[Evaluation of CVC-set].

Abstract

OBJECTIVE: Frequently central venous catheter sets do not contain all necessary materials. To evaluate, if combined measures using a specially arranged central venous catheter (CVC) set result in economical and clinical advantages, we compared both cost and time differences of a CVC complete set with ECG guide wire lead and an adhesive fixation with a standard set requiring additional materials, ECG fluid column lead and surgical suture. Furthermore, quality of different ECG leads, the reliability and tolerability of the adhesive fixation was compared. METHODS: 76 elective adult surgical patients were randomly assigned to receive either a control CVC set or a test CVC complete set, which was featured by preconnected stopcocks, included sterile drapes, guide wire ECG position control, and an adhesive fixation. We performed ECG-guided placement of the central venous catheter using a guide wire lead in the test CVC set vs. fluid column lead in the control CVC set. Time was recorded for preparation phase of the nurse and the anesthetist, for the puncture phase, for the ECG position control and time for CVC fixation. Quality of ECG position control using guide wire or fluid column was determined by forming Pmax/R ratio. Costs of the complete set and the standard set with additional material were compared. RESULTS: Times for preparation of nurse and anesthetists, for ECG position control and catheter fixation were significantly shorter using the test catheter set and resulted in a total time saving of 6 min (P < 0.01). Times for sterile preparation and central venous puncture were not significantly different between the groups. ECG position control using the guide wire was successful in 37 out of 38 patients (97%) and in 34 of 38 patients (89%), respectively. Pmax/R ratio was 0.8 +/- 0.2 using the guide wire versus 0.5 +/- 0.2, respectively. There were only 2 out of 38 adhesive fixations, that had to be replaced, while the mean duration of adhesive fixation was 6.2 days (3-15 days). Avoidance of disposable materials in the test CVC set led to a significant reduction of costs compared to the control CVC set. CONCLUSION: The test CVC complete set allows a significant time saving and cost reduction in performing a central venous catheter line because of completely included disposable materials. CVC position control via guide wire needs less time and shows significantly better quality of ECG compared to fluid column ECG lead. An adhesive revealed to be a reliable CVC fixation comparable to a surgical suture.