The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population

Kedar S. Deshpande, Carlo Hatem, Harry L. Ulrich, Brian P. Currie, Thomas K. Aldrich, Christopher W. Bryan-Brown, Vladimir Kvetan

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Objective: The objective was to assess the risk of central venous catheter infection with respect to the site of insertion in an intensive care unit population. The subclavian, internal jugular, and femoral sites were studied. Design: An epidemiologic, prospective, observational study. Setting: The setting is a well-functioning intensive care unit under a unified critical care medicine division in a university teaching hospital. Critical care medicine attendings and fellows covered on site 17 and 24 hrs per day, respectively. Patients: Patients were critically ill. All patients were triaged into the intensive care unit by on-site critical care medicine fellows. Interventions: None. Measurements and Main Results: In an intensive care unit population, we prospectively studied the incidence of central venous catheter infection and colonization at the subclavian, internal jugular, and femoral sites. The optimal insertion site for each individual patient was selected by experienced intensive care physicians (critical care medicine attendings and fellows). All of the operators were proficient in inserting catheters at all three sites. Confounding factors were eliminated; there were a limited number of experienced operators inserting the catheters, a uniform protocol stressing strict sterile insertion was enforced, and standardized continuous catheter care was provided by dedicated intensive care nurses proficient in all aspects of central venous catheter care. Two groups of patients were analyzed. Group 1 was patients with one catheter at one site, and group 2 was patients with catheters at multiple sites. Group 1 was the primary analysis, whereas group 2 was supporting. A total of 831 central venous catheters and 4,735 catheter days in 657 patients were studied. The incidence of catheter infection (4.01/1,000 catheter days, 2.29% catheters) and colonisation (5.07/1,000 catheter days, 2.89% catheters) was low overall. In group 1, the incidence of infection was subclavian: 0.881 infections/1,000 catheter days (0.45%), internal jugular: 0/1,000 (0%), and femoral: 2.98/1,000 (1.44%; p = .2635). The incidence of colonisation was subclavian: 0.881 colonization/1,000 catheter days (0.45%), internal jugular: 2.00/1,000 (1.05%), and femoral: 5.96/1,000 (2.88%, p = .1338). There was no statistically significant difference in the incidence of infection and colonization or duration of catheters (p = .8907) among the insertion sites. In group 2, there was also no statistically significant difference in the incidence of infection and colonization among the three insertion sites. Conclusion: In an intensive care unit population, the incidence of central venous catheter infection and colonization is low overall and, clinically and statistically, is not different at all three sites when optimal insertion sites are selected, experienced operators insert the catheters, strict sterile technique is present, and trained intensive care unit nursing staff perform catheter care.

Original languageEnglish (US)
Pages (from-to)13-20
Number of pages8
JournalCritical Care Medicine
Volume33
Issue number1
DOIs
StatePublished - Jan 2005

Fingerprint

Central Venous Catheters
Thigh
Intensive Care Units
Neck
Catheters
Incidence
Population
Critical Care
Infection
Medicine
Critical Care Nursing
Nursing Staff
Critical Illness
Teaching Hospitals

Keywords

  • Central venous catheters
  • Experienced operators
  • Femoral
  • Infection
  • Internal jugular
  • Subclavian

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. / Deshpande, Kedar S.; Hatem, Carlo; Ulrich, Harry L.; Currie, Brian P.; Aldrich, Thomas K.; Bryan-Brown, Christopher W.; Kvetan, Vladimir.

In: Critical Care Medicine, Vol. 33, No. 1, 01.2005, p. 13-20.

