Influence of insertion site on central venous catheter colonization and bloodstream infection rates
- John R. GowardmanAffiliated withDepartment of Intensive Care Medicine, Level 3, Ned Hanlon Building, Royal Brisbane and Woman’s HospitalUniversity of QueenslandGriffith University Email author
- , Iain K. RobertsonAffiliated withSchool of Human Life Sciences, University of TasmaniaDepartment of Biostatistics, Clifford Craig Medical Research Trust, Launceston General Hospital
- , Scott ParkesAffiliated withDepartment of Intensive Care and Respiratory Medicine, Launceston General HospitalSchool of Medicine, University of Tasmania
- , Claire M. RickardAffiliated withProfessor of Nursing, Griffith University Research Centre for Clinical Practice Innovation and School of Nursing and Midwifery
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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.
Twenty-four-month prospective study, with relative effects analyzed by Cox proportional hazards regression.
Eight-bed intensive care unit.
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.
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.
KeywordsCatheterization CVC Central venous catheter Intensive care Sepsis Colonization Subclavian Internal jugular Femoral
- Influence of insertion site on central venous catheter colonization and bloodstream infection rates
Intensive Care Medicine
Volume 34, Issue 6 , pp 1038-1045
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- Central venous catheter
- Intensive care
- Internal jugular
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- Author Affiliations
- 1. Department of Intensive Care Medicine, Level 3, Ned Hanlon Building, Royal Brisbane and Woman’s Hospital, Herston, 4029, Brisbane, QLD, Australia
- 2. University of Queensland, Queensland, Australia
- 3. Griffith University, Gold Coast, Queensland, Australia
- 4. School of Human Life Sciences, University of Tasmania, Launceston, Tasmania, Australia
- 5. Department of Biostatistics, Clifford Craig Medical Research Trust, Launceston General Hospital, Launceston, Tasmania, Australia
- 6. Department of Intensive Care and Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
- 7. School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
- 8. Professor of Nursing, Griffith University Research Centre for Clinical Practice Innovation and School of Nursing and Midwifery, Brisbane, Queensland, Australia