• J F Timsit, F Bruneel, C Cheval, M F Mamzer, M Garrouste-Orgeas, M Wolff, B Misset, S Chevret, B Regnier, and J Carlet.
• Réanimation Polyvalente, Hôpital Saint Joseph, Paris, France.
• Ann. Intern. Med. 1999 May 4;130(9):729-35.

BackgroundThe risk for catheter-related infection seems higher with femoral catheters than with catheters inserted at other sites.ObjectiveTo evaluate the effect of catheter tunneling on femoral catheter-related infection in critically ill patients.DesignRandomized, controlled trial.SettingThree intensive care units at academic hospitals in Paris, France.Patients345 adult patients requiring a femoral venous catheter for more than 48 hours.InterventionTunneled or nontunneled femoral catheters.MeasurementsTime to occurrence of systemic catheter-related sepsis, catheter-related bloodstream infection, and quantitative catheter tip culture with a cutoff of 10(3) colony-forming units/mL.ResultsOf 345 randomly assigned patients, 336 were evaluable. Probable systemic catheter-related sepsis occurred in 15 of 168 patients who received a nontunneled femoral catheter (controls) and in 5 of 168 patients who received a tunneled femoral catheter (estimated absolute risk reduction, 6% [95% CI, 0.9% to 11%]). Time to occurrence of catheter-related bloodstream infection was not significantly modified (relative risk, 0.28 [CI, 0.03 to 1.92]; P = 0.18); 3 events occurred in the control group and 1 event occurred in the tunneled-catheter group. After stratification by treatment center and adjustment for variables that were prognostic (use of broad-spectrum antimicrobial agents at catheter insertion) or imbalanced between both groups (mechanical ventilation at insertion), tunnelized catheterization reduced the proportion of patients who developed systemic catheter-related sepsis (relative risk, 0.25 [CI, 0.09 to 0.72]; P = 0.005) and positive quantitative culture of the catheter tip (relative risk, 0.48 [CI, 0.23 to 0.99]; P = 0.045).ConclusionThe incidence of femoral catheter-related infections in critically ill patients can be reduced by using subcutaneous tunneling.

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