This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

A Prospective Randomized Multicenter Study

Jean-François Timsit, MD; Véronique Sebille, PhD; Jean-Christophe Farkas, MD; Benoit Misset, MD; Jean-Baptiste Martin, MD; Sylvie Chevret, MD, PhD; Jean Carlet, MD

JAMA. 1996;276(17):1416-1420.

Abstract
Objective.
—To evaluate the effect of catheter tunneling on internal jugular catheter-related sepsis in critically ill patients.

Design.
—A prospective randomized controlled study involving 3 intensive care units (ICUs), stratified by number of catheter lumina (1 or 2) and center.

Setting.
—The 10-bed medical-surgical and 10-bed surgical ICUs at Saint Joseph Hospital and 8-bed surgical ICU at Clinique de la Défense, Paris, France.

Patients.
—Every patient older than 18 years admitted to the ICUs between March 1,1993, and July 17,1996, who required a jugular venous catheter for more than 48 hours.

Intervention.
—Random allocation to tunneled or nontunneled catheters.

Measurements.
—Times to occurrence of systemic catheter-related sepsis, catheter-related septicemia, or a quantitative catheter-tip culture with a cutoff of 103 colony-forming units per milliliter.

Results.
—A total of 241 patients were randomized. Ten patients in whom jugular puncture was not achieved were subsequently excluded. The proportion of patients receiving mechanical ventilation (87%) and mean±SD age (65±4 years), Simplified Acute Physiologic Score (13.3±4.9), Organ System Failure score (1.5±1.0), and duration of catheterization (8.7±5.0 days) were similar in both groups. Taking into account the first 231 catheters (114 nontunneled [control], 117 tunneled), we found that tunnelization decreased catheter-related sepsis (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.13-0.83; P=.02), catheter-related septicemia (OR, 0.23; 95% CI, 0.07-0.81; P=.02), and, though not statistically significant, positive quantitative tip-culture rate (OR, 0.62; 95% CI, 0.35-1.10; P=.10). These results were slightly modified after adjustment on parameters either imbalanced between both groups (duration of catheter placement and cancer at admission) or prognostic (insertion by a resident, use of antibiotics at catheter insertion, cancer, and sex).

Conclusion.
—The incidence of internal jugular catheter-related infections in critically ill patients can be reduced by using subcutaneous tunnelization.

Author Affiliations
From the Medical-Surgical Intensive Care Unit (Drs Timsit, Misset, and Carlet) and Surgical Intensive Care Unit (Dr Farkas), Hôpital Saint Joseph, Paris, France; U444 Institut National de la Santé et de la Recherche Médicale, Institut fédératif Saint Antoine de Recherche sur la Santé, Hôpital Saint-Antoine, Paris (Dr Sebille); Surgical Intensive Care Unit, Clinique de la Défense, Nanterre, France (Dr Martin); and Department of Biostatistics, Hôpital Saint Louis, Paris (Dr Chevret).

Footnotes
Reprints: Jean-François Timsit, MD, Clinique de réanimation des maladies infectieuses, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France.

Concepts in Emergency and Critical Care section editor: Roger C. Bone, MD, Consulting Editor, JAMA.

Advisory Panel: Bart Chernow, MD, Baltimore, Md; David Dantzker, MD, New Hyde Park, NY; Jerrold Leiken, MD, Chicago, Ill; Joseph E. Parrillo, MD, Chicago, Ill; William J. Sibbald, MD, London, Ontario; and Jean-Louis Vincent, MD, PhD, Brussels, Belgium.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Bacterial Colonization After Tunneling in 402 Perineural Catheters: A Prospective Study
Compere et al.
Anesth. Analg. 2009;108:1326-1330.
ABSTRACT | FULL TEXT  

The Risk of Bloodstream Infection in Adults With Different Intravascular Devices: A Systematic Review of 200 Published Prospective Studies
Maki et al.
Mayo Clin Proc. 2006;81:1159-1171.
ABSTRACT | FULL TEXT  

Randomized, Controlled Trial of Topical Exit-Site Application of Honey (Medihoney) versus Mupirocin for the Prevention of Catheter-Associated Infections in Hemodialysis Patients
Johnson et al.
J. Am. Soc. Nephrol. 2005;16:1456-1462.
ABSTRACT | FULL TEXT  

A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters
Johnson et al.
Nephrol Dial Transplant 2002;17:1802-1807.
ABSTRACT | FULL TEXT  

Intravascular Catheter-Related Infections: New Horizons and Recent Advances
Raad and Hanna
Arch Intern Med 2002;162:871-878.
ABSTRACT | FULL TEXT  

Infection Control in the ICU
Eggimann and Pittet
Chest 2001;120:2059-2093.
ABSTRACT | FULL TEXT  

Complications of Femoral and Subclavian Venous Catheterization in Critically Ill Patients: A Randomized Controlled Trial
Merrer et al.
JAMA 2001;286:700-707.
ABSTRACT | FULL TEXT  

Prevention of Intravascular Catheter-Related Infections
Mermel
ANN INTERN MED 2000;132:391-402.
ABSTRACT | FULL TEXT  

Fever in the ICU
Marik
Chest 2000;117:855-869.
ABSTRACT | FULL TEXT  

Tunneled Jugular Small-Bore Central Catheters as an Alternative to Peripherally Inserted Central Catheters for Intermediate-term Venous Access in Patients with Hemodialysis and Chronic Renal Insufficiency
Sasadeusz et al.
Radiology 1999;213:303-306.
ABSTRACT | FULL TEXT  

Antimicrobial-Impregnated Central Venous Catheters
Paterson et al.
NEJM 1999;340:1761-1762.
FULL TEXT  

Use of Tunneled Femoral Catheters To Prevent Catheter-Related Infection: A Randomized, Controlled Trial
Timsit et al.
ANN INTERN MED 1999;130:729-735.
ABSTRACT | FULL TEXT  

INTERNAL JUGULAR CATHETERIZATION: TUNNELING REDUCES SEPSIS
JWatch General 1996;1996:7-7.
FULL TEXT