[en] BACKGROUND: The risk for catheter-related infection seems higher with femoral catheters than with catheters inserted at other sites. OBJECTIVE: To evaluate the effect of catheter tunneling on femoral catheter-related infection in critically ill patients. DESIGN: Randomized, controlled trial. SETTING: Three intensive care units at academic hospitals in Paris, France. PATIENTS: 345 adult patients requiring a femoral venous catheter for more than 48 hours. INTERVENTION: Tunneled or nontunneled femoral catheters. MEASUREMENTS: Time to occurrence of systemic catheter-related sepsis, catheter-related bloodstream infection, and quantitative catheter tip culture with a cutoff of 10(3) colony-forming units/mL. RESULTS: Of 345 randomly assigned patients, 336 were evaluable. Probable systemic catheter-related sepsis occurred in 15 of 168 patients who received a nontunneled femoral catheter (controls) and in 5 of 168 patients who received a tunneled femoral catheter (estimated absolute risk reduction, 6% [95% CI, 0.9% to 11%]). Time to occurrence of catheter-related bloodstream infection was not significantly modified (relative risk, 0.28 [CI, 0.03 to 1.92]; P = 0.18); 3 events occurred in the control group and 1 event occurred in the tunneled-catheter group. After stratification by treatment center and adjustment for variables that were prognostic (use of broad-spectrum antimicrobial agents at catheter insertion) or imbalanced between both groups (mechanical ventilation at insertion), tunnelized catheterization reduced the proportion of patients who developed systemic catheter-related sepsis (relative risk, 0.25 [CI, 0.09 to 0.72]; P = 0.005) and positive quantitative culture of the catheter tip (relative risk, 0.48 [CI, 0.23 to 0.99]; P = 0.045). CONCLUSION: The incidence of femoral catheter-related infections in critically ill patients can be reduced by using subcutaneous tunneling.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Timsit, Jean-François
Bruneel, Fabrice
Cheval, Christine
Mamzer, Marie-France
Garrouste-Orgeas, Maïté
Wolff, Michel
Misset, Benoît ; Centre Hospitalier Universitaire de Liège - CHU > Service de Soins Intensifs
Chevret, Sylvie
Regnier, Bernard
Carlet, Jean
Language :
English
Title :
Use of tunneled femoral catheters to prevent catheter-related infection. A randomized, controlled trial.
Publication date :
1999
Journal title :
Annals of Internal Medicine
ISSN :
0003-4819
eISSN :
1539-3704
Publisher :
American College of Physicians, United States - Pennsylvania
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