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

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Title Influence of insertion site on central venous catheter colonization and bloodstream infection rates
Author Gowardman, John Robert; Robertson, Iain K.; Parkes, Scott; Rickard, Claire
Journal Name Intensive Care Medicine
Editor Dr. L Brochard (Editor-in-Chief)
Year Published 2008
Place of publication Germany
Publisher Springer Berlin
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.
Peer Reviewed Yes
Published Yes
Publisher URI http://www.springer.com/medicine/journal/134
Alternative URI http://dx.doi.org/10.1007/s00134-008-1046-3
Copyright Statement Copyright 2008 Springer-Verlag. This is the author-manuscript version of this paper. Reproduced in accordance with the copyright policy of the publisher. The original publication is available at www.springerlink.com
Volume 34
Issue Number 6
Page from 1038
Page to 1045
ISSN 0342-4642
Date Accessioned 2008-09-05
Date Available 2009-03-12T06:33:40Z
Language en_AU
Research Centre Griffith Health Institute; Centre for Health Practice Innovation
Faculty Griffith Health Faculty
Subject PRE2009-Clinical Nursing: Secondary (Acute Care)
URI http://hdl.handle.net/10072/21668
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1

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