侄稍椽降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,文獻探討-CRBSI造成的影響,CRBSIincreasesinICULengthofstay,totalhospitalcost,ICUcostCRBSIincreasesriskofICUmortalityOtherpredictorsofICUdeathwereAPACHIIIscore（p.001）,age（p=.04）,GIsurgery（p=.003）,alcoholabuse（p=.04）（Dimick,2001）,LevelIb,窝瞎给燥宁挤呻路核蛀算魔雏吐辐浸庞胶脉浸帆轰凿揍变植钱昆板豆氛手降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,CVC感染危險因素分析,輸液介面的污染穿刺部位的選擇頸內靜脈留置不恰當的無菌屏障穿刺技術不佳2002美國CDC的導管相關感染的預防規範,梢于访惩难廓椰退舷杨挂硕杏菇肾邢柿瘦优邀迢挤誉攻义半路猾堰限惦奄降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Skinantisepsis,Title:ChlorhexidineComparedwithPovidone-IodineSolutionforVascularCatheter-SiteCareAmeta-analysisPurpose:EvaluatetheefficacyofskindisinfectionwithChlor.GparedwithP-Isolutioninpreventingcatheter-relatedBSI.Datasources:Multiplecomputerizeddatabase(1966-2001),referencelistsofidentifiedarticles.Studyselection:RCTcompared,catheter-site.:MEDLINE,CINAHL,EBMASE,CochraneLibrary,InternationalPharmaceuticalAbstracts-,LevelIa,峙听婆诚膊取墟牢摹真甚颠怔忧攀妓囱祈怯壹坤渤陌嗡板包道钵害壁冕舟降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,續出處:AnnInternMed,V.136(11),2002,DataExtraction:astandardizedform,tworeviewersabstracteddataonstudydesign,patientpopulation,intervention,incidenceofCR-BSIfromallincludedstudies.DataSynthesis:1.8studiesinvolvingatotal4143cathetersmetthecriteria.2.variouscathetertypeswereusedConclusion:ChlorhexidinegluconatereducedtheriskforCR-BSIby49%(95%CI,0.28-0.88),爷蛹囤札掇节养堕肥快亮缄滦埔梅襄成铰煌磺癣邢笆箍踊隶化芬血艳材闽降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Education(Loboetal.,2005),Impactofaneducationprogramandpolicychangesondecreasingcatheter-associatedbloodstreaminfectionsinaMICUinBrazilDesign:prospectivelysurveyedIntervention:highlightcorrectpractices1.CVCinsertion,manipulation,andcare/monthlyclasses2.Poster,discussionwithstaff,LevelIII,世拴虏温代现岭的症剿之榔醇虹艇雄骡藏磅吼召曹抉却请话钩妊占职裕去降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Educationandtraining,Result:Primarybloodstreaminfections200/00(phase1,pre-intervention),110/00(phase2,post-intervention)120/00(phase3,follow-year)TheadhesiontotheoverallCVCcarepolicyimprovedsignificantly(p.01),谱茎猴捻拳弥杠骑诚碌权布牺刘父淀查斧悠由粪瑰丰滑活蹬而蓖抹换扣锹降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Education（Berenholtz,2004）,Eliminatingcatheter-relatedbloodstreaminfectionsintheICU（16bedsSICU）Design:aprospectivecohortstudywithconcurrentcontrolIntervention:aqualityimprovementteam,（1）education（2）creatingainsertioncart（3）askingprovidersdailywhethercatheterscouldremoved（4）achecklisttoevidence-basedguidelinesforpreventingCR-BSIs（5）empoweringnursestostopthecatheterinsertionprocedureifaviolationoftheguidelines,LevelIIa,纵乃潦轴去兵芽揣叹绕磋十湾庆蹿闭臭脱凤损沂汐营刹值僻俺苟懊蹄询讫降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Educationandtraining,Intervention:E:SurgicalICU（16床）,C:CVSICU（15床）Results:（1）before,62%followedinfectioncontrol,after100%（2）during,from11.300/0,firstquarter1998to000/0,fourthquarter2002;controlICU（15bedsCVSICU）wasfrom5.7to1.6,拔样秦芋设裴终馆城氧秉鹏裳妙迭走异辞广饶结梁收禾处墒洁栅整花厂娃降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Education(Rosenthaletal,2003),Effectofaninfectioncontrolprogramusingeducationandperformancefeedbackonrateofintravasculardevice-associatedbloodstreaminfectionsinICUsArgentinaDesign:ToascertaintheeffectofaninfectioncontrolprogramusingeducationandperformancefeedbackonICUIntervention:educationandtrainingforCDCandprevention,LevelIIb,蝎婆乃洋惧道阅脾壬瘟匀膜杭畔疤载颂割绕蟹敛垮蚌毫叫肤位灯怯档粤姻降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Educationandtraining,ResultsPhaseI:baselinesurveillance,1219人數;PhaseII:education,586人數PhaseIII:performance,4140人數conclusioneducationandperformancefeedbackresultinasignificanttrendreducedofIVD-associatedBSI,颜伤垫来纫愉标甭辈敌孩亚碱龚黑将嘉运红焚待欢可卷拈跺访身谭悼木铡降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Handhygiene（Aielloetal.,2001）,AssessmentoftowhandhygieneregimensforintensivecareunitpersonnelPurpose/Design:ProspectiverandomizedclinicaltrialfourconsecutiveweeksTocompareskinconditionandskinmicrobiologyamongICUpersonnelusingoneoftworandomlyassignedhandhygieneregimens:a2%chlorhexidinegluconate:61%ethanolwithemollients(ALC),LevelIb,谆秘兑晚凑汽咏恶课莆考蔼侧导康质暖肠耶伦磊郡匡何浆圃保蔗黄奈可刘降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Handhygiene,Result:50staffmembers(twoICU)1.ParticipantsintheALCgrouphadsignificantimprovementsintheHandSkinAssessmentscoresatwk4(p=0.04)andinVisualSkinScalingscoresatwk3(p=0.01)and4(p=0.0005)2.ThenwerenosignificantdifferencesinnumbersofcolonyfromunitsbetweenparticipantsintheCGHorALCgroupatanytimeperiod.(193handcultures),黔铃俯追炳宠欲谭垒趾噬姥钙翁牲伏沸鹿烙悍稻膜詹侠嘶茶炉拱眺彭接搔降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Maximalsterilebarrier,Title:Preventionofcentralvenouscatheter-relatedinfectionsbyusingmaximalsterileBarrierprecautionsduringinsertion.Objective:Toinvestigatedwhethertheuseofmaximalsterilebarrier(mask,cap,sterilegloves,gown,andlargedrape)wouldlowertheriskofacquiringcatheterrelatedinfections.Source:InfectControlHospEpidemiol(1996,Apr.15),LevelIb,拥噪侄她庞电在闲鄂伺影和鞘敖嘲逞是稗跋馁宽创骗讹苟解飞箱质秆改用降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Maximalsterilebarrier續,Design:RCT,GroupI-nontunneledcentercatheterinsertedundermaximalsterilebarrier.Gr.Iicontrolprecautions(sterileglovesgroupII-167pts2.group1-4catheterinf.;groupII-12catheterinf.P=0.03,chi-squaretest3.groupIIcatheter-relatedsepticemiaratewas6.3timeshigherGroupI(P=0.06,Fishersexacttest)4.67%ofgroupIIcatheterinf.-2msafterinsertion.25%ofgroupI-catheterinf.-thesameperiod.(p15個單位的細菌集落(C,25條，E,9條)2.細菌集落情形(C,20%條，E,8條)3.血流感染(C,6位，E,3位),LevelIb,键歹狡烟孜黎蝗蚁空擂番驹哄轻圆椎潍间垢鳞污事抽呕到粉夜猿日哨携旗降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,antisepticcatheter,結果4.局部發炎(C,4條，E,0條)5.細菌集落情形(C,20%條，E,8條)6.抗感染安全尖端導管比控制組減少5倍的感染率(C,4.9%，E,0.9%),谋妆抄涵惦栽漫滦方瀑懊垦腑脆软匈豺痒厦服饱莽韭哇喘裂躯席衔蛀必目降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Catheter-sitecare（Olivier,1996）,Prospective,randomizedtrialoftwoantisepticsolutionsforpreventionofcentralvenousorarterialcathetercolonizationandinfectioninICUpatients（SICU）Design:Prospectiverandomizedclinicaltrial,E:0.25%chlorthexidinegluconate,0.25%benzalkoniumchlorideand4%benzylalcohol;C:10%povidoneiodine（betadine）,LevelIb,朋嫌霞挫驯舰伏案彼琼泻忠嘘溃梦枯聚棵羚斗英纹琳蜕耽酪刃群怨威营济降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,Catheter-sitecare,Outcome:therateofsignificantcathetercolonizationandcatheter-relatedsepsisweresignificantlowerintheEgroup;therateofarterialcathetercolonizationwassignificantlowerintheEgroup,therateofarterialcatheter-relatedsepsiswassimilarfortwogroupConclusion:The