Incidence and predictors of central venous catheter related infection in intensive care patients

Excerpt

This study contains a small group of patients with half being neurosurgical patients. I am sure that much can be gained by combining this group with other 'general' intensive care patients. Almost by definition the groups will have a very different case mix and it would have been interesting to see some evidence of this. The total number of non-neurosurgical patients was only 36 which makes significant statistical analysis difficult to reach. What can we learn from this study? Firstly it reinforces the message that the risk of internal jugular line infection greatly exceeds that of the subclavian site. We know that at the time of insertion risks of the internal jugular site are less; reduced risk of pneumothorax, local bleeding can be controlled with pressure. It is my own personal observation that where no clear contraindication to either site exists the choice of site comes down to personal preference with most anaesthetists probably feeling happier with the internal jugular site. Perhaps the subclavian site should be utilised more in the respiratory and possibly the cardiac patient. Duration of catheterisation has recently been challenged as an independent risk factor for infection and this study supports that challenge suggesting that routinely line change in the absence of clinical evidence of local infection is unnecessary. However the importance of strict asepsis is clearly reinforced. …