Arterial catheter-related infections in the intensive care unit: prospective study during 1 year

Introduction

Peripheral arterial catheters (PAC) are usually inserted into the radial or femoral artery and permit continuous blood pressure monitoring and blood gas measurements. There are no recommendations concerning change for arterial catheters.

Aim

To estimate the incidence of the arterial catheter-related infections (ACRI) and to identify the associated risk factors.

Materials and methods

It is a prospective study, performed between December 2001 and November 2002. We realize a culture of the hub of stopcock. After removal, the tip of the catheter was systematically cultured using a quantitative culture technique and we realize a simultaneous bloodstream by venipuncture.

Results

One hundred successive PAC are studied (77 radial and 23 femoral) in 70 patients with mean age 48 ± 18 years, sex ratio = 1.5, SAPS II = 42 ± 17, APACHE II = 20 ± 10, McCabe = 0.95 ± 0.9, OSF = 2.7 ± 1. The mean duration of cannulation was 7.3 days. Twelve are contaminated (< 10³ CFU/ml), two colonized (> 10³ CFU/ml). The rate of catheter-related sepsis is three of 100, and that of catheter-related bacteraemia is two of 100. Risk factors retained are: duration of catheterization (additional risk is multiplied by 4.33 in passing from 1–5 days to 6–10 days), length of stay in ICU (> 28 days), and positive culture of the hub of stopcock (sensibility = 100%, specificity = 82%, positive predictive value = 22% and negative predictive value = 100%).

Discussion

Peripheral arterial catheters can be accessed several times per day for haemodynamic measurement or to obtain samples for laboratory analysis, increasing the potential for contamination and subsequent clinical infection. The following three risk factors for catheter-related infections were identified: duration of catheterization, length of stay in ICU and manipulation of the stopcock.

Conclusion

The ACRI are not frequent. Their arising is bound to the duration of catheterization with an increase of the risk of colonization after 5 days. A positive culture of stopcock may indicate the removal or the change of APC.