Research output: Contribution to journalArticle

Deshpande, Kedar S. ; Hatem, Carlo ; Ulrich, Harry L. ; Currie, Brian P. ; Aldrich, Thomas K. ; Bryan-Brown, Christopher W. ; Kvetan, Vladimir. / The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. In: Critical Care Medicine. 2005 ; Vol. 33, No. 1. pp. 13-20.
@article{b13e7a723777498d91a646cca1bd1b9b,
title = "The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population",
abstract = "Objective: The objective was to assess the risk of central venous catheter infection with respect to the site of insertion in an intensive care unit population. The subclavian, internal jugular, and femoral sites were studied. Design: An epidemiologic, prospective, observational study. Setting: The setting is a well-functioning intensive care unit under a unified critical care medicine division in a university teaching hospital. Critical care medicine attendings and fellows covered on site 17 and 24 hrs per day, respectively. Patients: Patients were critically ill. All patients were triaged into the intensive care unit by on-site critical care medicine fellows. Interventions: None. Measurements and Main Results: In an intensive care unit population, we prospectively studied the incidence of central venous catheter infection and colonization at the subclavian, internal jugular, and femoral sites. The optimal insertion site for each individual patient was selected by experienced intensive care physicians (critical care medicine attendings and fellows). All of the operators were proficient in inserting catheters at all three sites. Confounding factors were eliminated; there were a limited number of experienced operators inserting the catheters, a uniform protocol stressing strict sterile insertion was enforced, and standardized continuous catheter care was provided by dedicated intensive care nurses proficient in all aspects of central venous catheter care. Two groups of patients were analyzed. Group 1 was patients with one catheter at one site, and group 2 was patients with catheters at multiple sites. Group 1 was the primary analysis, whereas group 2 was supporting. A total of 831 central venous catheters and 4,735 catheter days in 657 patients were studied. The incidence of catheter infection (4.01/1,000 catheter days, 2.29{\%} catheters) and colonisation (5.07/1,000 catheter days, 2.89{\%} catheters) was low overall. In group 1, the incidence of infection was subclavian: 0.881 infections/1,000 catheter days (0.45{\%}), internal jugular: 0/1,000 (0{\%}), and femoral: 2.98/1,000 (1.44{\%}; p = .2635). The incidence of colonisation was subclavian: 0.881 colonization/1,000 catheter days (0.45{\%}), internal jugular: 2.00/1,000 (1.05{\%}), and femoral: 5.96/1,000 (2.88{\%}, p = .1338). There was no statistically significant difference in the incidence of infection and colonization or duration of catheters (p = .8907) among the insertion sites. In group 2, there was also no statistically significant difference in the incidence of infection and colonization among the three insertion sites. Conclusion: In an intensive care unit population, the incidence of central venous catheter infection and colonization is low overall and, clinically and statistically, is not different at all three sites when optimal insertion sites are selected, experienced operators insert the catheters, strict sterile technique is present, and trained intensive care unit nursing staff perform catheter care.",
keywords = "Central venous catheters, Experienced operators, Femoral, Infection, Internal jugular, Subclavian",
author = "Deshpande, {Kedar S.} and Carlo Hatem and Ulrich, {Harry L.} and Currie, {Brian P.} and Aldrich, {Thomas K.} and Bryan-Brown, {Christopher W.} and Vladimir Kvetan",
year = "2005",
month = "1",
doi = "10.1097/01.CCM.0000149838.47048.60",
language = "English (US)",
volume = "33",
pages = "13--20",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population

AU - Deshpande, Kedar S.

AU - Hatem, Carlo

AU - Ulrich, Harry L.

AU - Currie, Brian P.

AU - Aldrich, Thomas K.

AU - Bryan-Brown, Christopher W.

