Influence of insertion site on central venous catheter colonization and bloodstream infection rates

Objective: To compare colonization and catheter-related bloodstream infection ( CR-BSI) rates among three insertion sites ( subclavian, internal jugular, femoral) used for central venous catheter ( CVC) placement. Design: Twenty-four-month prospective study, with relative effects analyzed by Cox proportional hazards regression. Setting: Eight-bed intensive care unit. Patients: Four hundred and ten critically ill patients requiring CVC placement. Measurements and results: All short-term multi-lumen CVCs, including antimicrobial-coated devices, were studied with management standardized. Six hundred and five CVCs ( 4,040 catheter days) were analyzed. Colonization and CR-BSI incidence were, respectively, 15.1 ( 95% CI 13.5-21.0) and 1.8 ( 95% CI 1.2-4.2) per 1,000 catheter-days. Colonization was higher at the internal jugular ( HR 3.64; 95% CI 1.32-10.00; p = 0.01) and femoral ( HR 5.15; 95% CI 1.82-14.51; p = 0.004) sites than at the subclavian site. The femoral site carried a greater risk of being colonized by non-S. epidermidis species than the subclavian and internal jugular sites combined ( HR 4.15; 95% CI 1.79-9.61; p = 0.001). CVCs inserted in the Department of Emergency Medicine were more colonized than those inserted in the ICU or operating room ( HR 2.66; 95% CI 1.27-5.56; p = 0.01), and CVCs were less colonized in females than in males ( HR 0.49; 95% CI 0.26-0.89; p = 0.02). No difference in CR-BSI rates was noted between the three sites. Conclusions: Colonization was lowest at the subclavian site. Regional differences exist with respect to type of pathogen isolated. Colonization was influenced by insertion location and gender. The incidence of CR-BSI was not different.