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Multi-lumen central venous catheters increase the risk of bloodstream infection: evidence from a systematic review

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Background and aim

Infections due to central venous catheters (CVC) contribute to hospital morbidity [1]. There is a controversy as to whether there is a particularly high risk of infection with multiple lumen CVCs. The aim of this systematic review of randomised trials was to test the evidence that multi-lumen CVCs, compared with single-lumen catheters, increase the risk of bloodstream infection, catheter colonisation, and insertion site infection.

Materials and methods

Systematic search (Medline, Embase, Cochrane Library, bibliographies, to 12.2001, any language) for published full reports of randomised comparisons of multi-lumen versus single-lumen CVCs in adults, reporting data on the incidence of infection according to published criteria [2]. Two authors independently screened all retrieved reports and extracted data. Methodological validity of the reports was assessed by all authors using the Oxford scale. Data were combined using a fixed effect model and reported as relative risk (RR) with 95% confidence interval (CI).

Results

Fourteen potentially relevant reports were retrieved; nine were subsequently excluded (not randomised, invalid endpoints). Settings were ICU or surgical ward. In five studies (530 CVCs), bloodstream infection was increased with multi-lumen CVCs compared with single-lumen CVCs (9.5% vs 3.5%, RR 2.62 [95% CI 1.25-5.49]). In four studies (353 CVCs), there was no difference in colonisation (13.1% with multi-lumen vs 14.7% with single-lumen, RR 0.93 [95% CI 0.56-1.55]). In two studies (125 CVCs), there was no difference in insertion site infection (53.1% with multi-lumen vs 39.3% with single-lumen, RR 1.35 [95% CI 0.91-2.01]).

Conclusions

There is evidence from randomised trials that on average one in 17 multi-lumen CVCs will lead to a bloodstream infection which would not have been the case had single-lumen CVCs been used. These data may have clinical implications.

References

  1. 1.

    Pittet , et al.: JAMA 1994, 271: 1598-1601. 10.1001/jama.271.20.1598

  2. 2.

    Maki , et al.: N Engl J Med 1977, 296: 1305-1309.

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Zürcher, M., Tramèr, M. & Walder, B. Multi-lumen central venous catheters increase the risk of bloodstream infection: evidence from a systematic review. Crit Care 6, P95 (2002). https://doi.org/10.1186/cc1800

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Keywords

  • Relative Risk
  • Randomise Trial
  • Central Venous Catheter
  • Systematic Search
  • Fixed Effect Model