中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (08): 542-548.doi: 10.3969/j.issn.1671-4091.2018.08.009

• 血管通路 • 上一篇    下一篇

透析前Ⅰ型安尔碘浸泡血液透析导管盖子对导管相关性感染预防作用

李洪1,黄杏1,陈冰1,梁让1,曾欣1,蔡莉1,陈汝满1,安娜1,冯海欢2   

  1. 1 海南省人民医院血液净化中心
    2 华西医院医保办
  • 收稿日期:2017-10-27 修回日期:2018-06-01 出版日期:2018-08-12 发布日期:2018-08-12
  • 通讯作者: 李洪hpph01@163.com E-mail:hpph01@163.com

TThe infection prevention by soaking the catheter hubs in type I entoiodine before hemodialysis sessions

  • Received:2017-10-27 Revised:2018-06-01 Online:2018-08-12 Published:2018-08-12

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摘要： 【摘要】目的前后对照，血液透析有隧道涤纶套导管(tunneled central venous catheter, TCC)使用前用Ⅰ型安尔碘浸泡盖子2 年、不浸泡盖子2 年，比较导管相关性感染(catheter related infection,CRI)发病率差异；同步体外研究常用消毒液对导管毁损情况。方法尿毒症维持透析3 月以上，以TCC 为维持透析通路者总共119 名患者参与研究。2013 年9 月1 日～2015 年8 月31 日期间导管盖子用Ⅰ型安尔碘消毒液浸泡3～5min 上机；同一批患者以及2015 年以后新入患者、2015 年9 月～2017 年8 月30 日予不泡盖子上机。详细记录导管相关性感染情况，每3 月做CRI 小结。导管毁损实验用导管：每组4条TCC，分别4 种消毒液(75%酒精、Ⅰ型安尔碘、Ⅲ型安尔碘、洗必泰酒精)和生理盐水浸泡，每日观察导管毁损变化，每组有1 只导管破损即终止实验。结果浸泡组：共37246 导管日，出口感染17 例，导管相关血液感染(catheter related blood infection,CRB)5 例，隧道感染5 例，可疑CRB 1 例。非浸泡组：共35452 导管日，出口感染61 例，CRB12 例，隧道感染4 例。2 组间各种导管相关性感染按照相应季度时间对比：第3 季度出口感染率浸泡组显著低于不浸泡组(0.16/1000 导管日比0.73/1000 导管日，χ2=5.524，P=
0.019)，并导致该季度浸泡组CRI 发生率比不浸泡组显著降低(0.40/1000 导管日比0.65/1000 导管日，χ2=144.810，P＜0.001)；第4 季度出口感染率浸泡组显著低于不浸泡组(0.06/1000 导管日比0.50/1000导管日，χ2=6.716，P=0.010),并导致浸泡组CRI 显著低于不浸泡组(0.06/1000 导管日比0.65 /1000 导管日，χ2=9.632，P=0.002)；其他各亚种、各时间段感染率无差异。导管浸泡与否2 年CRI 总感染率比较：出口感染率浸泡组显著低于无浸泡组(2.15/1000 导管日比4.47/1000 导管日，χ2=16.211,P=0.001)；隧道感染率浸泡组与不浸泡组无统计学差异(0.29/1000 导管日比0.37/1000 导管日，χ2=0.308，P=0.741)；总CRB 浸泡组与不浸泡组无统计学差异(0.24/1000 导管日比1.49/1000 导管日，χ2=1.987，P=0.159)；总CRI浸泡组与不浸泡组有统计学差异(2.66/1000 导管日对6.32/1000 导管日，χ2=11.893，P=0.001)，主要是不浸泡组出口感染较多导致。结论TCC 导管盖子使用前用Ⅰ型安尔碘浸泡可降低出口感染，但不能显著降低CRB；用消毒液搓搽接头15～30 秒、换新盖子可以有效预防CRB；消毒液长时间浸泡TCC 可导致导管严重破损，以酒精最重、氯乙定酒精最小，生理盐水无破坏性。

关键词: 血液透析, 带隧道带涤纶套导管, 导管相关性感染, 导管相关性血液感染

Abstract: 【Abstract】Purpose The cap of tunneled central venous catheter (TCC) was soaked in type I entoiodine for 3-5 min before use for 2 years and then was switched to routine care procedure without type I entoiodine treatment for 2 years. Catheter-related infection (CRI) was compared in the periods with and without type I entoiodine treatment. Damage of TCCs by disinfectants was also studied. Methods A total of 119 maintenance hemodialysis patients using TCC as the blood access route for more than 3 months were enrolled in this study. During the period from Sept. 1st, 2013 to Aug. 31st, 2015, the catheter caps were soaked in type I entoiodine for 3-5 min and then scrubbed with typeⅠentoiodine for 15-30 sec before connecting tubes. During the period from Sept. 1st, 2015 to Aug. 31st, 2017, the catheter caps of the same patients were treated with the same procedure but without type I entoiodine treatment. CRI was recorded and summarized every 3 months. In addi-tion, 5 groups of TCCs (4 TCCs/each group) were soaked in 75% alcohol, type I entoiodine, type III entoiodine, chlorhexidine alcohol, and normal saline respectively, and observed every day until one of the TCCs was damaged. Results In the soaked group, there were totally 37,246 catheter days, in which exit infection in 17 cases, catheter-related blood infection (CRB) in 5 cases, tunnel infection in 5 cases, and suspected CRB in one case were detected. In non-soaked group, there were totally 35,452 catheter days, in which exit infection in 61 cases, CRB in 12 cases, and tunnel infection in 4 cases were detected. The comparisons of CRI according to seasons were made between the two groups. During the period from July to September, exit infections were lower in soaked group then in non-soaked group (0.16/1,000 catheter days vs. 0.73/1,000 catheter days, χ2=
5.524, P=0.019), and CRIs were also lower in soaked group then in non-soaked group (0.40/1,000 catheter days vs. 0.65/1,000 catheter days, χ2=144.810, P＜0.001). During the period from October to December, exit infections were lower in soaked group then in non-soaked group (0.06/1,000 catheter days vs. 0.50/1,000 catheter days, χ2=6.716, P=0.010), and CRIs were also lower in soaked group then in non-soaked group (0.06/1,000 catheter days vs. 0.65/1,000 catheter days, χ2=9.632, P=0.002). There were no differences in the prevalence of other infections according to seasons between the two groups. The comparisons of CRI in the two years were then made between the two groups. Exit infections were lower in soaked group then in non-soaked group (2.15/1,000 catheter days vs. 4.47/1,000 catheter days, χ2=16.211, P=0.001). However, there were no differences in tunnel infection (0.29/1,000 catheter days vs. 0.37/1,000, χ2=0.308, P=0.741), CRB (0.24/1,000 catheter days vs. 1.49/1,000 catheter days, χ2=1.987, P=0.159), and CRI (2.66/1,000 catheter days vs. 6.32/1,000 catheter days, χ2=11.893, P=0.001) between the two groups. Except for chlorhexidine alcohol and saline, 75% alcohol, type I entoiodine and type III entoiodine, especially 75% alcohol, damaged TCCs after soaked in for 4 days. Conclusion Caps of TCC soaked in type I entoiodine before use could prevent exit infection but not CRB. Scrub the hubs with disinfectant 15- 30 sec and change the caps could effectively prevent CRB. TCCs soaked in disinfectants for long time caused catheter damage. 75% alcohol severely damaged TCCs, and chlorhexidine alcohol mildly damaged TCCs.

Key words: hemodialysis, tunneled-cuffed catheter, catheter related infection, catheter related blood infection.