title: Use of tunneled femoral catheters to prevent catheter-related infection. A randomized, controlled trial.
abstract: BACKGROUND
  The risk for catheter-related infection seems higher with femoral catheters than with catheters inserted at other sites.
  
  
  OBJECTIVE
  To evaluate the effect of catheter tunneling on femoral catheter-related infection in critically ill patients.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  Three intensive care units at academic hospitals in Paris, France.
  
  
  METHODS
  345 adult patients requiring a femoral venous catheter for more than 48 hours.
  
  
  METHODS
  Tunneled or nontunneled femoral catheters.
  
  
  METHODS
  Time to occurrence of systemic catheter-related sepsis, catheter-related bloodstream infection, and quantitative catheter tip culture with a cutoff of 10(3) colony-forming units/mL.
  
  
  RESULTS
  Of 345 randomly assigned patients, 336 were evaluable. Probable systemic catheter-related sepsis occurred in 15 of 168 patients who received a nontunneled femoral catheter (controls) and in 5 of 168 patients who received a tunneled femoral catheter (estimated absolute risk reduction, 6% [95% CI, 0.9% to 11%]). Time to occurrence of catheter-related bloodstream infection was not significantly modified (relative risk, 0.28 [CI, 0.03 to 1.92]; P = 0.18); 3 events occurred in the control group and 1 event occurred in the tunneled-catheter group. After stratification by treatment center and adjustment for variables that were prognostic (use of broad-spectrum antimicrobial agents at catheter insertion) or imbalanced between both groups (mechanical ventilation at insertion), tunnelized catheterization reduced the proportion of patients who developed systemic catheter-related sepsis (relative risk, 0.25 [CI, 0.09 to 0.72]; P = 0.005) and positive quantitative culture of the catheter tip (relative risk, 0.48 [CI, 0.23 to 0.99]; P = 0.045).
  
  
  CONCLUSIONS
  The incidence of femoral catheter-related infections in critically ill patients can be reduced by using subcutaneous tunneling.
authors.affiliation: Réanimation Polyvalente, Hôpital Saint Joseph, Paris, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Timsit
authors.forename: F
authors.initials: F
authors.lastname: Bruneel
authors.forename: C
authors.initials: C
authors.lastname: Cheval
authors.forename: M F
authors.initials: MF
authors.lastname: Mamzer
authors.forename: M
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: M
authors.initials: M
authors.lastname: Wolff
authors.forename: B
authors.initials: B
authors.lastname: Misset
authors.forename: S
authors.initials: S
authors.lastname: Chevret
authors.forename: B
authors.initials: B
authors.lastname: Regnier
authors.forename: J
authors.initials: J
authors.lastname: Carlet
mesh_terms: D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods*; D002985:Clinical Protocols; D016638:Critical Illness / Q000628:therapy; D004866:Equipment Contamination; D005260:Female; D005268:Femoral Vein; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D018709:Statistics, Nonparametric