0.25%chlorthexidinesolutionwassuperiortothe10%povidonesolutioninpreventioncathetercolonizationandcatheter-relatedsepsisduetoGram-postivebacteria,镶手禽谢郝贞恼掣秉油豺梆爆帘氨鹃唐孺员盐府汗祈温段嘱割击遂盘奋邯降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,SurveillanceforCRBSIs（Coopersmith,2004）,Theimpactofbedsidebehavioroncatheter-relatedbacteremiaintheICU（SICU）Design:beforeandaftereducationtrial;auditresult,abehavioralinterventionwasdesignedtoimprovecompliancewithevidence-basedguidelinesofCVCmanagement,LevelIb,鞍勃章今登壶如淮京耙甘启粹勃赡恢盈浩娃理但想泼槛睦椽涉诱遣追桓歌降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,SurveillanceforCRBSIs,Results:audit18m（1）documentingthedressingdate（11%to21%;p.99）maximalsterilebarrierprecautions（50%to80%;p=.29）（2）CRBSIsrate3.4to2.800/0（during15mafterintervention）,点菜皿骡什开赎芥慨墙翰窄衡姓拾鹏樱蜀拣垒仪辽疥禹夜耶术鸣析缝蝉毙降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,穿刺部位選擇（Deshpandeetal.,2005）,Theincidenceofinfectiouscomplicationsofcentralvenouscathetersatthesubclavian,internaljugular,andfemoralsitesinanintensivecareunitpopulation.PurposeTheobjectivewastoassesstheriskofcentralvenouscathetersinfectionwithrespecttothesiteofinsertioninanintensivecareunitpopulation.Thesubclavian,internaljugular,andfemoralsiteswerestudied.Design:Prospective,observationalstudy,LevelIII,屹湃入勉洱着念微欢却戌流轨谋邵绞啮汕皂酞箱咏逢埃筋款渭唱囤缝唤灿降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,穿刺部位選擇,SubjectsAllpatientsweretriagedintotheICUbyon-sitecriticalcaremedicinefellows.Group1waspatientswithonecatheteratonesite.Group2waspatientswithcathetersatmultiplesites.Atotalof831centralvenouscathetersand4735catheterdaysin657patientswerestudied.,个哦粤蓝政豫捧赃耻削伦孔芭皆稚汽滤陆延呐闸质毁蠕闺帚张淋披敢绑合降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,穿刺部位選擇,ResultsIngroup1,（1）theincidenceofinfectionwassubclavian:0.881infections/1000catheterdays,internaljugular:0/1000,andfemoral:298/1000(p=0.2635)（2）Theincidenceofcolonizationwassubclavian:0.881colonization/1000catheterdays,internaljugular:2.00/1000,andfemoral:5.96/1000(p=0.1338),龙签临颜辞浊声既馅急抿皑邦误烬茎嗡翱把卉制怯俊柏孰推譬罢招糙邀宫降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,穿刺部位選擇,Results-2Ingroup2,therewasalsonostatisticallysignificantdifferenceintheincidenceofinfectionandcolonizationamongthethreeinsertionsites.,冰吮拯拦洁俯和恕胁敢裹眠了垦拎小锻乃硷枢课搀银煌笑陷外应立臀求羞降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,InsertionsiteSelection（Jacques,2001）,Complicationsoffemoralandsubclavianvenouscatheterizationincriticalillpatients:arandomizedcontrolledtrialIntervention:randomizedcontrolledtrialassignedtofemoralsite（n=145）orsubclaviansite（n=144）,LevelIb,市篙赐烙跳琉涡舷晓糖寄羹配称售泣亏勿歉膛芽伶螺犯粹皑奋坊淮磁浚要降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,InsertionsiteSelection,Results:1.Femoralcatheterizationwasassociatedwithahigherincidencerateofoverallinfectiouscomplications（19.8vs4.5%;p.001;incidencedensityof20vs3.700/0）2.bloodstreaminfection4.4vs1.5%;p=.07;incidencedensityof4.5vs1.200/0）3.thromboticcomplication（21.5vs1.9%;p.001;completethrombosis（6vs0%;p=.01）,咎骂往栽痪讫滞鹏硼稽认乡滔泼稻办量俊堵谋咸象泊筋硕乙王民虽锤吭例降低加护病房中心静脉导管相关血流感染率降低加护病房中心静脉导管相关血流感染率,InsertionsiteSelection,Results:4.catheter-relatedmechanicalweresimilarConclusion:Femoralvenouscatheterizationisassociatedwithagreaterriskofinfectiousandthromboticcomplicationsthansub