Influence of insertion site on central venous catheter colonization and bloodstream infection rates

Gowardman, John R., Robertson, Iain K., Parkes, Scott and Rickard, Claire M. (2008) Influence of insertion site on central venous catheter colonization and bloodstream infection rates. Intensive Care Medicine, 34 6: 1038-1045. doi:10.1007/s00134-008-1046-3


Author Gowardman, John R.
Robertson, Iain K.
Parkes, Scott
Rickard, Claire M.
Title Influence of insertion site on central venous catheter colonization and bloodstream infection rates
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 0342-4642
Publication date 2008-06-01
Year available 2008
Sub-type Article (original research)
DOI 10.1007/s00134-008-1046-3
Open Access Status
Volume 34
Issue 6
Start page 1038
End page 1045
Total pages 8
Editor L Brochard
Place of publication Heidelberg, Germany
Publisher Springer-Verlag
Language eng
Subject C1
920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified
110310 Intensive Care
Formatted abstract
Objective To compare colonization and catheter-related bloodstream infection (CR-BSI) rates among three insertion sites (subclavian, internal jugular, femoral) used for central venous catheter (CVC) placement.
Design Twenty-four-month prospective study, with relative effects analyzed by Cox proportional hazards regression.
Setting Eight-bed intensive care unit.
Patients Four hundred and ten critically ill patients requiring CVC placement.
Measurements and results All short-term multi-lumen CVCs, including antimicrobial-coated devices, were studied with management standardized. Six hundred and five CVCs (4,040 catheter days) were analyzed. Colonization and CR-BSI incidence were, respectively, 15.1 (95% CI 13.5–21.0) and 1.8 (95% CI 1.2–4.2) per 1,000 catheter-days. Colonization was higher at the internal jugular (HR 3.64; 95% CI 1.32–10.00; p = 0.01) and femoral (HR 5.15; 95% CI 1.82–14.51; p = 0.004) sites than at the subclavian site. The femoral site carried a greater risk of being colonized by non-S. epidermidis species than the subclavian and internal jugular sites combined (HR 4.15; 95% CI 1.79–9.61; p = 0.001). CVCs inserted in the Department of Emergency Medicine were more colonized than those inserted in the ICU or operating room (HR 2.66; 95% CI 1.27–5.56; p = 0.01), and CVCs were less colonized in females than in males (HR 0.49; 95% CI 0.26–0.89; p = 0.02). No difference in CR-BSI rates was noted between the three sites.
Conclusions Colonization was lowest at the subclavian site. Regional differences exist with respect to type of pathogen isolated. Colonization was influenced by insertion location and gender. The incidence of CR-BSI was not different.

Keyword Catheterization
CVC
Central Venous Catheter
intensive care
Sepsis
Colonization
subclavian
internal jugular
femoral
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2009 Higher Education Research Data Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 37 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 16 Apr 2009, 01:42:28 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH