Cumulative evidence of randomized controlled and observational studies on catheter-related infection risk of central venous catheter insertion site in ICU patients: a pairwise and network meta-analysis

Arvaniti, Kostoula, Lathyris, Dimitrios, Blot, Stijn, Apostolidou-Kiouti, Fani, Koulenti, Despoina and Haidich, Anna-Bettina (2017) Cumulative evidence of randomized controlled and observational studies on catheter-related infection risk of central venous catheter insertion site in ICU patients: a pairwise and network meta-analysis. Critical Care Medicine, 45 4: e437-e448. doi:10.1097/CCM.0000000000002092


Author Arvaniti, Kostoula
Lathyris, Dimitrios
Blot, Stijn
Apostolidou-Kiouti, Fani
Koulenti, Despoina
Haidich, Anna-Bettina
Title Cumulative evidence of randomized controlled and observational studies on catheter-related infection risk of central venous catheter insertion site in ICU patients: a pairwise and network meta-analysis
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 1530-0293
0090-3493
Publication date 2017-04-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/CCM.0000000000002092
Open Access Status Not yet assessed
Volume 45
Issue 4
Start page e437
End page e448
Total pages 12
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Collection year 2018
Language eng
Formatted abstract
Background: Selection of central venous catheter insertion site in ICU patients could help reduce catheter-related infections. Although subclavian was considered the most appropriate site, its preferential use in ICU patients is not generalized and questioned by contradicted meta-analysis results. In addition, conflicting data exist on alternative site selection whenever subclavian is contraindicated.

Objective: To compare catheter-related bloodstream infection and colonization risk between the three sites (subclavian, internal jugular, and femoral) in adult ICU patients.

Data Source: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, CINAHL, and ClinicalTrials.gov.

Study Selection: Eligible studies were randomized controlled trials and observational ones.

Data Extraction: Extracted data were analyzed by pairwise and network meta-analysis.

Data Synthesis: Twenty studies were included; 11 were observational, seven were randomized controlled trials for other outcomes, and two were randomized controlled trials for sites. We evaluated 18,554 central venous catheters: 9,331 from observational studies, 5,482 from randomized controlled trials for other outcomes, and 3,741 from randomized controlled trials for sites. Colonization risk was higher for internal jugular (relative risk, 2.25 [95% CI, 1.84-2.75]; I2 = 0%) and femoral (relative risk, 2.92 [95% CI, 2.11-4.04]; I2 = 24%), compared with subclavian. Catheter-related bloodstream infection risk was comparable for internal jugular and subclavian, higher for femoral than subclavian (relative risk, 2.44 [95% CI, 1.25-4.75]; I2 = 61%), and lower for internal jugular than femoral (relative risk, 0.55 [95% CI, 0.34-0.89]; I2 = 61%). When observational studies that did not control for baseline characteristics were excluded, catheter-related bloodstream infection risk was comparable between the sites.

Conclusions: In ICU patients, internal jugular and subclavian may, similarly, decrease catheter-related bloodstream infection risk, when compared with femoral. Subclavian could be suggested as the most appropriate site, whenever colonization risk is considered and not, otherwise, contraindicated. Current evidence on catheter-related bloodstream infection femoral risk, compared with the other sites, is inconclusive.
Keyword Catheter-related infections
Central venous catheter
Insertion site
Intensive care unit
Meta-analysis
Network meta-analysis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
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Created: Tue, 11 Apr 2017, 00:25:16 EST by Web Cron on behalf of Learning and Research Services (UQ Library)