Risk of Infection Due to Central Venous Catheters: Effect of Site of Placement and Catheter Type

Objective: To determine the influence of catheter site and type (single- vs triple-lumen) on infection rates associated with central venous catheterization. Design: Prospective observational study of all nontunneled central venous catheters over a 28-month period. Data collected included patient characteristics, insertion site, catheter type, and receipt of parenteral nutrition. End points were clinical infection (bacteremia or site infection) and catheter contamination (clinical infection or colonization with >15 colonies on semiquantitative culture). Setting: Medical-surgical wards of Veterans' Affairs hospital. Results: Three hundred catheters were inserted into 204 patients. Seventy percent were inserted into upper-body sites, and 30% were inserted into the femoral vein. Forty-five percent were triple-lumen catheters. Bacteremia occurred in 2.7% of catheter insertions; insertion-site infections developed in 1.3%, and catheter colonization developed in 12%. Catheter contamination was associated with emergent insertion (odds ratio [OR], 6.2; 95% confidence interval $[CI_{95}]$, 1.1-36.7; P=.04) by logistic regression and with femoral location (hazard, 4.2; $CI_{95}$, 2.0-8.8; P=.0001) and history of transplantation (hazard, 2.8; $CI_{95}$, 1.1-6.7; P=.024) by Cox regression. Clinical infection was not associated with any of the risk factors evaluated, although there was a trend for association with femoral location by Cox regression (hazard, 4.7; $CI_{95}$, 0.82-26; P=.08). We did not identify an association between infection and use of triple-lumen catheters or parenteral nutrition. Conclusion: Our data support an association between intravenous catheter contamination and insertion at a femoral site.