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CRITICAL CARE AND TRAUMA

Colonization and Bloodstream Infection with Single- Versus Multi-Lumen Central Venous Catheters: A Quantitative Systematic Review

Division of Surgical Intensive Care and the Center for Evidence-Based Critical Care, Anesthesia and Pain Treatment, Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland

Address correspondence and reprint requests to Mathias Zürcher, MD, Department of Anesthesiology, University of Basel, Kantons- spital, CH-4031 Basel, Switzerland. Address email to zumthis{at}bluewin.ch

There is a controversy as to whether the number of lumens in the central venous catheters may impact the incidence of catheter-related bloodstream infection. We performed a systematic search (MEDLINE, PREMEDLINE, Cochrane Library, EMBASE, BIOSIS Previews, CINAHL, HealthSTAR/Ovid healthstar, bibliographies, any language, to April, 2003) for full reports on randomized comparisons of single-lumen and multi-lumen catheters. Trials had to report on dichotomous data of catheter colonization or bloodstream infection. Meta-analyses were performed using a fixed effect model. Data were expressed as odds ratio (OR) and number-needed-to-treat (NNT) with 95% confidence interval (CI). Five randomized trials (1987–1995) with data on 255 single-lumen and 275 multi-lumen catheters were analyzed. Average insertion times were 8 to 21 days with multi-lumen catheters and 9 to 24 days with single-lumen catheters. In 4 trials, 23 of 176 (13.1%) multi-lumen and 26 of 177 (14.7%) single-lumen catheters were colonized (OR, 0.92; 95% CI, 0.49–1.72). In 5 trials, bloodstream infection occurred with 23 of 275 (8.4%) multi-lumen and with 8 of 255 (3.1%) single-lumen catheters (OR, 2.58; 95% CI, 1.24–5.37; NNT, 19; 95% CI, 11–75). For every 20 single-lumen catheters inserted, one bloodstream infection will be avoided that would have occurred had multi-lumen catheters been used. The risk of catheter colonization is not decreased. Although these conclusions are based on limited data, single-lumen catheters should be used whenever feasible.

IMPLICATIONS: Each catheter that is placed into a central vein may induce some morbidity: complications are mechanical, thrombotic, and infectious. Catheter-related bloodstream infection is the most important complication. This systematic review of randomized controlled trials suggests that for every 20 single-lumen catheters inserted, one bloodstream infection would be avoided that would have occurred had multi-lumen catheters been used.

This article has been cited by other articles:

				M. Zurcher, M. Tramer, and B. Walder Intravascular Catheter-Associated Infection Anesth. Analg., April 1, 2005; 100(4): 1217 - 1217. [Full Text] [PDF]

				A. Khader, R. Srivastava, and N. Parekh Intravascular Catheter-Associated Infection Anesth. Analg., April 1, 2005; 100(4): 1216 - 1217. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999