The effect of ultrasonography guided femoral central venous catheterization on central catheter related bloodstream infection

Central venous catheterization has many complications such as infection, hematoma, thrombosis, air embolism, pneumothorax, hemothorax, pericardial tamponade, brachial plexus injury. In our study, we aimed to retrospectively research the effect of ultrasonography (USG) guided femoral vein catheterization on the ratio of development of central catheter related bloodstream infection (SKİ-KDE) and possible complications. After the confirmation of the ethics committee, the data of 927 adult intensive care patients hospitalized in the last year (1 September 2020 – 1 September 2021) were scanned, demographic data of patients; the most recent coagulation parameters before the procedure; the technique of placement of the catheter (Landmark or USG) and the experience of the physician; the size of the placed catheter; the central vein to which it is placed and the purpose of placement; comorbidities and medications of the patients were recorded. Of these patients, 109 patients who applied femoral vein catheterization were included in the study. Fifty-three patients who had a catheter placed under the guidance of USG (USG group) and 56 patients who had a catheter placed with the landmark technique (landmark group) were compared. Culture samples are taken from patients who are routinely hospitalized in the AYBÜ. The absence of microorganisms in the blood culture taken before the catheterization of the patients who applied catheterization and the growth of >103 CFU of microorganisms in the blood culture taken from the catheter or peripheral route 48 hours after the catheterization were accepted as SKİ-KDE. The relationship between landmark and USG techniques with SKİ-KDE and possible complications were compared using the data obtained. There was no significant difference between the groups in terms of demographic data, side of intervention, previous catheterization history, coagulation parameters, number of punctures, experience of the catheter practitioner, type and size of the catheter placed. There was no statistical difference between the groups in which SKİ-KDE was found by Landmark in 1 (%1.8) case and USG in 2 (%3.8) cases (p=0.611). When the complication development status of the patients was evaluated, although the total complication ratio was found to be %32.1 in the landmark group and %17 in the USG group, no statistically significant difference was found between the groups in terms of total complications, change of intervention side, change of physician, and hematoma. The incidence of unintended arterial puncture in the Landmark group (%26.8) was statistically significantly higher than the ratio in the USG group (%9.4) (p=0.019). In conclusion, in our study, although USG guidance in femoral vein catheterization provided a decrease in the possible complication rate (especially unintentional arterial puncture) compared to the classical landmark technique, it was observed that it did not change the rate of development of central catheter related bloodstream infection. Keywords: Femoral central venous catheter, Ultrasonography, Landmark, Central catheter related bloodstream infection