Catheter-related bloodstream infection according to central venous accesses

Introduction

Which venous catheterization site is associated with the higher risk of infection remains controversial. In the CDC guidelines of 1996 and in the latest guidelines of 2002, central venous catheter (CVC) insertion at the subclavian site is recommended rather than a femoral or a jugular access to minimize infection risk. The objective of this study was to analyze the incidence of catheter-related bloodstream infection (CRBSI) of CVCs according to different accesses.

Methods

A prospective and observational study, conducted in a polyvalent medical–surgical ICU. We included all consecutive patients admitted to the ICU during 4 years (1 May 2000–30 April 2004). The comparison of CRBSI incidence per 1,000 catheter-days between the different central venous accesses was performed using Poisson regression. P < 0.05 was considered statistically significant.

Results

The number of CVCs, days of catheterization duration, number of bacteremias and the CRBSI incidence density per 1,000 days were: global, 1,769, 15,683, 48 and 3.06; subclavian, 877, 7,805, 8, 1.02; posterior jugular, 169, 1,647, 2 and 1.21; central jugular, 515, 4,552, 22 and 4.83; and femoral, 208, 1,679, 16 and 9.52. The CRBSI incidence density was statistically higher for femoral than for central jugular (OR = 1.40, 95% CI = 1.04–infinite, P = 0.03), posterior jugular (OR = 1.99, 95% CI = 1.30–infinite, P < 0.001) and subclavian accesses (OR = 9.30, 95% CI = 4.27–infinite, P < 0.001); for central jugular than for posterior jugular (OR = 3.98, 95% CI = 1.15–infinite, P = 0.03) and subclavian accesses (OR = 4.72, 95% CI = 2.27–infinite, P < 0.001); and there were no significant differences between posterior jugular and subclavian access (OR = 1.09, 95% CI = 0.43–infinite, P = 0.99).

Conclusion

Our results suggest that the order for venous punction, to minimize the CVC-related infection risk, should be subclavian or posterior internal jugular as the first option, subsequently central internal jugular and finally the femoral vein.