Web site designed and maintained by Chris Cairns  © SICS EBM Group 2004                                  

Up

 

The first large ICU CVC study.

 

In this study the Internal Jugular site was associated with a higher rate of CVC colonization, but not CVCrBSI, that the subclavian site.

Level of evidence: 2- (Cohort study with a high risk of bias)

 

Citation/s: Richet H, et al. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-venous catheter cultures in intensive care patients. J Clin Micro 1990;28:2520-2525.
 

Lead author's name and fax: H Richet, Laboratoire de Bacteriologie, Hotel Dieu, France

 

Three-part Clinical Question: What are the risk factors for CVC complications in ICU patients
Search Terms: see summary

 

The Study: Cohort Study.
 

The Study Patients: ICU patients in 8 French units. Prospective survey of all vascular catheters. Standard definitions. 503 CVCs. 114 IJ, 194 SubCl, 69 Fem, 4 other.
 

Exposure of Interest: Different insertion sites. Peripheral or central catheters. For the purposes of this CAT only the results of CVCs and infection will be considered.
 

The Outcome: Catheter colonization and CVCrBSI.
Can't tell if the subjects were defined and similar in other important ways. The exposures and outcomes were either objective or measured blind. Follow-up was long enough; can't tell if follow-up was complete enough.

 

The Evidence:

 

 

 

Catheter colonization

 

 

Present

Absent

 

 

Number

Proportion

Number

Proportion

insertion sites

Int jug

46

0.40

68

0.60

Sub Cl

54

0.28

140

0.72

Relative Risk:

1.45

95% CI:

1.36 to 1.54

 

Number Needed to Harm:

8

 

 

 

Chi Square

4.58

 

 

 

 

No raw data for CVCrBSI in paper.

 

Comments:
No difference in CVCrBSI rates (less than 25 CVCs removed due to  bacteraemia)

 

1.       Do the methods allow accurate testing of the hypothesis? No. Unable to determine similar baseline characteristics across site cohorts from the data presented in the paper. The authors carried out a regression analysis which found that the jugular site was associated with increased colonization rates (OR 2.7, 1.0-7.5, p<0.05). However the 95% CI include 1.

2.      Do the statistical tests correctly test the results to allow differentiation of statistically significant results? Yes

3.      Are conclusions valid in light of the results? No. The 95% CI of the OR of colonization risk associated with the internal jugular sire include 1.

4.      Did results get omitted, and why? Unable to tell.

5.      Did they suggest areas of further research? No.

6.      Did they make any recommendations based on the results and were they appropriate? Yes – use of the subclavian site rather than internal jugular. Yet to be seen if a statistically difference in colonization rates only is a clinically significant difference.

7.      Is the study relevant to my clinical practice? Yes

8.      What level of evidence does this study represent? No

9.      What grade of recommendation can I make on this result alone? none

10.  What grade of recommendation can I make when this study is considered along with other available evidence? N/A

11.  Should I change my practice because of these results? no

12.  Should I audit my current practice because of these results? no

 

Appraised by: Dr Chris Cairns, Consultant, ICU, Stirling Royal Infirmary.; 02 June 2005
Email: Chris.Cairns@fvah.scot.nhs.uk
Kill or update By: June 2010

 

Printer friendly version

 

©SICS EBMG 2005