Infection was diagnosed with higher rate in catheters inserted via jugular vein in comparison with subclavian vein (95% CI: 1.32&x02013;4.81, p = 0.005). Cancer. Arch Intern Med. [Arch Intern Med. 1987]. Three-year experience with sonicated vascular catheter cultures in a clinical microbiology laboratory. J Clin Microbiol. 1990] Diagnosis of vascular catheter-related bloodstream infection: a meta-analysis. [J Clin Microbiol.

During the study period 300 patients with central venous catheters were prospectively studied. The catheters used were nontunneled, noncuffed, triple lumen and made of polyurethane material. Catheters were cultured by semiquantitative method and blood cultures done when indicated. Ninety-one (30.3%) of the catheters were colonized and infection was found with 50 (16.7%) catheters. Infection was diagnosed with higher rate in catheters inserted via jugular vein in comparison with subclavian vein (95% CI: 1.32&x02013;4.81, p = 0.005).

The incidence of infection was higher in catheters which were kept in place for more than seven days (95% CI 1.05&x02013;3.87, p = 0.03). The incidence of infection was lower in patients who were using glycopeptide antibiotic during catheterization (95% CI: 1.49&x02013;5.51, p = 0.005). The rate of infection with Gram positive cocci was significantly lower in glycopeptide antibiotic using patients (p = 0.01).

Duration of catheterization and catheter insertion site were independent risk factors for catheter related infection.

Patients and Methods.

Authors' contributions. References. Background Central venous catheters (CVCs) are widely used in critically ill patients throughout the developed world. They permit hemodynamic monitoring and allow access for the administration of fluids, blood products, medications, and total parenteral nutrition (TPN). Estimates of their use in the United States alone suggest that over five million CVCs are inserted annually [ 1 , 2 ].

Although CVCs have significant benefits in many clinical situations, the increase in their use over the last 20 years has been associated with at least a doubling of resultant nosocomial infections [ 3 , 4 ]. A number of factors may contribute to the risk of catheter related infections (CRI) [ 5 |

Authors' contributions. References. . Patients and Methods.. . Human research ethics committee approval was obtained for the study. As there were no interventions, requirement for written patient consent was waived. All patients admitted to medical, neurosurgical and surgical ICUs of Istanbul Faculty of Medicine between January 2001 and December 2001 who submitted to a CVC were included in the study.

The catheters used were nontunneled, noncuffed, triple lumen and made of polyurethane material (Arrow, Erding, Germany). All catheters were inserted via new percutaneous puncture in intensive care units by experienced anaesthetists under strict aseptic techniques. After washing hands and forearms with antiseptic soap, drying with a sterile towel, maximal sterile barrier precautions (sterile gloves, longsleeved sterile gown, mask, cap, and large sterile sheet drape) were observed prior to catheter insertion.

Povidone-iodine was used as antiseptic for cleansing the CVC insertion site. After catheter insertion the site was covered with sterile gauze. Every 48 hours the dressing was removed, the site was inspected and cleansed with povidone-iodine, and a new dressing was applied. Catheters were followed for the duration of their insertion and data were obtained daily on inflammation of the catheter sites by a single observer.

The catheters were removed at the end of the day seven as scheduled replacement is followed in the ICUs of our hospital. Catheters were removed in less than seven days when the patient had no more need for central line and suspected to have CRI. There was provision for discretionary clinical judgement to leave the catheter longer than seven days.

. During the study period 300 patients with CVCs were assessed. One hundred and seventy &x02013; six (58.6%) of the patients were from the general ICU, 92 (30.7%) were from the surgical ICU and the other 32 (10.7%) were from the neurosurgical ICU. The patients studied were 148 (49.3%) males and 152 (51.7%) females. The mean age was 44 &x000b1; 21.1. The primary diagnosis of the patients were as follows; 81 (27%) cardiorespiratory failure, 72 (%24) trauma, 72 (24%) postsurgical and 75 (25%) others.

CVCs were inserted either into jugular vein (n = 132, 44%) or into the subclavian vein (n = 168, 56%). Twenty &x02013; eight (9.3%) patients were receiving TPN. The mean length of time the catheter was kept in place was 7 &x000b1; 2.8 days.

Of the CRIs; 28 (%9.3) D-CRB, 8 (2.7%) P-CRB and 17 (5.6%) exit site infection was diagnosed. Three (1%) patients had both D-CRB and exit site infection. The unadjusted risk ratios of risk factors are given in Table 1 . No significant difference were found for age, gender, unit, primary diagnosis, repeated catheterization and TPN use. CRI was diagnosed with higher rate (n = 30, 22.7%) in CVCs inserted via jugular vein in comparison with subclavian vein (n = 20, 11.9%) (p = 0.01).

The incidence of CRI (n = 24, 24.2%) was higher in catheters which were kept in place for more than seven days (p = 0.01).

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