The safety of prolonging the use of central venous catheters: a prospective analysis of the effects of using antiseptic-bonded catheters with daily site care.
OBJECTIVE
To determine rates of catheter colonization and catheter-related bloodstream infection (CRBSI) when antiseptic-bonded central venous catheters (CVCs) and standardized daily site care are used with no predetermined interval for removal.


METHODS
Prospective observational study.


METHODS
Two major trauma centers.


METHODS
All trauma patients admitted to two major trauma centers that received a CVC from May 1996 through May 1998.


METHODS
None.


RESULTS
Catheters were semiquantitatively cultured to identify bacterial colonization and CRBSI. Monitored variables included total catheter days, anatomical site of catheter insertion, and area in hospital of catheter insertion. CVC tips and intracutaneous segments were semiquantitatively cultured. A total of 460 (92%) of 501 catheters placed in 324 trauma patients were evaluable, representing 95.5% of all catheter days during the study period. Rates of catheter colonization and CRBSI were 5% (5/1000 catheter days) and 1.5% (1.511000 catheter days), respectively. Subclavian catheters were in place longer than femoral or internal jugular catheters (p < .0001), but the colonization rate was significantly lower (p = .03; relative risk, 0.34; 95% confidence interval, 0.15-0.77). No differences in CRBSI rates among anatomical sites or between catheters used < or =14 days and those used >14 days were identified.


CONCLUSIONS
Femoral and internal jugular antiseptic-bonded CVCs develop bacterial colonization earlier than subclavian CVCs. Subclavian antiseptic-bonded CVCs combined with standardized daily site care may be safely used >14 days in trauma patients.
Norwood
S
S
East Texas Medical Center, Tyler, USA.
Wilkins
H E
HE
Vallina
V L
VL
Fernandez
L G
LG
McLarty
J W
JW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local; D016470:Bacteremia / Q000382:microbiology* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002710:Chlorhexidine; D020099:Coated Materials, Biocompatible; D003422:Critical Care; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000382:microbiology* / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D012837:Silver Sulfadiazine
D000891:Anti-Infective Agents, Local; D020099:Coated Materials, Biocompatible; D002710:Chlorhexidine; D012837:Silver Sulfadiazine