Internal jugular venous catheter-related bacteremia according to central and posterior accesses.

BACKGROUND

Although there are many studies about central venous catheter-related infection, we have not found any analysis of the incidence of internal jugular venous catheter-related bacteremia associated with different accesses.

OBJECTIVE

The objective of this study was to test whether the position of the internal jugular venous catheter, central or posterior, influences the incidence of bacteremia.

DESIGN

A cohort study.

SETTING

A 12-bed polyvalent medical-surgical intensive care unit (ICU).

PATIENTS

Patients admitted to ICU between 1 May 2000 and 30 April 2004 who received one or more internal jugular venous catheters.

MEASUREMENTS AND RESULTS

A total of 1,483 patients were admitted to the polyvalent ICU, of whom 1,311 underwent central venous catheterization. A total of 547 patients received 684 internal jugular venous catheters, 169 by posterior and 515 by central access. There were no significant differences between central and posterior access patients in sex, age, APACHE II (14.1 +/- 5.0 vs. 13.9 +/- 5.2, p = 0.40), diagnosis, order of catheter insertion, use of mechanical ventilation, use of antimicrobials, use of total parenteral nutrition or use of pulmonary artery catheter. We found a higher incidence of internal jugular venous catheter-related bacteremia with central (4.8 per 1000 catheter-day) than with posterior (1.2 per 1000 catheter-day) access (odds ratio 3.9; 95% confidence interval 1.1-infinite; p = 0.03).

CONCLUSION

Posterior access has a lower incidence of internal jugular venous catheter-related bacteremia than central access in non-severely ill patients (according to the low APACHE II score values of the study patients).