Risk of colonization of central venous catheters: catheters for total parenteral nutrition vs other catheters.
BACKGROUND
Infected central venous catheters cause morbidity and mortality.


OBJECTIVE
To compare the risk for colonization of central venous catheters used for total parenteral nutrition with that of catheters used for other purposes.


METHODS
Retrospective review of prospectively acquired data on 260 patients with a stay in a surgical intensive care unit longer than 3 days. Single-lumen catheters used solely for total parenteral nutrition were inserted into the subclavian vein and cared for by a dedicated team. Catheters for other purposes were placed and cared for by other staff. Catheters were cultured if clinical findings suggested infection.


RESULTS
Of 854 central venous catheters, 61 (7%) were used for total parenteral nutrition. During 4712 catheter days of observation, 89 catheters of all types were colonized. Risk factors for colonization included duration of catheterization (P < .001), having 3 or more lumens (hazard ratio, 1.7; 95% CI, 1.1-2.6), pulmonary artery catheterization (hazard ratio, 1.7; 95% CI, 1.1-2.7), and placement in the internal jugular vein (hazard ratio, 1.6; 95% CI, 1.1-2.5). Catheters used for total parenteral nutrition (hazard ratio, 0.14; 95% CI, 0.04-0.57) and those in the subclavian vein (hazard ratio, 0.51; 95% CI, 0.3-0.8) were at lower risk of colonization. In a multivariate Cox model, the only significant factor was a 5-fold lower risk of infection for catheters used for total parenteral nutrition (hazard ratio, 0.19; 95% CI, 0.04-0.83).


CONCLUSIONS
Rates of colonization were lowest for catheters used solely for total parenteral nutrition, suggesting that a team approach improves patients' care.
Dimick
Justin B
JB
School of Medicine, Johns Hopkins University, Baltimore, Md., USA.
Swoboda
Sandra
S
Talamini
Mark A
MA
Pelz
Robert K
RK
Hendrix
Craig W
CW
Lipsett
Pamela A
PA
D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007239:Infections / Q000209:etiology*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013350:Subclavian Vein