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Department of Anesthesiology; University Hospital Basel; Basel, Switzerland; mzuercher{at}uhbs.ch
In Response:
Khader et al. suggest that there are only rare indications for insertion of single-lumen central venous catheter (CVC). Our quantitative systematic review reports on infection-risks of single versus multilumen CVC; thus, indications for CVC insertion were not investigated (1). We included only randomized controlled trials. Accordingly, confounding factors such as emergency insertion of CVCs are reduced because these parameters are also controlled and randomly distributed between the groups.
We would like to make a personal comment to the letter of Khader et al. outside of our performed scientific work in this setting (1–3). We fully agree with the authors that in critically ill patients suffering from conditions like a septic shock or an acute renal failure requiring continuous renal replacement therapy, multilumen catheters are needed. However, two indications mentioned by Khadar et al. should be critically appraised: parenteral nutrition and central venous pressure (CVP) measurement. There is good evidence that enteral nutrition is equivalently efficient compared with parenteral (4), however with a reduced infection risk. Thus, also in critically ill patients, enteral nutrition should be the rule and parenteral nutrition should be the exception. With different adapted forms of nutritional tubes, failure risk of enteral nutrition should be diminished. Consequently, the number of multilumen CVCs for parenteral nutrition should be rather low. Additionally, there is no evidence that CVP measurement has an impact on outcome. Even the more invasive hemodynamic measurement with a Swan-Ganz catheter (including CVP measurement) has not observed any outcome benefit for major surgery requiring postoperative intensive care (5). Therefore, indications for multilumen CVC insertion for hemodynamic estimations presumably are rather rare.
In daily clinical practice and in the absence of adequate scientific evidence, the indication for multilumen central venous line insertion is based on local experience, and thus differs between institutions. In our article, we give some arguments to stimulate reflections on the CVC number of lumen inserted regarding CVC-induced bloodstream infections.
References
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