Use of Tunneled Femoral Catheters To Prevent Catheter-Related Infection

A Randomized, Controlled Trial

4 May 1999 | Volume 130 Issue 9 | Pages 729-735

Background: The risk for catheter-related infection seems higher with femoral catheters than with catheters inserted at other sites.

Objective: To evaluate the effect of catheter tunneling on femoral catheter-related infection in critically ill patients.

Design: Randomized, controlled trial.

Setting: Three intensive care units at academic hospitals in Paris, France.

Patients: 345 adult patients requiring a femoral venous catheter for more than 48 hours.

Intervention: Tunneled or nontunneled femoral catheters.

Measurements: Time to occurrence of systemic catheter-related sepsis, catheter-related bloodstream infection, and quantitative catheter tip culture with a cutoff of 10³ colony-forming units/mL.

Results: Of 345 randomly assigned patients, 336 were evaluable. Probable systemic catheter-related sepsis occurred in 15 of 168 patients who received a nontunneled femoral catheter (controls) and in 5 of 168 patients who received a tunneled femoral catheter (estimated absolute risk reduction, 6% [95% CI, 0.9% to 11%]). Time to occurrence of catheter-related bloodstream infection was not significantly modified (relative risk, 0.28 [CI, 0.03 to 1.92]; P = 0.18); 3 events occurred in the control group and 1 event occurred in the tunneled-catheter group. After stratification by treatment center and adjustment for variables that were prognostic (use of broad-spectrum antimicrobial agents at catheter insertion) or imbalanced between both groups (mechanical ventilation at insertion), tunnelized catheterization reduced the proportion of patients who developed systemic catheter-related sepsis (relative risk, 0.25 [CI, 0.09 to 0.72]; P = 0.005) and positive quantitative culture of the catheter tip (relative risk, 0.48 [CI, 0.23 to 0.99]; P = 0.045).

Conclusion: The incidence of femoral catheter-related infections in critically ill patients can be reduced by using subcutaneous tunneling.

Author and Article Information

From Hôpital Saint Joseph, Hôpital Bichat-Claude Bernard, Hôpital Necker, and Hôpital Saint Louis, Paris, France.

Grant Support: In part by the Fondation-Hôpital Saint Joseph, Bellon, Eli Lilly & Co., Marion Merrell Dow, Inc., Pfizer, Inc., SmithKline Beecham Pharmaceuticals, Roche Laboratories, Roussel & Diamant, and Wyeth-Lederle. Plastimed provided 50 tunneled catheters.

Requests for Reprints: Jean-François Timsit, Réanimation Polyvalente, Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France.

Current Author Addresses: Drs. Timsit, Misset, Garrouste-Orgeas, and Carlet: Réanimation Polyvalente, Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France.

Drs. Bruneel, Wolff, and Regnier: Clinique de Réanimation des Maladies Infectieuses, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France.

Dr. Cheval: Surgical Intensive Care Unit, Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France.

Dr. Mamzer: Réanimation Néphrologique et Transplantation, Hôpital Necker, 75013 Paris, France.

Dr. Chevret: Biostatistic Department, Hôpital Saint Louis, 75010 Paris, France.