Central venous catheter-related infection in a prospective and observational study of 2,595 catheters.
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).
Lorente
Leonardo
L
Department of Intensive Care, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. lorentemartin@msn.com
Henry
Christophe
C
Martín
María M
MM
Jiménez
Alejandro
A
Mora
María L
ML
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