Abstract
AimTo evaluate the CVC-related infection rate according to catheter insertion site and to analyze the risk factors for catheter-related local infections (CRLI) and bloodstream infections (CRBSI) among severe trauma patients.MethodsWe reviewed the medical records of 736 severe trauma patients with an Injury Severity Score of >15. Poisson regression was used to compare the infection rates according to the catheter insertion sites. Univariate analysis of the groups with and without CVC-related infection was used to identify confounding variables for inclusion in multivariate models that were used to identify the risk factors for CRLI and CRBSI.ResultsWe evaluated 1646 catheter insertions and their duration of insertion and found 1241 subclavian (18,461 days), 251 internal jugular (3454 days), and 154 femoral catheters (1526 days). The CRLI infection rate per 1000 catheter days was significantly lower for subclavian, compared to that for internal jugular (4.83 vs. 9.55, respectively; P < 0.001) and femoral catheters (4.83 vs. 7.93, respectively; P = 0.013). Multivariate logistic regression analysis revealed that catheter insertion duration [odds ratio (95 % confidence interval): 1.035 (1.021–1.050), P < 0.001] and subclavian access [0.532 (0.366–0.775), P < 0.001] were significantly associated with CRLI, while catheter insertion duration [1.024 (1.002–1.046), P = 0.032] was significantly associated with CRBSI.ConclusionsTo reduce the rate of CVC-related infections in severe trauma patients, we suggest that catheters be shifted from the internal jugular or femoral veins to the subclavian vein as soon as possible and that the duration of catheter insertion should be minimized.
Highlights
Central venous catheters (CVCs) are inserted for severe trauma patients who are hemodynamically unstable at the time of their admission to the trauma department
To reduce the rate of CVC-related infections in severe trauma patients, we suggest that catheters be shifted from the internal jugular or femoral veins to the subclavian vein as soon as possible and that the duration of catheter insertion should be minimized
The subclavian vein was involved in 91 catheter-related local infections (CRLI) episodes (4.83 per 1000 days), compared to 33 episodes (9.55 per 1000 days) in the internal jugular vein and 15 episodes (7.93 per 1000 days) in the femoral vein
Summary
Other indications for CVCs include resuscitations and patients with a deteriorating condition after surgical or radiological interventions In this context, CVCs provide many benefits in the acute and critical care fields, including hemodynamic monitoring, fluid resuscitation, massive transfusion, administration of medication, and nutritional support [1, 2]. CVCs provide many benefits in the acute and critical care fields, including hemodynamic monitoring, fluid resuscitation, massive transfusion, administration of medication, and nutritional support [1, 2] Despite these benefits, CVCs are associated with various complications, including infections, hemorrhage, World J Surg (2015) 39:2400–2406 pneumothorax, arterial puncture, and thrombosis. This study aimed to evaluate infection rate according to catheter insertion site and to analyze the risk factors for CVC-related infection among severe trauma patients
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