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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: A Pairwise and Network Meta-Analysis.

TitleCumulative Evidence of Randomized Controlled and Observational Studies on Catheter-Related Infection Risk of Central Venous Catheter Insertion Site in ICU Patients: A Pairwise and Network Meta-Analysis.
Publication TypeJournal Article
Year of Publication2017
AuthorsArvaniti, K., Lathyris D., Blot S., Apostolidou-Kiouti F., Koulenti D., & Haidich A-B.
JournalCrit Care Med
Volume45
Issue4
Paginatione437-e448
Date Published2017 Apr
ISSN1530-0293
KeywordsCatheter-Related Infections, Catheterization, Central Venous, Femoral Vein, Humans, Intensive Care Units, Jugular Veins, Network Meta-Analysis, Observational Studies as Topic, Randomized Controlled Trials as Topic, Risk Factors, Sepsis, Subclavian Vein
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 = 0%) and femoral (relative risk, 2.92 [95% CI, 2.11-4.04]; I = 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 = 61%), and lower for internal jugular than femoral (relative risk, 0.55 [95% CI, 0.34-0.89]; I = 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.

DOI10.1097/CCM.0000000000002092
Alternate JournalCrit. Care Med.
PubMed ID27632678

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