Featured Research

from universities, journals, and other organizations

Comparison Of Catheter Insertion Sites For Dialysis Finds Little Difference In Risk Of Infection

Date:
May 27, 2008
Source:
JAMA and Archives Journals
Summary:
For critically ill patients requiring dialysis, insertion of the catheter in a vein in the neck does not appear to reduce the risk of infection compared to vein access in the upper leg, except for patients at higher weight levels.

For critically ill patients requiring dialysis, insertion of the catheter in a vein in the neck does not appear to reduce the risk of infection compared to vein access in the upper leg, except for patients at higher weight levels, according to a new study.

Catheterizations involving the femoral vein (in the upper, inner thigh), jugular vein (in the neck) and subclavian vein (beneath the clavicle) are routinely performed during critically ill patient care. These invasive procedures can contribute to additional illness, death and costs from complications and infections. Femoral venous catheterization is considered an emergency procedure that should be avoided if possible because of complication risks. The subclavian site is less suitable for larger catheters. Based on concerns about the risk of infection, the jugular site is often preferred over the femoral site for short-term dialysis, according to background information in the article.

Jean-Jacques Parienti, M.D., D.T.M. & H., of the Cote de Nacre University Hospital Center, Caen, France, and colleagues compared the rates of catheter colonization (growth of bacteria on the inserted catheter, detected at the time of catheter removal) and the rates of catheter-related blood stream infections between jugular and femoral catheterization among 750 severely ill patients in intensive care units (ICUs) in France who required a catheter insertion for acute renal replacement therapy (i.e., dialysis). Patients were randomized to receive jugular or femoral vein catheterization.

The risk of catheter colonization at the time of catheter removal did not differ significantly between the femoral and jugular groups (incidence of 40.8 vs. 35.7 per 1,000 catheter-days). Catheter-related bloodstream infection occurred in 3 of 324 patients (0.9 percent) with femoral catheters and in 5 of 313 patients (1.6 percent) with jugular catheters, a difference that was not statistically significant.

"[These results are] inconsistent with the widely accepted convention to avoid femoral catheterization to prevent the risk of catheter-related infection," the authors write.

The rate of hematoma formation (localized area of bleeding beneath the skin) was significantly higher for patients in the jugular catheterization group (3.6 percent) compared with those in the femoral catheterization group (1.1 percent).

Patients with a lower body mass index (BMI; less than 24.2) had twice the risk of catheter colonization in the jugular vs. femoral group, while patients with a higher BMI (greater than 28.4) had a 60 percent lower incidence of catheter colonization in the jugular vs. femoral group.

"In conclusion, the decision for the best site of insertion to prevent complications might be more complex than previously suggested. Our results support the current guideline for preventing catheter complications regarding the optimal site for catheter insertion in the ICU. If a subclavian approach is not available, and the ... individual risk of complications between the jugular and femoral sites is equal, the jugular site should be strongly considered for patients with higher BMI. We suggest that first-choice careful femoral catheterization by an experienced operator with full sterile precautions and appropriate post-insertion site care in non-obese, bed-bound, severely ill patients is acceptable and could reduce catheter-related morbidity compared with jugular catheterization," the researchers write.


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Jean-Jacques Parienti, MD, DTM&H; Marina Thirion, MD; Bruno Mégarbane, MD, PhD; Bertrand Souweine, MD, PhD; Abdelali Ouchikhe, MD; Andrea Polito, MD; Jean-Marie Forel, MD; Sophie Marqué, MD; Benoît Misset, MD; Norair Airapetian, MD; Claire Daurel, MD; Jean-Paul Mira, MD, PhD; Michel Ramakers, MD; Damien du Cheyron, MD, PhD; Xavier Le Coutour, MD; Cédric Daubin, MD; Pierre Charbonneau, MD; for Members of the Cathedia Study Group. Femoral vs Jugular Venous Catheterization and Risk of Nosocomial Events in Adults Requiring Acute Renal Replacement Therapy. JAMA. 2008;299[20]:2413-2422

Cite This Page:

JAMA and Archives Journals. "Comparison Of Catheter Insertion Sites For Dialysis Finds Little Difference In Risk Of Infection." ScienceDaily. ScienceDaily, 27 May 2008. <www.sciencedaily.com/releases/2008/05/080527183021.htm>.
JAMA and Archives Journals. (2008, May 27). Comparison Of Catheter Insertion Sites For Dialysis Finds Little Difference In Risk Of Infection. ScienceDaily. Retrieved July 28, 2014 from www.sciencedaily.com/releases/2008/05/080527183021.htm
JAMA and Archives Journals. "Comparison Of Catheter Insertion Sites For Dialysis Finds Little Difference In Risk Of Infection." ScienceDaily. www.sciencedaily.com/releases/2008/05/080527183021.htm (accessed July 28, 2014).

Share This




More Health & Medicine News

Monday, July 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

$15B Deal on Vets' Health Care Reached

$15B Deal on Vets' Health Care Reached

AP (July 28, 2014) — A bipartisan deal to improve veterans health care would authorize at least $15 billion in emergency spending to fix a veterans program scandalized by long patient wait times and falsified records. (July 28) Video provided by AP
Powered by NewsLook.com
Traditional African Dishes Teach Healthy Eating

Traditional African Dishes Teach Healthy Eating

AP (July 28, 2014) — Classes are being offered nationwide to encourage African Americans to learn about cooking fresh foods based on traditional African cuisine. The program is trying to combat obesity, heart disease and other ailments often linked to diet. (July 28) Video provided by AP
Powered by NewsLook.com
West Africa Gripped by Deadly Ebola Outbreak

West Africa Gripped by Deadly Ebola Outbreak

AFP (July 28, 2014) — The worst-ever outbreak of the deadly Ebola epidemic grips west Africa, killing hundreds. Duration: 00:48 Video provided by AFP
Powered by NewsLook.com
Trees Could Save More Than 850 Lives Each Year

Trees Could Save More Than 850 Lives Each Year

Newsy (July 27, 2014) — A national study conducted by the USDA Forest Service found that trees collectively save more than 850 lives on an annual basis. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins