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Am J Crit Care. 2003 Jul;12(4):328-35.

Risk of colonization of central venous catheters: catheters for total parenteral nutrition vs other catheters.

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1
School of Medicine, Johns Hopkins University, Baltimore, Md., USA.

Abstract

BACKGROUND:

Infected central venous catheters cause morbidity and mortality.

OBJECTIVE:

To compare the risk for colonization of central venous catheters used for total parenteral nutrition with that of catheters used for other purposes.

METHODS:

Retrospective review of prospectively acquired data on 260 patients with a stay in a surgical intensive care unit longer than 3 days. Single-lumen catheters used solely for total parenteral nutrition were inserted into the subclavian vein and cared for by a dedicated team. Catheters for other purposes were placed and cared for by other staff. Catheters were cultured if clinical findings suggested infection.

RESULTS:

Of 854 central venous catheters, 61 (7%) were used for total parenteral nutrition. During 4712 catheter days of observation, 89 catheters of all types were colonized. Risk factors for colonization included duration of catheterization (P < .001), having 3 or more lumens (hazard ratio, 1.7; 95% CI, 1.1-2.6), pulmonary artery catheterization (hazard ratio, 1.7; 95% CI, 1.1-2.7), and placement in the internal jugular vein (hazard ratio, 1.6; 95% CI, 1.1-2.5). Catheters used for total parenteral nutrition (hazard ratio, 0.14; 95% CI, 0.04-0.57) and those in the subclavian vein (hazard ratio, 0.51; 95% CI, 0.3-0.8) were at lower risk of colonization. In a multivariate Cox model, the only significant factor was a 5-fold lower risk of infection for catheters used for total parenteral nutrition (hazard ratio, 0.19; 95% CI, 0.04-0.83).

CONCLUSION:

Rates of colonization were lowest for catheters used solely for total parenteral nutrition, suggesting that a team approach improves patients' care.

PMID:
12882063
[Indexed for MEDLINE]
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