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Online ISSN 1827-1596
Vincent COMPÈRE 1, George DACCACHE 2, Nora AMDJAR 1, Véronique FOURDRINIER 1, Jérôme MORICEAU 1, Anne FOUTEL 1, Noël FREBOURG 3, Eric MOURGEON 4, Esthelle HOUIVET 5, Bertrand DUREUIL 1
1 Department of Anaesthesia and Intensive Care, Rouen University Hospital, Rouen, France; 2 Department of Anaesthesia and Intensive Care, Caen University Hospital, Caen, France; 3 Department of Bacteriology, Rouen University Hospital, Rouen, France; 4 Department of Anaesthesia, Saint Martin Private Hospital, Caen, France; 5 Department of Biostatistics, Rouen University Hospital, Rouen, France
BACKGROUND: Infection of perineural catheter is rare, although bacterial colonization is frequent. An observational study reported that subcutaneous tunneling perineural catheter could decrease its colonization rate. We performed a comparative study to assess the incidence of catheter related bacterial colonization of tunnelized femoral perineural catheters.
METHODS: This bicentric, randomized, single-blind, controlled and intention-to-treat study was conducted from December 2009 to December 2011. The catheter was secured with adhesive strips in the control group and was tunneled subcutaneously in the tunnelization group. Primary endpoint was catheter colonization rate assessed by by Brun-Buisson quantitative culture. Secondary endpoints included catheter-related infection, inadvertent catheter dislodgement rate, incidence of technical problems with subcutaneous tunneling and, risk factors for catheter-related colonization.
RESULTS: Of the total 338 patients included, 2 patients were later excluded and 78 were lost to follow-up for primary endpoint. Inadvertent removal of femoral catheter accounted for 33 of these 78 patients (10 for the tunnelization group versus 23 for the control group, p=0.02). There was a lower colonization rate in the patient group with tunnelization compared to the control group without tunnelization (6 % versus 13.5 %, respectively; OR = 2.4; 95% CI: 1.1– 5.3; p=0.02). No infection was observed. Coagulase-negative staphylococci is present in 61 %. The absence of tunnelization is the only risk factor of colonization. For 7 patients, accidental perforation of perineural catheter during procedure was observed.
CONCLUSION: Tunneled subcutaneous perineural catheter decreased the incidence of colonization. Moreover, tunnelization is an effective technique for securing the perineural catheter.