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Intensive Care Medicine

Published in:

01-06-2008 | Original

Influence of insertion site on central venous catheter colonization and bloodstream infection rates

Authors: John R. Gowardman, Iain K. Robertson, Scott Parkes, Claire M. Rickard

Published in: Intensive Care Medicine | Issue 6/2008

Abstract

Objective

To compare colonization and catheter-related bloodstream infection (CR-BSI) rates among three insertion sites (subclavian, internal jugular, femoral) used for central venous catheter (CVC) placement.

Design

Twenty-four-month prospective study, with relative effects analyzed by Cox proportional hazards regression.

Setting

Eight-bed intensive care unit.

Patients

Four hundred and ten critically ill patients requiring CVC placement.

Measurements and results

All short-term multi-lumen CVCs, including antimicrobial-coated devices, were studied with management standardized. Six hundred and five CVCs (4,040 catheter days) were analyzed. Colonization and CR-BSI incidence were, respectively, 15.1 (95% CI 13.5–21.0) and 1.8 (95% CI 1.2–4.2) per 1,000 catheter-days. Colonization was higher at the internal jugular (HR 3.64; 95% CI 1.32–10.00; p = 0.01) and femoral (HR 5.15; 95% CI 1.82–14.51; p = 0.004) sites than at the subclavian site. The femoral site carried a greater risk of being colonized by non-S. epidermidis species than the subclavian and internal jugular sites combined (HR 4.15; 95% CI 1.79–9.61; p = 0.001). CVCs inserted in the Department of Emergency Medicine were more colonized than those inserted in the ICU or operating room (HR 2.66; 95% CI 1.27–5.56; p = 0.01), and CVCs were less colonized in females than in males (HR 0.49; 95% CI 0.26–0.89; p = 0.02). No difference in CR-BSI rates was noted between the three sites.

Conclusions

Colonization was lowest at the subclavian site. Regional differences exist with respect to type of pathogen isolated. Colonization was influenced by insertion location and gender. The incidence of CR-BSI was not different.

Polderman KH, Girbes AJ (2002) Central venous catheter use. 1. Mechanical complications. Intensive Care Med 28:1–17PubMedCrossRef

Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, Rigaud JP, Casciani D, Misset B, Bosquet C, Outin H, Brun-Buisson C, Nitenberg G (2001) French Catheter Study Group in Intensive Care. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 286:700–707PubMedCrossRef

Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D (2000) Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 355:1864–1868PubMedCrossRef

Sadoyama G, Gontijo Filho PP (2003) Comparison between the jugular and subclavian vein as insertion site for central venous catheters: microbiological aspects and risk factors for colonization and infection. Braz J Infect Dis 7:142–148PubMedCrossRef

Ruesch S, Walder B, Tramer MR (2002) Complications of central venous catheters: internal jugular versus subclavian access-a systematic review. Crit Care Med 30:454–460

Collignon P, Soni N, Pearson I, Sorrell T, Woods P (1988) Sepsis associated with central vein catheters in critically ill patients. Intensive Care Med 14:227–231PubMedCrossRef

Goetz AM, Wagener MM, Miller JM, Muder RR (1998) Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol 19:842–845PubMedCrossRef

Richet H, Hubert B, Nitemberg G, Andremont A, Buu-Hoi A, Ourbak P, Galicier C, Veron M, Boisivon A, Bouvier AM ( 1990) Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. J Clin Microbiol 11:2520–2525

Nagashima G, Kikuchi T, Tsuyuzaki H, Kawano R, Tanaka H, Nemoto H, Taguchi K, Ugajin K (2006) To reduce catheter-related bloodstream infections: is the subclavian route better than the jugular route for central venous catheterization? J Infect Chemother 12:363–365PubMedCrossRef

10.

Lorente L, Henry C, Martin MM, Jimenez A, Mora ML (2005) Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care 9:631–635

11.

O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 51:1–29PubMed

12.

Durbec O, Viviand X, Potie F, Vialet R, Albanese J, Martin C (1997) A prospective evaluation of the use of femoral venous catheters in critically ill adults. Crit Care Med 25:1986–1989PubMedCrossRef

13.

Williams JF, Seneff MG, Friedman BC, McGrath BJ, Gregg R, Sunner J, Zimmerman JE (1991) Use of femoral venous catheters in critically ill adults: prospective study. Crit Care Med 19:550–553PubMedCrossRef

14.

Deshpande KS, Hatem C, Ulrich HL, Currie BP, Aldrich TK, Bryan-Brown CW, Kvetan V (2005) The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 33:13–20PubMedCrossRef

15.

Venkataraman ST, Thompson AE, Orr RA (1997) Femoral vascular catheterization in critically ill infants and children. Clin Pediatr (Phila) 36:311–319CrossRef

16.

Murr MM, Rosenquist MD, Lewis RW 2nd, Heinle JA, Kealey GP (1991) A prospective safety study of femoral vein versus non femoral vein catheterization in patients with burns. J Burn Care Rehabil 12:576–578

17.

O'Grady NP, Dezfulian C (2005) The femoral site as first choice for central venous access? Not so fast. Crit Care Med 33:234–235PubMedCrossRef

18.

Gowardman JR, Kelaher C, Whiting J, Collignon PJ (2005) Impact of a formal removal policy for central venous catheters on duration of catheterisation. Med J Aust 182:249–250PubMed

19.

Maki DG, Weise CE, Sarafin HW (1977) A semi quantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 296:1305–1309PubMedCrossRef

20.

Rijnders BJ, Van Wijngaerden E, Peetermans WE (2002) Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence? Clin Infect Dis 35:1053–1058PubMedCrossRef

21.

Ruesch S, Walder B, Tramer MR (2002) Complications of central venous catheters: internal jugular versus subclavian access. A systematic review. Crit Care Med 30:454–460PubMedCrossRef

22.

Lorente L, Jimenez A, Iribarren JL, Jimenez JJ, Martin MM, Mora ML (2006) The micro-organism responsible for central venous catheter related bloodstream infection depends on catheter site. Intensive Care Med 32:1449–1450PubMedCrossRef

23.

Lorente L, Jimenez A, Santana M, Iribarren JL, Jimenez JJ, Martin MM, Mora ML (2007) Microorganisms responsible for intravascular catheter-related bloodstream infection according to the catheter site. Crit Care Med 35:2424–2427PubMedCrossRef

24.

Crnich CJ, Maki DG (2004) Are antimicrobial-impregnated catheters effective? Don't throw out the baby with the bathwater. Clin Infect Dis 38:1287–1292PubMedCrossRef

25.

McConnell SA, Gubbins PO, Anaissie EJ (2003) Do antimicrobial-impregnated central venous catheters prevent catheter-related bloodstream infection? Clin Infect Dis 37:65–72PubMedCrossRef

26.

Maki DG, Kluger DM, Crnich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81:1159–1171PubMed

27.

Crnich CJ, Maki DG (2005) Are antimicrobial-impregnated catheters effective? When does repetition reach the point of exhaustion? Clin Infect Dis 41:681–685PubMedCrossRef

Title: Influence of insertion site on central venous catheter colonization and bloodstream infection rates
Authors: John R. Gowardman
Iain K. Robertson
Scott Parkes
Claire M. Rickard
Publication date: 01-06-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 6/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1046-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Influence of insertion site on central venous catheter colonization and bloodstream infection rates

Abstract

Objective

Design

Setting

Patients

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Measurements and results

Conclusions

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