Jean-François Timsit, MD; Fabrice Bruneel, MD; Christine Cheval, MD; Marie-France Mamzer, MD; Maïté Garrouste-Orgeas, MD; Michel Wolff, MD; Benoît Misset, MD; Sylvie Chevret, MD, PhD; Bernard Regnier, MD; Jean Carlet, MD
The risk for catheter-related infection seems higher with femoral catheters than with catheters inserted at other sites.
To evaluate the effect of catheter tunneling on femoral catheter-related infection in critically ill patients.
Randomized, controlled trial.
Three intensive care units at academic hospitals in Paris, France.
345 adult patients requiring a femoral venous catheter for more than 48 hours.
Tunneled or nontunneled femoral catheters.
Time to occurrence of systemic catheter-related sepsis, catheter-related bloodstream infection, and quantitative catheter tip culture with a cutoff of 103 colony-forming units/mL.
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).
The incidence of femoral catheter-related infections in critically ill patients can be reduced by using subcutaneous tunneling.
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Timsit J, Bruneel F, Cheval C, Mamzer M, Garrouste-Orgeas M, Wolff M, et al. Use of Tunneled Femoral Catheters To Prevent Catheter-Related Infection: A Randomized, Controlled Trial. Ann Intern Med. 1999;130:729-735. doi: 10.7326/0003-4819-130-9-199905040-00004
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Published: Ann Intern Med. 1999;130(9):729-735.
Hospital-Acquired Infections, Infectious Disease, Multi-Organ Failure and Sepsis, Nephrology, Pulmonary/Critical Care.
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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