title: Initial and extended use of femoral versus nonfemoral double-lumen vascular catheters and catheter-related infection during continuous renal replacement therapy.
abstract: BACKGROUND
  The risk of catheter-related infection or bacteremia, with initial and extended use of femoral versus nonfemoral sites for double-lumen vascular catheters (DLVCs) during continuous renal replacement therapy (CRRT), is unclear.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Critically ill patients on CRRT in a combined intensive care unit of a tertiary institution.
  
  
  METHODS
  Femoral versus nonfemoral venous DLVC placement.
  
  
  RESULTS
  Catheter-related colonization (CRCOL) and bloodstream infection (CRBSI).
  
  
  METHODS
  CRCOL/CRBSI rates expressed per 1,000 catheter-days.
  
  
  RESULTS
  We studied 458 patients (median age, 65 years; 60% males) and 647 DLVCs. Of 405 single-site only DLVC users, 82% versus 18% received exclusively 419 femoral versus 82 jugular or subclavian DLVCs, respectively. The corresponding DLVC indwelling duration was 6±4 versus 7±5 days (P=0.03). Corresponding CRCOL and CRBSI rates (per 1,000 catheter-days) were 9.7 versus 8.8 events (P=0.8) and 1.2 versus 3.5 events (P=0.3), respectively. Overall, 96 patients with extended CRRT received femoral-site insertion first with subsequent site change, including 53 femoral guidewire exchanges, 53 new femoral venipunctures, and 47 new jugular/subclavian sites. CRCOL and CRBSI rates were similar for all such approaches (P=0.7 and P=0.9, respectively). On multivariate analysis, CRCOL risk was higher in patients older than 65 years and weighing >90kg (ORs of 2.1 and 2.2, respectively; P<0.05). This association between higher weight and greater CRCOL risk was significant for femoral DLVCs, but not for nonfemoral sites. Other covariates, including initial or specific DLVC site, guidewire exchange versus new venipuncture, and primary versus secondary DLVC placement, did not significantly affect CRCOL rates.
  
  
  CONCLUSIONS
  Nonrandomized retrospective design and single-center evaluation.
  
  
  CONCLUSIONS
  CRCOL and CRBSI rates in patients on CRRT are low and not influenced significantly by initial or serial femoral catheterizations with guidewire exchange or new venipuncture. CRCOL risk is higher in older and heavier patients, the latter especially so with femoral sites.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia; Division of Nephrology, Department of Medicine, National University Hospital, National University Health System, Singapore.
authors.forename: Horng-Ruey
authors.initials: HR
authors.lastname: Chua
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Intensive Care, Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Antoine G
authors.initials: AG
authors.lastname: Schneider
authors.affiliation: Department of Microbiology and Infectious Diseases, Austin Hospital, Melbourne, Australia.
authors.forename: Norelle L
authors.initials: NL
authors.lastname: Sherry
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Nadiah
authors.initials: N
authors.lastname: Lotfy
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Chan
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Galtieri
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Wong
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Surgery, Section of Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
authors.forename: Miklos
authors.initials: M
authors.lastname: Lipcsey
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Cauê de Araujo
authors.initials: Cde A
authors.lastname: Matte
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Collins
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Garcia-Alvarez
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Society (ANZICS) Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: rinaldo.bellomo@austin.org.au.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000368:Aged; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000453:epidemiology*; D062905:Central Venous Catheters / Q000009:adverse effects* / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D005268:Femoral Vein / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000009:adverse effects* / Q000295:instrumentation*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Acute kidney injury (AKI); acute renal failure (ARF); catheter-related bloodstream infection (CRBSI); catheter-related colonization; catheter-related infection; continuous renal replacement therapy (CRRT); critical care; critical illness; double lumen vascular catheter; femoral venous catheter; guidewire exchange versus new venipuncture; intensive care; jugular and subclavian venous catheter; line infection; line sepsis; nontunneled dialysis catheter