EBQ:Catheter related infections

incomplete Journal Club Article

Marik PE et al. "The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis.". Critical Care Medicine. 2012. 40(8):2479-85.
PubMed Full text PDF

Clinical Question

What is the rate of catheter-related infections of non-tunneled catheters placed at the femoral vein site as compared with subclavian and internal jugular sites?

Conclusion

• Although earlier studies showed a lower risk of catheter related bloodstream infections when the internal jugular was compared to the femoral site, recent studies show no difference in the rate of catheter-related bloodstream infections between the three sites.

Major Points

• 3230 catheters were placed in the subclavian vein, 10,958 in the internal jugular and 3,188 in the femoral vein for a total of 113,652 catheter days.
• Avg catheter related blood stream infections density was 2.5 per 1,000 catheter days (range 0.6–7.2).
• There was no significant difference in the risk of catheter related bloodstream infections between the femoral and subclavian/internal jugular sites in the two randomized controlled trials
• There was no significant difference in the risk of catheter related bloodstream infections between the femoral and subclavian sites.
• The internal jugular site was associated with a significantly lower risk of catheter-related bloodstream infections compared to the femoral site
  • Risk ratio 1.90; 95% CI 1.21–2.97, p = .005, I2 = 35%.
  • This difference was explained by two of the studies that were statistical outliers.
    • When these two studies were removed from the analysis there was no significant difference in the risk of catheter related bloodstream infections between the femoral and internal jugular sites' (risk ratio 1.35; 95% confidence interval 0.84–2.19, p = 0.2, I2 = 0%).
• Meta-regression demonstrated a significant interaction between the risk of infection and the year of publication (p = .01), with the femoral site demonstrating a higher risk of infection in the earlier studies.
• There was no significant difference in the risk of catheter related bloodstream infection between the subclavian and internal jugular sites.
• A meta analysis of this data demonstrates that there was no difference in the risk of deep venous thrombosis when the femoral site was compared to the subclavian and internal jugular sites combined.

Design

• Systematic Review and meta-analysis

Data Inclusion

• Data Sources: MEDLINE, Embase, Cochrane Register of Con- trolled Trials, citation review of relevant primary and review articles, and an Internet search (Google).
• Study Selection: Randomized controlled trials and cohort studies that reported the frequency of catheter-related bloodstream infections (infections per 1,000 catheter days) in patients with non-tunneled central venous catheters placed in the femoral site as compared to subclavian or internal jugular placement.
• Data Extraction: Data were abstracted on study design, study size, study setting, patient population, number of catheters at each insertion site, number of catheter-related bloodstream infections, and the prevalence of deep venous thrombosis.
  • Studies were subgrouped according to study design (cohort and randomized controlled trials).

Inclusion Studies

Two randomized controlled trials (1006 catheters) and 8 cohort (16,370 catheters) studies

Sources

Authors

Ross Donaldson