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

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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.

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Acknowledgements

The authors thank the nursing and medical staff of the ICU, Launceston General Hospital, Launceston, Tasmania, Australia, for their cooperation in the execution of the study. They would also like to thank Mr. Andy Brown (Nurse Educator, Launceston General Hospital ICU) for database development, data acquisition, and assistance with study implementation. Statistical analysis was funded by the Clifford Craig Medical Research Trust, Launceston, Tasmania, Australia.

Author information

Authors and Affiliations

  1. Department of Intensive Care Medicine, Level 3, Ned Hanlon Building, Royal Brisbane and Woman’s Hospital, Herston, 4029, Brisbane, QLD, Australia

    John R. Gowardman

  2. University of Queensland, Queensland, Australia

    John R. Gowardman

  3. Griffith University, Gold Coast, Queensland, Australia

    John R. Gowardman

  4. School of Human Life Sciences, University of Tasmania, Launceston, Tasmania, Australia

    Iain K. Robertson

  5. Department of Biostatistics, Clifford Craig Medical Research Trust, Launceston General Hospital, Launceston, Tasmania, Australia

    Iain K. Robertson

  6. Department of Intensive Care and Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania, Australia

    Scott Parkes

  7. School of Medicine, University of Tasmania, Launceston, Tasmania, Australia

    Scott Parkes

  8. Professor of Nursing, Griffith University Research Centre for Clinical Practice Innovation and School of Nursing and Midwifery, Brisbane, Queensland, Australia

    Claire M. Rickard

Authors
  1. John R. Gowardman
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  2. Iain K. Robertson
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  3. Scott Parkes
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  4. Claire M. Rickard
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Corresponding author

Correspondence to John R. Gowardman.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-008-1047-2.

Conflicts of interest: The authors have no conflicts of interest to declare.

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Gowardman, J.R., Robertson, I.K., Parkes, S. et al. Influence of insertion site on central venous catheter colonization and bloodstream infection rates. Intensive Care Med 34, 1038–1045 (2008). https://doi.org/10.1007/s00134-008-1046-3

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  • DOI: https://doi.org/10.1007/s00134-008-1046-3

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