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In previous guidelines of the Centers for Disease Control and Prevention (CDC)  and in the recently published Guidelines of the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA)  it is recommended to avoid the femoral access to reduce the risk of catheter-related bacteremia (CRB). However, in these guidelines there are no recommendations for the catheter site regarding the presence of tracheostomy, and we have not found data about the incidence of CRB comparing a central jugular site with tracheostomy and a femoral site. The objective of this study was to determine whether a jugular site with tracheostomy may have a higher risk of CRB than a femoral site.
A prospective, observational, 4-year study (from 1 May 2000 to 30 April 2004) was carried out in the medical-surgical ICU of the University Hospital of the Canary Islands (Tenerife, Spain). We included all patients undergoing a central jugular catheterization with tracheostomy or femoral venous catheterization.
In the period of study, were used 208 catheters in femoral access and 52 catheters in central internal jugular access with tracheostomy. There were no significant differences between patients with central jugular with tracheostomy and femoral access in age, sex, APACHE II score, diagnosis group, use of mechanical ventilation, use of antimicrobials, use of total parenteral nutrition, use of pulmonary artery catheter, and duration of the catheter. We diagnosed 16 CRB in 208 femoral catheters during 1,679 days of catheterization and 10 CRB in 52 central internal jugular catheters with tracheostomy during 462 days of catheterization. The incidence of CRB was higher in the central internal jugular with tracheostomy than in the femoral site (21.64 vs 9.52 per 1,000 catheter-days; risk ratio = 2.27; 95% confidence interval = 1.04 to 4.97; P = 0.04).
The femoral site could be considered a more safe venous access than the central internal jugular in patients with tracheostomy to minimize the risk of CRB.