Sepsis associated with central vein catheters in critically ill patients.

In 440 critically ill patients, the association between different central vein catheter insertion sites, the duration of catheter insertion and catheter-associated sepsis was examined. Of 780 catheter tips studied, 19% were colonized by microorganisms. The incidence of colonization varied with the different insertion sites. The lowest percentage of colonized catheters occurred with catheters inserted via the subclavian vein (15%) and the highest, at the femoral vein insertion site (34%, p less than 0.01). The percentage of catheters colonized increased as the duration of insertion increased, at all insertion sites studied. Catheter colonization was closely related to the development of bacteraemia and was associated with approximately 10% of colonized catheters. Our results suggest that the subclavian site is associated with the lowest infective complication rate. To minimize catheter associated sepsis, catheters at all insertion sites should be used with parsimony and only kept in place for the minimum amount of time that their continuing use is necessary.