Ultrasound Guidance and Central Line Infection Risk

Written by Clay Smith

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Jugular and femoral central venous catheters inserted with ultrasound guidance (vs no US-guidance) were associated with an increased risk of catheter-related bloodstream infection (CRBSI).

?Why does this matter
Most US studies have focused on procedural aspects, such as success rates. While US generally increases procedural success and safety, does it introduce other possible risks, such as infection?

?Gel + needle = infection risk

Design: This was a post-hoc analysis of three prior RCTs to determine the rate of CRBSIs and, as a secondary outcome, major catheter-related infections (MCRIs). All three RCTs were designed to determine which preventive agents, like chlorhexidine dressings or skin antisepsis were more effective. Ultrasound use was non-random and at the discretion of the treating physicians.

Results: There were, “4636 patients and 5502 catheters inserted in 2088 jugular, 1733 femoral, and 1681 subclavian veins, in 19 ICUs.” There was an association, after weighting, of US and CRBSI in patients with both jugular and femoral (not subclavian) catheters, HR 2.21 (95%CI 1.17-4.16). There was also an association with MRCI and catheter colonization after removal.

Implications: US use shouldn’t be discouraged; rather, greater infection prevention measures are needed.

Limitations: Although these data were rigorously and prospectively collected, the original intent of these studies was not to determine infection rate from US or not. It’s impossible to determine if there was some difference in the US group. Maybe they had more difficult landmarks, greater BMI, or took more sticks, which increased the rate of infection.

Source
Ultrasound Guidance and Risk for Central Venous Catheter-Related Infections in the Intensive Care Unit: A Post Hoc Analysis of Individual Data of 3 Multicenter Randomized Trials. Clin Infect Dis. 2021 Sep 7;73(5):e1054-e1061. doi: 10.1093/cid/ciaa1817.

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