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Cumulative evidence of randomized controlled and observational studies on catheter-related infection risk of central venous catheter insertion site in ICU patients

(2017) CRITICAL CARE MEDICINE. 45(4). p.E437-E448
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Abstract
Background: Selection of central venous catheter insertion site in ICU patients could help reduce catheter-related infections. Although subclavian was considered the most appropriate site, its preferential use in ICU patients is not generalized and questioned by contradicted meta-analysis results. In addition, conflicting data exist on alternative site selection whenever subclavian is contraindicated. Objective: To compare catheter-related bloodstream infection and colonization risk between the three sites (subclavian, internal jugular, and femoral) in adult ICU patients. Data Source: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, CINAHL, and clinicaltrials.gov. Study Selection: Eligible studies were randomized controlled trials and observational ones. Data Extraction: Extracted data were analyzed by pairwise and network meta-analysis. Data Synthesis: Twenty studies were included; 11 were observational, seven were randomized controlled trials for other outcomes, and two were randomized controlled trials for sites. We evaluated 18,554 central venous catheters: 9,331 from observational studies, 5,482 from randomized controlled trials for other outcomes, and 3,741 from randomized controlled trials for sites. Colonization risk was higher for internal jugular (relative risk, 2.25 [95% CI, 1.84-2.75]; I-2 = 0%) and femoral (relative risk, 2.92 [95% CI, 2.11-4.04]; I-2 = 24%), compared with subclavian. Catheter-related bloodstream infection risk was comparable for internal jugular and subclavian, higher for femoral than subclavian (relative risk, 2.44 [95% CI, 1.25-4.75]; I-2 = 61%), and lower for internal jugular than femoral (relative risk, 0.55 [95% CI, 0.34-0.89]; I-2 = 61%). When observational studies that did not control for baseline characteristics were excluded, catheter-related bloodstream infection risk was comparable between the sites. Conclusions: In ICU patients, internal jugular and subclavian may, similarly, decrease catheter-related bloodstream infection risk, when compared with femoral. Subclavian could be suggested as the most appropriate site, whenever colonization risk is considered and not, otherwise, contraindicated. Current evidence on catheter-related bloodstream infection femoral risk, compared with the other sites, is inconclusive.
Keywords
catheter-related infections, central venous catheter, insertion site, intensive care unit, meta-analysis, network meta-analysis, BLOOD-STREAM INFECTIONS, CRITICALLY-ILL PATIENTS, INTENSIVE-CARE UNITS, CONTROLLED-TRIAL, MECHANICAL COMPLICATIONS, VEIN CATHETERIZATION, CHLORHEXIDINE, COLONIZATION, BACTEREMIA, PREVENTION

