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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 and Author 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
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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.

Figures

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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.

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

= 0.005 for difference between groups.

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