Authors: Hagen Bomberg, M.D. et al
Anesthesiology 4 2018, Vol.128, 764-773.
Background: Prolonged catheter use is controversial because of the risk of catheter-related infection, but the extent to which the risk increases over time remains unknown. We thus assessed the time-dependence of catheter-related infection risk up to 15 days.
Methods: Our analysis was based on the German Network for Regional Anesthesia, which includes 25 centers. We considered 44,555 patients who had surgery between 2007 and 2014 and had continuous regional anesthesia as well as complete covariable details. Cox regression analysis was performed and adjusted for confounding covariables to examine the relationship between catheter duration and probability of infection-free catheter use.
Results: After adjustment for confounding factors, the probability of infection-free catheter use decreases with each day of peripheral and epidural catheter use. In peripheral catheters, it was 99% at day 4 of catheter duration, 96% at day 7, and 73% at day 15. In epidural catheters, it was 99% at day 4 of catheter duration, 95% at day 7, and 73% at day 15. Only 31 patients (0.07%) had severe infections that prompted surgical intervention. Among these were five catheters that initially had only mild or moderate signs of infection and were left in situ; all progressed to severe infections.
Conclusions: Infection risk in catheter use increases over time, especially after four days. Infected catheters should be removed as soon as practical.
What We Already Know about This Topic
- Prolonged use of indwelling peripheral nerve blockade or epidural catheters may be associated with infection
- Multicenter, pragmatic data guiding duration of catheter use are not available
What This Manuscript Tells Us That Is New
- Ninety-nine percent of peripheral catheters and ninety-nine percent of epidural catheters were infection-free after four days
- Infected catheters should be removed as soon as is practical