Abstract
IntroductionCentral venous catheterization is commonly used in critically ill patients and may cause different complications, including infection. Although there are many studies about CVC-related infection, very few have analyzed it in detail. The objective of this study was to analyze the incidence of catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) with central venous catheters (CVCs) according to different access sites.MethodsThis is a prospective and observational study, conducted in a 24-bed medical surgical intensive care unit of a 650-bed university hospital. All consecutive patients admitted to the ICU during 3 years (1 May 2000 and 30 April 2003) were included.ResultsThe study included 2,018 patients. The number of CVCs and days of catheterization duration were: global, 2,595 and 18,999; subclavian, 917 and 8,239; jugular, 1,390 and 8,361; femoral, 288 and 2,399. CRLI incidence density was statistically higher for femoral than for jugular (15.83 versus 7.65, p < 0.001) and subclavian (15.83 versus 1.57, p < 0.001) accesses, and higher for jugular than for subclavian access (7.65 versus 1.57, p < 0.001). CRBSI incidence density was statistically higher for femoral than for jugular (8.34 versus 2.99, p = 0.002) and subclavian (8.34 versus 0.97, p < 0.001) accesses, and higher for jugular than for subclavian access (2.99 versus 0.97, p = 0.005).ConclusionOur results suggest that the order for punction, to minimize the CVC-related infection risk, should be subclavian (first order), jugular (second order) and femoral vein (third order).
Highlights
Central venous catheterization is commonly used in critically ill patients and may cause different complications, including infection
Our results suggest that the order for punction, to minimize the central venous catheters (CVCs)-related infection risk, should be subclavian, jugular and femoral vein
Our results suggest that the order for punction, to minimize CVC-related infection risk, should be subclavian, jugular and femoral
Summary
Central venous catheterization is commonly used in critically ill patients and may cause different complications, including infection. The objective of this study was to analyze the incidence of catheterrelated local infection (CRLI) and catheter-related bloodstream infection (CRBSI) with central venous catheters (CVCs) according to different access sites. Central venous catheters (CVCs) are commonly used in critically ill patients for the administration of fluids, medications, blood products and parenteral nutrition, for the insertion of a transvenous pacing electrode and to monitor hemodynamic status. The use of catheters is habitual in critically ill patients; in the EPIC study, 78% of critically ill patients had some form of CVC inserted [1]. Central venous catheterization may cause different complications, including infection, haemorrhage and thrombosis. Interest in catheter-related infection lies in the mortality [2,3,4,5] and the costs [6,7,8,9] it represents
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