TY - JOUR
T1 - Risk of colonization of central venous catheters
T2 - Catheters for total parenteral nutrition vs other catheters
AU - Dimick, Justin B.
AU - Swoboda, Sandra
AU - Talamini, Mark A.
AU - Pelz, Robert K.
AU - Hendrix, Craig W.
AU - Lipsett, Pamela A.
PY - 2003/7/1
Y1 - 2003/7/1
N2 - • 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.
AB - • 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.
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U2 - 10.4037/ajcc2003.12.4.328
DO - 10.4037/ajcc2003.12.4.328
M3 - Article
C2 - 12882063
AN - SCOPUS:0642313730
VL - 12
SP - 328
EP - 335
JO - American Journal of Critical Care
JF - American Journal of Critical Care
SN - 1062-3264
IS - 4
ER -