The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Use of Tunneled Femoral Catheters To Prevent Catheter-Related Infection: A Randomized, Controlled Trial

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; and Jean Carlet, MD
[+] Article, Author, and Disclosure Information

From Hôpital Saint Joseph, Hôpital Bichat-Claude Bernard, Hôpital Necker, and Hôpital Saint Louis, Paris, France.

Ann Intern Med. 1999;130(9):729-735. doi:10.7326/0003-4819-130-9-199905040-00004
Text Size: A A A

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 103 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.


Grahic Jump Location
Figure 1.
Diagram of a tunneled femoral catheter.

The catheter was inserted by using the Seldinger method. A tunnel was created by retrograde passage of the catheter through the cannula to the point of exit at a preselected site in the homolateral thigh. The distance separating the cutaneous puncture site from the venous entry site had to be 10 cm.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Estimated time to systemic catheter-related sepsis, according to randomization.P

= 0.005 for difference between groups.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.