AU - Kvetan, Vladimir

PY - 2005/1

Y1 - 2005/1

N2 - Objective: The objective was to assess the risk of central venous catheter infection with respect to the site of insertion in an intensive care unit population. The subclavian, internal jugular, and femoral sites were studied. Design: An epidemiologic, prospective, observational study. Setting: The setting is a well-functioning intensive care unit under a unified critical care medicine division in a university teaching hospital. Critical care medicine attendings and fellows covered on site 17 and 24 hrs per day, respectively. Patients: Patients were critically ill. All patients were triaged into the intensive care unit by on-site critical care medicine fellows. Interventions: None. Measurements and Main Results: In an intensive care unit population, we prospectively studied the incidence of central venous catheter infection and colonization at the subclavian, internal jugular, and femoral sites. The optimal insertion site for each individual patient was selected by experienced intensive care physicians (critical care medicine attendings and fellows). All of the operators were proficient in inserting catheters at all three sites. Confounding factors were eliminated; there were a limited number of experienced operators inserting the catheters, a uniform protocol stressing strict sterile insertion was enforced, and standardized continuous catheter care was provided by dedicated intensive care nurses proficient in all aspects of central venous catheter care. Two groups of patients were analyzed. Group 1 was patients with one catheter at one site, and group 2 was patients with catheters at multiple sites. Group 1 was the primary analysis, whereas group 2 was supporting. A total of 831 central venous catheters and 4,735 catheter days in 657 patients were studied. The incidence of catheter infection (4.01/1,000 catheter days, 2.29% catheters) and colonisation (5.07/1,000 catheter days, 2.89% catheters) was low overall. In group 1, the incidence of infection was subclavian: 0.881 infections/1,000 catheter days (0.45%), internal jugular: 0/1,000 (0%), and femoral: 2.98/1,000 (1.44%; p = .2635). The incidence of colonisation was subclavian: 0.881 colonization/1,000 catheter days (0.45%), internal jugular: 2.00/1,000 (1.05%), and femoral: 5.96/1,000 (2.88%, p = .1338). There was no statistically significant difference in the incidence of infection and colonization or duration of catheters (p = .8907) among the insertion sites. In group 2, there was also no statistically significant difference in the incidence of infection and colonization among the three insertion sites. Conclusion: In an intensive care unit population, the incidence of central venous catheter infection and colonization is low overall and, clinically and statistically, is not different at all three sites when optimal insertion sites are selected, experienced operators insert the catheters, strict sterile technique is present, and trained intensive care unit nursing staff perform catheter care.

AB - Objective: The objective was to assess the risk of central venous catheter infection with respect to the site of insertion in an intensive care unit population. The subclavian, internal jugular, and femoral sites were studied. Design: An epidemiologic, prospective, observational study. Setting: The setting is a well-functioning intensive care unit under a unified critical care medicine division in a university teaching hospital. Critical care medicine attendings and fellows covered on site 17 and 24 hrs per day, respectively. Patients: Patients were critically ill. All patients were triaged into the intensive care unit by on-site critical care medicine fellows. Interventions: None. Measurements and Main Results: In an intensive care unit population, we prospectively studied the incidence of central venous catheter infection and colonization at the subclavian, internal jugular, and femoral sites. The optimal insertion site for each individual patient was selected by experienced intensive care physicians (critical care medicine attendings and fellows). All of the operators were proficient in inserting catheters at all three sites. Confounding factors were eliminated; there were a limited number of experienced operators inserting the catheters, a uniform protocol stressing strict sterile insertion was enforced, and standardized continuous catheter care was provided by dedicated intensive care nurses proficient in all aspects of central venous catheter care. Two groups of patients were analyzed. Group 1 was patients with one catheter at one site, and group 2 was patients with catheters at multiple sites. Group 1 was the primary analysis, whereas group 2 was supporting. A total of 831 central venous catheters and 4,735 catheter days in 657 patients were studied. The incidence of catheter infection (4.01/1,000 catheter days, 2.29% catheters) and colonisation (5.07/1,000 catheter days, 2.89% catheters) was low overall. In group 1, the incidence of infection was subclavian: 0.881 infections/1,000 catheter days (0.45%), internal jugular: 0/1,000 (0%), and femoral: 2.98/1,000 (1.44%; p = .2635). The incidence of colonisation was subclavian: 0.881 colonization/1,000 catheter days (0.45%), internal jugular: 2.00/1,000 (1.05%), and femoral: 5.96/1,000 (2.88%, p = .1338). There was no statistically significant difference in the incidence of infection and colonization or duration of catheters (p = .8907) among the insertion sites. In group 2, there was also no statistically significant difference in the incidence of infection and colonization among the three insertion sites. Conclusion: In an intensive care unit population, the incidence of central venous catheter infection and colonization is low overall and, clinically and statistically, is not different at all three sites when optimal insertion sites are selected, experienced operators insert the catheters, strict sterile technique is present, and trained intensive care unit nursing staff perform catheter care.

KW - Central venous catheters

KW - Experienced operators

KW - Femoral

KW - Infection

KW - Internal jugular

KW - Subclavian

UR - http://www.scopus.com/inward/record.url?scp=12244306921&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=12244306921&partnerID=8YFLogxK

U2 - 10.1097/01.CCM.0000149838.47048.60

DO - 10.1097/01.CCM.0000149838.47048.60

M3 - Article

C2 - 15644643

AN - SCOPUS:12244306921

VL - 33

SP - 13

EP - 20

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 1

ER -