I don't remember the discussion about this, but I did promise to post this study. It is the only data I have seen on the risk associated with CVAD exchange
Exchange of peripherally inserted central cat... [Am J Perinatol. 2011] - PubMed - NCBI
. Am J Perinatol. 2011 Jun;28(6):419-24. doi: 10.1055/s-0030-1268709. Epub 2010 Nov
Exchange of peripherally inserted central catheters is associated with an
increased risk for bloodstream infection.
McCoy M, Bedwell S, Noori S.
Section on Neonatal-Perinatal Medicine, Department of Pediatrics, University of
Oklahoma Health Sciences Center, USA.
It is not uncommon that the peripherally inserted central catheter (PICC) needs
to be replaced either due to blockage or migration to a peripheral position. In
such circumstances, there are two methods of PICC placement: new-site insertion
and exchange by using the old PICC as a guide wire. Our objective was to
investigate risk of infection associated with the exchange method. In this
retrospective study, data on all PICC insertions in the neonatal intensive care
unit in 2004 to 2008 were obtained. In the population who needed removal of
existing PICC and insertion of a new one, we compared central line-associated
bloodstream infection (CLABSI) within 1 week of insertion between the two
insertion methods. Of 1148 PICC insertions reviewed, 164 (103 new-site and 61
exchange insertions) were performed after removal of a blocked/malpositioned PICC
and therefore comprised the study population. The rate of CLABSI was higher in
the exchange method (9.8% versus 1%, P < 0.007). After adjusting for the
confounders, the odds for CLABSI within 7 days of PICC insertion was higher with
the exchange method (odds ratio 25.2, 95% confidence interval: 2.17 to 292.98; P
= 0.01). In infants, insertion of PICCs using the exchange method carries an
increased risk of bloodstream infection.
© Thieme Medical Publishers.
PMID: 21082537 [PubMed - indexed for MEDLINE]