Arterial catheter-related infection according to the catheter site

Introduction

Although there are many studies on arterial catheter-related infection (ACRI), there are scarce data on such infection according to the catheter access site. Which particular arterial catheter site is associated with a higher risk of infection remains controversial. The guidelines of the Centers for Disease Control and Prevention make no recommendation about which site or sites minimize the risk of catheter-related infection. In previous studies, we have found a higher incidence of ACRI in arterial femoral than in radial access sites. In the present study, we increased the number of arterial catheters in order to increase the probability of finding significant differences in the incidence of ACRI between other arterial accesses. The objective of this study was to analyze the incidence of ACRI according to different access sites.

Methods

We performed a prospective observational study of all consecutive patients admitted to our 24-bed medical and surgical ICU of a 650-bed university hospital during 6 years (1 May 2000 to 30 April 2006). ACRI included catheter-related local infection and catheter-related bloodstream infection.

Results

A total of 1,085 arterial femoral catheters were inserted during 6,497 days, 2,088 radial during 12,007 days, 174 dorsalis pedis catheters during 1,050 days and 141 brachial during 852 days. We detected 33 cases of ACRI (11 with bacteremia and 22 with local infection) in femoral catheters, 12 cases of ACRI (three with bacteremia and nine with local infection) in radial catheters, zero in dorsalis pedis catheters, and zero in brachial catheters. The ACRI incidence per 1,000 arterial catheter days was significantly higher for femoral (5.08) than for radial (1.76) access (OR = 5.1, 95% CI = 2.56 to 10.81; P ≤ 0.001), dorsalis pedis (0) access (OR = 7.6; 95% CI = 1.37 to infinite; P = 0.01) and brachial (0) access (OR = 6.2, 95% CI = 1.11 to infinite; P = 0.03). We did not find significant differences in the ACRI incidence per 1,000 arterial catheter days between radial and dorsalis pedis (OR = 1.5; 95% CI = 0.24 to infinite; P = 0.73); and between radial and brachial access (OR = 1.2; 95% CI = 0.20 to infinite; P = 0.88).

Conclusion

Our results suggest that femoral arterial access should be avoided in order to minimize the risk of arterial catheter-related infection.