Use of tunneled femoral catheters to prevent catheter-related infection - A randomized, controlled trial

Background: The risk for catheter-related infection seems higher with femor al 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 t han 48 hours. Intervention: Tunneled or nontunneled femoral catheters. Measurements: Time to occurrence of systemic catheter-related sepsis, cathe ter-related bloodstream infection, and quantitative catheter tip culture wi th a cutoff of 10(3) colony-forming units/mL. Results: Of 345 randomly assigned patients, 336 were evaluable. Probable sy stemic catheter-related sepsis occurred in 15 of 168 patients who received a nontunneled femoral catheter (controls) and in 5 of 168 patients who rece ived a tunneled femoral catheter (estimated absolute risk reduction, 6% [95 % CI, 0.9% to 11%]). Time to occurrence of catheter-related bloodstream inf ection was not significantly modified (relative risk, 0.28 [CI, 0.03 to 1.9 2]; P = 0.18); 3 events occurred in the control group and 1 event occurred in the tunneled-catheter group. After stratification by treatment center an d adjustment for variables that were prognostic (use of broad-spectrum anti microbial agents at catheter insertion) or imbalanced between both groups ( mechanical ventilation at insertion), tunnelized catheterization reduced th e proportion of patients who developed systemic catheter-related sepsis (re lative 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 critica lly ill patients can be reduced by using subcutaneous tunneling.