Central venous catheter infections: Identification of high-risk patients

Infection of central venous catheters (CVCs) is an independent risk factor for increased mortality and morbidity. As a method to prevent infection, prescheduled changing of all catheters to a new site is costly and is associated with procedure-related complications. The aim of the study was to analyze various patient-related parameters that can place patients at risk of acquiring catheter infection and to identify the subset of patients at highest risk of developing catheter infection, so that prescheduled relocation of catheters to a new site is limited to them. A retrospective review of 300 patients with CVC was conducted to identify the patients who had evidence of catheter infection. The patients who did not develop infection were taken as control. The potential risk factors were compared between the groups. The χ² test and Student's t test were used, when appropriate, to test the statistical significance. A serum albumin level of <25 g/L on admission, a fall in serum albumin of >9 g/L, and prolonged (>12 days) use of a catheter were also associated with increased risk of CVC infection. The age, past medical history, immunocompromised states, concurrent antibiotic usage, or infusion of nutritional substances through the CVC were not found to have any influence on the infection rate. Serum albumin on admission combined with serial measurements can be used as an inexpensive but reliable guide to identify the patients most likely to develop catheter infection. It would be cost effective and safer if relocation of catheters at predetermined intervals is limited to such high- risk patients.