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Safety of mid-thigh exit site venous catheters in multidrug resistant colonized patients

Arianna Bartoli1, Mattia Donadoni1, Massimiliano Quici1

  • 1Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Lombardy, Italy.

The Journal of Vascular Access
|July 19, 2023
PubMed
Abstract

Insights

Mid-thigh venous catheters in superficial femoral veins are safe for patients colonized with multidrug-resistant bacteria. This study found no increased risk of catheter-related infections in patients with positive rectal swabs.

Area of Science:

  • Infectious Diseases
  • Vascular Access
  • Medical Device Infections

Background:

  • Superficial femoral vein cannulation with mid-thigh exit sites offers a feasible venous access method, particularly for agitated or delirious patients.
  • The increasing prevalence of multidrug-resistant (MDR) bacterial strains poses a significant clinical challenge, with rising rates of patient colonization.
  • Evaluating infection risks associated with venous catheters in colonized patients is crucial for patient safety.

Purpose of the Study:

  • To assess the incidence of central line-associated bloodstream infections (CLABSI) and catheter-related bloodstream infections (CRBSI) in patients with mid-thigh catheters.
  • To specifically evaluate the safety and infection risk of these catheters in patients with positive rectal swabs for MDR bacteria.

Main Methods:

  • Retrospective observational study analyzing data from May 2021 to November 2022.
  • Inclusion of patients with mid-thigh catheters, recording surveillance rectal swab results.
  • Collection of data on CLABSI and CRBSI through blood and catheter tip cultures during hospitalization.

Main Results:

  • Out of 602 patients, 304 had rectal swabs, with 128 (42.1%) positive for MDR.
  • Nine CLABSI and three CRBSI were identified; only two CLABSI occurred in patients with positive rectal swabs.
  • No statistically significant difference in CLABSI/CRBSI rates was observed between the overall population and those with positive rectal swabs, or between patients with positive and negative swabs.

Conclusions:

  • Cannulation of the superficial femoral vein with mid-thigh exit sites is a safe procedure in patients colonized with MDR bacteria.
  • This approach does not appear to increase the risk of catheter-related bloodstream infections in this patient population.
Keywords:
CLABSCRBSIMDR infectionsMid-thigh cathetersMidlinefemoral inserted central catheter (FICC)peripherally inserted central catheter (PICC)rectal swab

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