Emergency Department or Ward? Does the Insertion Environment Influence Bloodstream Infection Risk After Central Venous Catheter Placement?

Metchanan Ue-areekul; Kris Keorochana; Somphon Roeksomtawin; Chidpong Siritongtaworn; Nantaporn Namviriyachote; Natthida Owattanapanich

doi:10.33192/smj.v78i11.283550

Authors

Metchanan Ue-areekul, M.D. Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Kris Keorochana, M.D. Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Somphon Roeksomtawin, M.D. Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chidpong Siritongtaworn, M.D. Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Nantaporn Namviriyachote, Ph.D. Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Natthida Owattanapanich, M.D., MACM Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v78i11.283550

Keywords:

Central Line–Associated Bloodstream Infection, catheter-related bloodstream infection, central venous catheter, emergency department, trauma-induced coagulopathy

Abstract

Objective: To compare the incidence of central line-associated bloodstream infection (CLABSI) and catheter-related bloodstream infection (CRBSI) between emergency department (ED)-inserted and non-ED-inserted central venous catheters (CVCs).

Materials and Methods: This single-center retrospective cohort study evaluated adult trauma patients (aged ≥18) who underwent CVC placement at a Level 1 trauma center from 2018 to 2025.

Results: The study analyzed 500 CVC placements (156 ED, 344 non-ED). The overall mean age was 46.6 ± 19.39 years, and 72.4% were male. Primary diagnoses were predominantly multiple trauma (38.8%) and burn injuries (27.0%). The internal jugular vein was the primary site (69.8%). Overall CLABSI incidence was 18.0% (n = 90), with no significant difference between ED and non-ED groups (17.9% vs. 18.0%, p = 0.984). Overall CRBSI incidence was 4.0% (n = 20), showing no significant difference between groups (ED 5.1% vs. non-ED 3.5%, p = 0.535). Multivariable logistic regression identified no independent risk factors for either CRBSI or CLABSI. Similarly, time-dependent analyses at 7 and 14 days did not identify any significant risk factors for either infection.

Conclusion: ED central line insertion was not significantly associated with an increased risk of CRBSI or CLABSI. No independent risk factors for either infection were identified in this cohort, including in the time-dependent analyses. Larger prospective multicenter studies are needed to further evaluate potential risk factors for central line–associated infections in trauma patients.

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