EFFECT OF SUBCUTANEOUS TUNNELING ON INTERNAL JUGULAR CATHETER-RELATEDSEPSIS IN CRITICALLY ILL PATIENTS - A PROSPECTIVE RANDOMIZED MULTICENTER STUDY

Objective.-To evaluate the effect of catheter tunneling on internal ju gular catheter-related sepsis in critically ill patients. Design.-A pr ospective randomized controlled study involving 3 intensive care units (ICUs), stratified by number of catheter lumina (1 or 2) and center. Setting.-The 10-bed medical-surgical and 10-bed surgical ICUs at Saint Joseph Hospital and 8-bed surgical ICU at Clinique de la Defense, Par is, France. Patients.-Every patient older than 18 years admitted to th e ICUs between March 1, 1993, and July 17, 1996, who required a jugula r venous catheter for more than 48 hours. Intervention.-Random allocat ion to tunneled or nontunneled catheters. Measurements-Times to occurr ence of systemic catheter-related sepsis, catheter-related septicemia, or a quantitative catheter-tip culture with a cutoff of 103 colony-fo rming units per milliliter. Results.-A total of 241 patients were rand omized, Ten patients in whom jugular puncture was not achieved were su bsequently excluded, The proportion of patients receiving mechanical v entilation (87%) and mean+/-SD age (65+/-4 years), Simplified Acute Ph ysiologic Score (13.3+/-4.9), Organ System Failure score (1.5+/-1.0), and duration of catheterization (8.7+/-5.0 days) were similar in both groups. Taking into account the first 231 catheters (114 nontunneled [ control], 117 tunneled), we found that tunnelization decreased cathete r-related sepsis (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.13-0.83; P=.02), catheter-related septicemia (OR, 0.23; 95% CI, 0.0 7-0.81; P=.02), and, though not statistically significant, positive qu antitative tip-culture rate (OR, 0.62; 95% CI, 0.35-1.10; P=.10). Thes e results were slightly modified after adjustment on parameters either imbalanced between both groups (duration of catheter placement and ca ncer at admission) or prognostic (insertion by a resident, use of anti biotics at catheter insertion, cancer, and sex). Conclusion.-The incid ence of internal jugular catheter-related infections in critically ill patients can be reduced by using subcutaneous tunnelization.