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R. H. Flowers III, MD; Barry M. Farr, MD
University of Virginia Health Sciences Center Charlottesville

JAMA. 1989;262(5):614.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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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.¹

We 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 . . . [Full Text PDF of this Article]

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