Catheter-related infection of arterial catheters in critical care

Objective

To describe the incidence of catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) of arterial catheters (AC) in critically ill patients.

Methods

A prospective study of patients admitted in a 24-bed medical–surgical intensive care unit of a 650-bed university hospital, from 1 May 2000 to 31 October 2001, and who had some AC. A multiple proportion comparison of CRLI and CRBSI incidence density between the different catheter accesses was performed using the Fisher–Freeman–Halton exact test. P < 0.05 was considered significant.

Results

During this period of time 988 patients (60.12% male) were admitted in the ICU. The mean age was 55.63 ± 18.49 years, APACHE II score was 13.65 ± 5.83, and mortality was 14.37%. Patient distribution was: 49.69% cardiac surgery, 8.60% cardiologic, 12.14% neurologic, 11.84% traumathology, 7.29% respiratory, 6.58% digestive, 2.93% intoxication. The number of patients with AC, the number of AC and the days on risk for each AC were: global, 817, 1231 and 7171; radial, 753, 1057 and 5763; femoral, 111, 125 and 1091; pedia, 27, 30 and 226; humeral, 16, 19 and 91. The number of CRLI and CRBSI per 1000 days of catheterization were: general, 0.97 and 0.41; radial, 0.86 and 0.34; femoral, 1.83 and 0.91; pedia, 0; humeral, 0. Femoral arterial access had higher incidence density of CRLI (1.83/1000 catheter-days, P = 0.001) and CRBSI (0.91/1000 catheter-days, P = 0.001) than radial access. The three CRBSI were due to the following microorganisms: two Staphylococcus cogulasa negativo, one Staphylococcus aureus.

Conclusions

CDC guidelines for the prevention of catheter-related infection make no recommendation about the arterial catheter site. Our data suggest that any arterial site is preferable to the femoral arterial access.