Infection rates in single- and double-lumen central venous catheters in critically ill patients

Catheter-related sepsis is a well known complication in critically ill patients receiving total parenteral nutrition. Micro-organisms may travel from the skin puncture wound along the external surface of the catheter or from the hub through the lumen of the catheter, to be shed into the circulation causing bacteraemia and sepsis. The incidence of sepsis is said to be about three times greater with multiple-lumen catheters than with single-lumen catheters.

Fifty patients admitted to our intensive care unit were randomly assigned to have either a single-lumen (Group I, 25 patients) or double-lumen (Group II, 25 patients) hydromer-coated, polyurethane central venous catheters of the same gauge and length, placed through the infraclavicular subclavian approach using the Seldinger technique. A sterile dry gauze dressing at the skin puncture site was changed every day. Skin swabs were taken for semi-quantitative culture studies before catheter insertion and removal, from the proximal 3 cm (lying subcutaneously) and distal 5 cm of the catheter segments on removal of the catheter, and venous blood was drawn from a peripheral vein before removal of the catheter.

The most common isolate was coagulase negative Staphylococcus. No significant difference was found between the two groups in the incidence of catheter-related infection and catheter-related sepsis.

Double-lumen central venous catheters placed in critically ill patients do not cause more sepsis than single-lumen catheters.