Catheter related blood stream infection: 3 sites 2015

Question 1

3 sites clinical Q

Answer 1

In critically ill patients requiring central venous access, how do complications vary by central venous catheter (CVC) access site?

Question 2

3 sites clinical Q

Answer 2

In critically ill patients requiring central venous access, how do complications vary by central venous catheter (CVC) access site?

Question 3

3 sites Bottom Line

Answer 3

In this study with limited generalizability to US academic centers, subclavian insertion was associated with fewer bloodstream infections and DVTs compared to jugular and femoral approaches, but was balanced by more mechanical complications including pneumothorax.

Question 4

3 sites primary outcome

Answer 4

Major catheter-related complications (bloodstream infection or symptomatic DVT)

Question 5

3 sites secondary outcome

Answer 5

Major mechanical complications

Question 6

3 sites criticisms

Answer 6

• By not including mechanical complications in the primary outcome, it is difficult to determine whether the reduction in the primary outcome achieved by subclavian access is outweighed by an increase in mechanical complications.
• The short-term nature of the study precludes analysis of longer-term and potentially more relevant outcomes such as mortality and length of ICU stay.
• Ultrasound guidance was not randomized and therefore its effect is uncertain. Results may not be generalizable to settings in which ultrasound guidance is either uniformly used or unavailable.

Question 7

3 sites Bottom Line

Answer 7

In this study with limited generalizability to US academic centers, subclavian insertion was associated with fewer bloodstream infections and DVTs compared to jugular and femoral approaches, but was balanced by more mechanical complications including pneumothorax.

Question 8

3 sites primary outcome

Answer 8

Major catheter-related complications (bloodstream infection or symptomatic DVT)

Question 9

3 sites secondary outcome

Answer 9

Major mechanical complications

Question 10

3 sites criticisms

Answer 10

• By not including mechanical complications in the primary outcome, it is difficult to determine whether the reduction in the primary outcome achieved by subclavian access is outweighed by an increase in mechanical complications.
• The short-term nature of the study precludes analysis of longer-term and potentially more relevant outcomes such as mortality and length of ICU stay.
• Ultrasound guidance was not randomized and therefore its effect is uncertain. Results may not be generalizable to settings in which ultrasound guidance is either uniformly used or unavailable.