title: Central venous catheter-related infection in a prospective and observational study of 2,595 catheters.
abstract: BACKGROUND
  Central venous catheterization is commonly used in critically ill patients and may cause different complications, including infection. Although there are many studies about CVC-related infection, very few have analyzed it in detail. The objective of this study was to analyze the incidence of catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) with central venous catheters (CVCs) according to different access sites.
  
  
  METHODS
  This is a prospective and observational study, conducted in a 24-bed medical surgical intensive care unit of a 650-bed university hospital. All consecutive patients admitted to the ICU during 3 years (1 May 2000 and 30 April 2003) were included.
  
  
  RESULTS
  The study included 2,018 patients. The number of CVCs and days of catheterization duration were: global, 2,595 and 18,999; subclavian, 917 and 8,239; jugular, 1,390 and 8,361; femoral, 288 and 2,399. CRLI incidence density was statistically higher for femoral than for jugular (15.83 versus 7.65, p < 0.001) and subclavian (15.83 versus 1.57, p < 0.001) accesses, and higher for jugular than for subclavian access (7.65 versus 1.57, p < 0.001). CRBSI incidence density was statistically higher for femoral than for jugular (8.34 versus 2.99, p = 0.002) and subclavian (8.34 versus 0.97, p < 0.001) accesses, and higher for jugular than for subclavian access (2.99 versus 0.97, p = 0.005).
  
  
  CONCLUSIONS
  Our results suggest that the order for punction, to minimize the CVC-related infection risk, should be subclavian (first order), jugular (second order) and femoral vein (third order).
authors.affiliation: Department of Intensive Care, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. lorentemartin@msn.com
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lorente
authors.forename: Christophe
authors.initials: C
authors.lastname: Henry
authors.forename: María M
authors.initials: MM
authors.lastname: Martín
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jiménez
authors.forename: María L
authors.initials: ML
authors.lastname: Mora
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D005268:Femoral Vein; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007601:Jugular Veins; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013350:Subclavian Vein; D016019:Survival Analysis