A prospective safety study of femoral vein versus nonfemoral vein catheterization in patients with burns.

A prospective study was undertaken to determine the safety of femoral vein catheterization in patients with burns. Forty-two patients had a total of 275 catheterizations and were divided into two groups: group 1, femoral vein catheterization = 80 catheters and group 2, nonfemoral vein catheterization = 195 catheters (180 subclavian, 8 internal jugular, and 7 supraclavicular). All catheters were changed to new sites every 48 hours, and dressings were changed every 24 hours. Bacteriologic surveillance was accomplished by submitting the tip and subcutaneous segment of the catheter for semiquantitative cultures. Skin exit-site cultures were obtained, and blood was drawn through the catheters for fungal-isolator cultures before removal. Catheter colonization was defined as greater than or equal to 5 colony-forming units on either the subcutaneous segment or the catheter tip. Catheter-related sepsis was diagnosed when the same organism was recovered from the fungal isolator bottle and either part of the catheter and when there was no other identifiable source of sepsis. The rate of occurrence of colonized catheters was 7.5% (6 of 80) in the femoral vein catheterization group and 13.8% (27 of 195) in the nonfemoral vein catheterization group. Catheter-related sepsis occurred in 2.5% (2 of 80) of femoral and 1% (2 of 195) of nonfemoral catheters. None of these differences are statistically significant. There were no noninfectious complications from femoral vein catheterization. Two subclavian catheters had to be repositioned. This study suggests that central venous access in patients with burns can be safely employed with the use of the femoral vein.