降低中心導管相關血流感染之血管內留置導管選擇共識

Consensus for Vascular Access Device Selection to Prevent Central Line-Associated Bloodstream Infection

留置型中心靜脈導管（簡稱中心導管）是醫療照護的重要工具，但使用不當會增加感染風險。臺灣醫界多年來推動預防中心導管相關血流感染的組合式照護，已有成效。但近年來病人狀況日益複雜，加上新醫療器材進展迅速，為進一步減少中心導管相關血流感染率，建議導入2.0版組合式照護「選手大消除」。本文乃聚焦血管內留置導管最佳選擇的決策指引，根據實證建立跨學會跨團隊專家共識。使用血管內留置導管時，應該依照臨床情境，針對不同的病況、醫療需求、預期使用時間，來評估選擇適當的導管，並給予妥善照護。中心導管包括非隧道式中心導管、隧道式中心導管、周邊置入中心靜脈導管（peripherally inserted central catheter，PICC）等。近期引進的PICC可留置數個月，使用在適當的病人能降低感染與併發症、提升舒適度並縮短住院天數。由於許多PICC出院後仍需使用，本指引建議加強維護及衛教，以預防感染。

Central venous catheters (CVCs) are indispensable in modern healthcare; however, their use is associated with an increased risk of infection. While the medical community in Taiwan has successfully promoted care bundles to prevent central line-associated bloodstream infection (CLABSI) for many years, the increasing complexity of patient profiles and evolving trends in healthcare delivery present new challenges. Consequently, it is suggested to implement the second edition of care bundles known as ''Selection, Hand Hygiene, Large Area Cleaning, Disinfection, Flush and Removal''. This article focuses on the guidelines for optimal decision-making in selecting indwelling vascular catheters. Based on evidence, a consensus has been established by experts across societies and teams. When using indwelling vascular catheters, appropriate selection and care should be given according to the clinical scenario, considering different patient conditions, medical needs, and expected duration of use. Options include non-tunneled CVCs, tunneled CVCs, and peripherally inserted central catheters (PICC). Recently introduced PICCs can indwell for several months. When used in appropriate patients, they are associated with lower infection rates, fewer complications, greater patient comfort, and the facilitation of earlier discharge. Since a significantly high proportion of PICCs stay in use after discharge, experts emphasize the critical need for proper maintenance care and patient/caregiver education to prevent infection.