In Reply. —
We would agree that guide-wire changes are widely used, but we are unable to find randomized, controlled trials demonstrating the precise rate of infectious or mechanical complications associated with their use. We excluded guide-wire changes from our study because previous data suggested a lack of protection from use of the Vitacuff in such cases, presumably because the cuff has no effect on a previously colonized subcutaneous catheter tract.1We acknowledge that some patients have contraindications to new sticks such as coagulopathy or widespread cutaneous burns. In such instances, one leaves the first catheter in place longer and uses a guide-wire change when necessary. Our data and those of Maki et al1 suggest that the first catheter placed in such patients would be less likely to require changing for infectious complications if placed with a Vitacuff. The average catheter life in our study was 4 to
Flowers RH, Farr BM. The Vitacuff and Intravascular Catheter—Related Infection-Reply. JAMA. 1989;262(5):614. doi:10.1001/jama.1989.03430050023011
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