uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Initial and Extended Use of Femoral Versus Nonfemoral Double-Lumen Vascular Catheters and Catheter-Related Infection During Continuous Renal Replacement Therapy
Show others and affiliations
2014 (English)In: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 64, no 6, 909-917 p.Article in journal (Refereed) Published
Abstract [en]

Background: The risk of catheter-related infection or bacteremia, with initial and extended use of femoral versus nonfemoral sites for double-lumen vascular catheters (DLVCs) during continuous renal replacement therapy (CRRT), is unclear. Study Design: Retrospective observational cohort study. Setting & Participants: Critically ill patients on CRRT in a combined intensive care unit of a tertiary institution. Factor: Femoral versus nonfemoral venous DLVC placement. Outcomes: Catheter-related colonization (CRCOL) and bloodstream infection (CRBSI). Measurements: CRCOL/CRBSI rates expressed per 1,000 catheter-days. Results: We studied 458 patients (median age, 65 years; 60% males) and 647 DLVCs. Of 405 single-site only DLVC users, 82% versus 18% received exclusively 419 femoral versus 82 jugular or subclavian DLVCs, respectively. The corresponding DLVC indwelling duration was 6 +/- 4 versus 7 +/- 5 days (P = 0.03). Corresponding CRCOL and CRBSI rates (per 1,000 catheter-days) were 9.7 versus 8.8 events (P = 0.8) and 1.2 versus 3.5 events (P = 0.3), respectively. Overall, 96 patients with extended CRRT received femoral-site insertion first with subsequent site change, including 53 femoral guidewire exchanges, 53 new femoral venipunctures, and 47 new jugular/subclavian sites. CRCOL and CRBSI rates were similar for all such approaches (P = 0.7 and P = 0.9, respectively). On multivariate analysis, CRCOL risk was higher in patients older than 65 years and weighing >90 kg (ORs of 2.1 and 2.2, respectively; P < 0.05). This association between higher weight and greater CRCOL risk was significant for femoral DLVCs, but not for nonfemoral sites. Other covariates, including initial or specific DLVC site, guidewire exchange versus new venipuncture, and primary versus secondary DLVC placement, did not significantly affect CRCOL rates. Limitations: Nonrandomized retrospective design and single-center evaluation. Conclusions: CRCOL and CRBSI rates in patients on CRRT are low and not influenced significantly by initial or serial femoral catheterizations with guidewire exchange or new venipuncture. CRCOL risk is higher in older and heavier patients, the latter especially so with femoral sites.

Place, publisher, year, edition, pages
2014. Vol. 64, no 6, 909-917 p.
Keyword [en]
Acute kidney injury (AKI), acute renal failure (ARF), catheter-related bloodstream infection (CRBSI), line sepsis, catheter-related colonization, catheter-related infection, line infection, double lumen vascular catheter, nontunneled dialysis catheter, continuous renal replacement therapy (CRRT), critical illness, intensive care, critical care, femoral venous catheter, guidewire exchange versus new venipuncture, jugular and subclavian venous catheter
National Category
Urology and Nephrology
URN: urn:nbn:se:uu:diva-240065DOI: 10.1053/j.ajkd.2014.04.022ISI: 000345404200013PubMedID: 24882583OAI: oai:DiVA.org:uu-240065DiVA: diva2:775970
Available from: 2015-01-05 Created: 2015-01-05 Last updated: 2015-01-05Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Lipcsey, Miklós
By organisation
Anaesthesiology and Intensive Care
In the same journal
American Journal of Kidney Diseases
Urology and Nephrology

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 289 hits
ReferencesLink to record
Permanent link

Direct link