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MLA
Arvaniti, Kostoula, et al. “Cumulative Evidence of Randomized Controlled and Observational Studies on Catheter-Related Infection Risk of Central Venous Catheter Insertion Site in ICU Patients.” CRITICAL CARE MEDICINE, vol. 45, no. 4, 2017, pp. E437–48, doi:10.1097/ccm.0000000000002092.
APA
Arvaniti, K., Lathyris, D., Blot, S., Apostolidou-Kiouti, F., Koulenti, D., & Haidich, A.-B. (2017). Cumulative evidence of randomized controlled and observational studies on catheter-related infection risk of central venous catheter insertion site in ICU patients. CRITICAL CARE MEDICINE, 45(4), E437–E448. https://doi.org/10.1097/ccm.0000000000002092
Chicago author-date
Arvaniti, Kostoula, Dimitrios Lathyris, Stijn Blot, Fani Apostolidou-Kiouti, Despoina Koulenti, and Anna-Bettina Haidich. 2017. “Cumulative Evidence of Randomized Controlled and Observational Studies on Catheter-Related Infection Risk of Central Venous Catheter Insertion Site in ICU Patients.” CRITICAL CARE MEDICINE 45 (4): E437–48. https://doi.org/10.1097/ccm.0000000000002092.
Chicago author-date (all authors)
Arvaniti, Kostoula, Dimitrios Lathyris, Stijn Blot, Fani Apostolidou-Kiouti, Despoina Koulenti, and Anna-Bettina Haidich. 2017. “Cumulative Evidence of Randomized Controlled and Observational Studies on Catheter-Related Infection Risk of Central Venous Catheter Insertion Site in ICU Patients.” CRITICAL CARE MEDICINE 45 (4): E437–E448. doi:10.1097/ccm.0000000000002092.
Vancouver
1.
Arvaniti K, Lathyris D, Blot S, Apostolidou-Kiouti F, Koulenti D, Haidich A-B. Cumulative evidence of randomized controlled and observational studies on catheter-related infection risk of central venous catheter insertion site in ICU patients. CRITICAL CARE MEDICINE. 2017;45(4):E437–48.
IEEE
[1]
K. Arvaniti, D. Lathyris, S. Blot, F. Apostolidou-Kiouti, D. Koulenti, and A.-B. Haidich, “Cumulative evidence of randomized controlled and observational studies on catheter-related infection risk of central venous catheter insertion site in ICU patients,” CRITICAL CARE MEDICINE, vol. 45, no. 4, pp. E437–E448, 2017.
@article{8529908,
  abstract     = {{Background: Selection of central venous catheter insertion site in ICU patients could help reduce catheter-related infections. Although subclavian was considered the most appropriate site, its preferential use in ICU patients is not generalized and questioned by contradicted meta-analysis results. In addition, conflicting data exist on alternative site selection whenever subclavian is contraindicated. 
Objective: To compare catheter-related bloodstream infection and colonization risk between the three sites (subclavian, internal jugular, and femoral) in adult ICU patients. 
Data Source: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, CINAHL, and clinicaltrials.gov. 
Study Selection: Eligible studies were randomized controlled trials and observational ones. 
Data Extraction: Extracted data were analyzed by pairwise and network meta-analysis. 
Data Synthesis: Twenty studies were included; 11 were observational, seven were randomized controlled trials for other outcomes, and two were randomized controlled trials for sites. We evaluated 18,554 central venous catheters: 9,331 from observational studies, 5,482 from randomized controlled trials for other outcomes, and 3,741 from randomized controlled trials for sites. Colonization risk was higher for internal jugular (relative risk, 2.25 [95% CI, 1.84-2.75]; I-2 = 0%) and femoral (relative risk, 2.92 [95% CI, 2.11-4.04]; I-2 = 24%), compared with subclavian. Catheter-related bloodstream infection risk was comparable for internal jugular and subclavian, higher for femoral than subclavian (relative risk, 2.44 [95% CI, 1.25-4.75]; I-2 = 61%), and lower for internal jugular than femoral (relative risk, 0.55 [95% CI, 0.34-0.89]; I-2 = 61%). When observational studies that did not control for baseline characteristics were excluded, catheter-related bloodstream infection risk was comparable between the sites. 
Conclusions: In ICU patients, internal jugular and subclavian may, similarly, decrease catheter-related bloodstream infection risk, when compared with femoral. Subclavian could be suggested as the most appropriate site, whenever colonization risk is considered and not, otherwise, contraindicated. Current evidence on catheter-related bloodstream infection femoral risk, compared with the other sites, is inconclusive.}},
  author       = {{Arvaniti, Kostoula and Lathyris, Dimitrios and Blot, Stijn and Apostolidou-Kiouti, Fani and Koulenti, Despoina and Haidich, Anna-Bettina}},
  issn         = {{0090-3493}},
  journal      = {{CRITICAL CARE MEDICINE}},
  keywords     = {{catheter-related infections,central venous catheter,insertion site,intensive care unit,meta-analysis,network meta-analysis,BLOOD-STREAM INFECTIONS,CRITICALLY-ILL PATIENTS,INTENSIVE-CARE UNITS,CONTROLLED-TRIAL,MECHANICAL COMPLICATIONS,VEIN CATHETERIZATION,CHLORHEXIDINE,COLONIZATION,BACTEREMIA,PREVENTION}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{E437--E448}},
  title        = {{Cumulative evidence of randomized controlled and observational studies on catheter-related infection risk of central venous catheter insertion site in ICU patients}},
  url          = {{http://doi.org/10.1097/ccm.0000000000002092}},
  volume       = {{45}},
  year         = {{2017}},
}

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