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Infectious risk associated with arterial catheters compared with central venous catheters*

Lucet, Jean-Christophe MD, PhD; Bouadma, Lila MD; Zahar, Jean-Ralph MD; Schwebel, Carole MD; Geffroy, Arnaud MD; Pease, Sebastian MD; Herault, Marie-Christine MD; Haouache, Hakim MD; Adrie, Christophe MD; Thuong, Marie MD; Français, Adrien RT; Garrouste-Orgeas, Maïté MD; Timsit, Jean-François MD, PhD

doi: 10.1097/CCM.0b013e3181d4502e
Continuing Medical Education Articles

Background: Scheduled replacement of central venous catheters and, by extension, arterial catheters, is not recommended because the daily risk of catheter-related infection is considered constant over time after the first catheter days. Arterial catheters are considered at lower risk for catheter-related infection than central venous catheters in the absence of conclusive evidence.

Objectives: To compare the daily risk and risk factors for colonization and catheter-related infection between arterial catheters and central venous catheters.

Methods: We used data from a trial of seven intensive care units evaluating different dressing change intervals and a chlorhexidine-impregnated sponge. We determined the daily hazard rate and identified risk factors for colonization using a marginal Cox model for clustered data.

Results: We included 3532 catheters and 27,541 catheter-days. Colonization rates did not differ between arterial catheters and central venous catheters (7.9% [11.4/1000 catheter-days] and 9.6% [11.1/1000 catheter-days], respectively). Arterial catheter and central venous catheter catheter-related infection rates were 0.68% (1.0/1000 catheter-days) and 0.94% (1.09/1000 catheter-days), respectively. The daily hazard rate for colonization increased steadily over time for arterial catheters (p = .008) but remained stable for central venous catheters. Independent risk factors for arterial catheter colonization were respiratory failure and femoral insertion. Independent risk factors for central venous catheter colonization were trauma or absence of septic shock at intensive care unit admission, femoral or jugular insertion, and absence of antibiotic treatment at central venous catheter insertion.

Conclusions: The risks of colonization and catheter-related infection did not differ between arterial catheters and central venous catheters, indicating that arterial catheter use should receive the same precautions as central venous catheter use. The daily risk was constant over time for central venous catheter after the fifth catheter day but increased significantly over time after the seventh day for arterial catheters. Randomized studies are needed to investigate the impact of scheduled arterial catheter replacement. (Crit Care Med 2010; 38:1030–1035)

Head of Infection Control Unit (J-CL), Bichat-Claude Bernard University Hospital, Assistance publique–hôpitaux de Paris, Paris; Professor (J-CL), Denis Diderot University, Paris, France; Physician (LB), Medical ICU, Bichat Claude Bernard University Hospital, Assistance publique–hôpitaux de Paris, Paris, France; Physician (J-RZ), Infection Control Unit, CHU Necker Enfants-Malade, Universite Paris Descartes, Paris, France; Physician (CS), Service de Reanimation Medicale, Centre Hospitalier Universitaire, Grenoble, France; Physician (AG), Surgical ICU, Bichat–Claude Bernard University Hospital, Assistance publique–hôpitaux de Paris, Paris France; Attending Physician (SP), Assistance publique–hôpitaux de Paris, France; Hospitalary Practice Physician (M-CH), Reanimation University Hospital, Grenoble, France; Physician (HH), Medical-Surgical ICU, Delafontaine Hospital, Saint Denis, France; Associate Professor (CA), Cochin Hospital & Paris Descartes Paris University, Paris, France; Physician (MT), National Biomedecine Agency, Saint Denis la Plaine, France; Physican (AF), INSERM U823, “Outcome of cancers and critical illness,” Albert Bonniot Institute, 38076, La Tronche Cedex, Paris, France; Physician (MG-O), Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France; and Director of Research (J-FT), Team 11, INSERM U823, Grenoble; France; and Chief (J-FT), Medical Intensive Care Unit, Grenoble, France.

The project was supported by a public grant from the French Ministry of Health (Projet Hospitalier de Recherche Clinique #2005-PHN01).

Ethicon donated the Biopatch dressings.

Neither the French Ministry of Health nor Ethicon had any influence on the designing or conduct of the study, on the management, analysis, or interpretation of the study data, or on the preparation, review, final approval, or decision to submit the manuscript.

For information regarding this article, E-mail: jean-christophe.lucet@bch.aphp.fr

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins