Tunneling short-term central venous catheters to prevent catheter-related infection: a meta-analysis of randomized, controlled trials

Crit Care Med. 1998 Aug;26(8):1452-7. doi: 10.1097/00003246-199808000-00038.


Objective: To evaluate the efficacy of tunneling short-term central venous catheters to prevent catheter-related infections.

Data sources: MEDLINE, EMBASE, conference proceedings, citation review of relevant primary and review articles, personal files, and contact with expert informants.

Study selection: From a pool of 225 randomized, controlled trials of venous and arterial catheter management, we identified 12 relevant trials and included seven of these trials in the analysis.

Data extraction: In duplicate, independently, we abstracted data on the population, intervention, outcomes, and methodologic quality.

Data synthesis: Tunneling decreased bacterial colonization of the catheter by 39% (relative risk of 0.61; 95% confidence interval [CI] of 0.39 to 0.95) and decreased catheter-related sepsis with bacteriologic confirmation by 44% (relative risk of 0.56; 95% CI of 0.31 to 1) in comparison with standard placement. The majority of the benefit in the decreased rate of catheter-sepsis came from one trial at the internal jugular site (relative risk of 0.30, 95% CI of 0.10 to 0.89) and the reduction in risk was not significant when the data from five subclavian catheter trials were pooled (relative risk of 0.71, 95% CI of 0.36 to 1.43). Tunneling was not associated with increased risk of mechanical complications from placement or technical difficulties during placement. However, this outcome was not rigorously evaluated.

Conclusions: Tunneling decreases central venous catheter-related infections. However, current evidence does not support routine tunneling until its efficacy is evaluated at different placement sites and relative to other interventions.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Bacteremia / etiology
  • Bacteremia / prevention & control*
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / methods*
  • Catheters, Indwelling / adverse effects*
  • Catheters, Indwelling / microbiology
  • Critical Illness / therapy
  • Equipment Contamination*
  • Humans
  • Intensive Care Units
  • Jugular Veins
  • Randomized Controlled Trials as Topic*
  • Subclavian Vein