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Dialysis Catheter Placement Makes Little Difference in Infection Risk
Date:5/27/2008

Neck, leg sites similar, but jugular should be choice for patients with higher BMI

TUESDAY, May 27 (HealthDay News) -- There's little overall difference in infection risk if a catheter for dialysis is inserted into a neck vein or an upper leg vein in critically ill patients, French researchers report.

Currently, it's widely believed the neck catheter is less likely to cause infection than the leg catheter.

The researchers compared rates of bacteria growth on catheters (catheter colonization) at the time of their removal and rates of catheter-related blood stream infections among 750 severely ill patients in intensive care units who required catheter insertion for dialysis. The patients were randomly selected to have the catheter inserted in the neck (jugular) vein or the leg (femoral) vein.

Catheter colonization occurred at a rate of 40.8 per 1,000 catheter-days among patients in the femoral group and a rate of 35.7 per 1,000 catheter-days among those in the jugular group. Catheter-related bloodstream infection occurred in three of 324 (0.9 percent) of patients in the femoral group and in five of 313 (1.6) percent of patients in the jugular group. This was not a statistically significant difference.

The study authors said the findings are "inconsistent with the widely accepted convention to avoid femoral catheterization to prevent the risk of catheter-related infection."

They did find that hematoma formation (localized area of bleeding beneath the skin) was significantly higher in the jugular group (3.6 percent) than in the femoral group (1.1 percent).

The researchers also found that people with a body-mass index (BMI) of less than 24.2 had twice the risk of catheter colonization when given a jugular catheter than when given a femoral catheter. But patients with a BMI greater than 28.4 were 60 percent less likely to develop catheter colonization when given a jugular catheter than when
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