Safety of triple lumen catheters in the critically ill

The authors performed this prospective study to determine the infection rate of triple lumen catheters (TLC) in their surgical intensive care unit (SICU) patient population. Patients who required a central venous line for the first time while in their SICU were studied. Those with preexisting catheter infections, bacteremias, and TLC reinsertions were excluded. TLC was placed through the internal jugular or the subclavian vein and all peripheral lines were removed. The distal port was used for parenteral nutrition and the other two ports were used for fluids and medications. Dressings were changed daily and blood cultures were obtained through each port of the TLC. At the time of catheter removal, blood, catheter tip, and the subcutaneous tract were cultured. Duration of catheterization was recorded. Eighty-six catheters were studied. The mean duration of catheterization was 6.2 days and the range was two to 23 days. Six of 86 (6.9%) catheter tip cultures were positive and the remaining 80 (93.1%) were negative. Two positive tips (2.3%) had negative blood cultures for two catheter infections (CIs). The remaining four catheters (4.6%) had associated bacteremias for four catheter sepsis (CS). The two catheter infections occurred among catheters indwelling for 10 days or less while the four cases of catheter sepsis occurred among catheters indwelling longer than 10 days. In conclusion, triple lumen catheters can be safely left in place for up to 10 days with minimal risk for bacteremia.